A tissue loss amputation is a procedure that is performed by a hand surgeon to manage an injury to a digit or the hand. Amputations may be immediate or post-trauma depending on the particular condition. Every case is unique but we identified some common factors in determining if amputation is required. When it comes to digital amputations, there are four types of injuries.
Type I include distal tip amputations – these involve only a small portion of the nail bed. When these injuries are free of exposed bone or tendon, they can be treated with irrigation and dressings. These injuries typically heal well with positive cosmetic and fully functional results.
Type II involve any injury that encompasses <50% of the nail bed and a significant portion of the finger tip. Often these injuries are treated with a shortening and closure of the wound. If such a large portion of the nail bed is compromised, it is unlikely that maintaining the nail will produce positive results. Removing the nail bed will avoid conditions like hook nail – which can be painful and result in significant complications down the road.
Type III injuries are amputations through the distal interphalangeal joint, aka your second knuckle. In clean injuries replantation can be considered but there are many factors in predicting the success of such an endeavor. Recovery from this type of amputation is significantly greater than Type II as more nerves are involved as well as a compromised grip.
Type IV injuries spare a significant amount of dorsal tissue – if the tissue area lost is less than 1x1cm and the bone and tendon are not exposed, these injuries can heal with flushing and wrapping. In instances where the loss is greater, local flaps may be applied to cover up the exposed areas. Unlike other areas, grafts do not take well in Type IV injuries and are typically not used.
Should you have the unfortunate circumstance of requiring this type of treatment make sure that you are seeing a board certified surgeon who specializes in hand surgery. The digits and hands are such a sensitive area that seeking appropriate treatment as soon as possible is critical. Questions? Contact us today!
