PMC4347358_01
Amputation with significant soft tissue degloving immediately distal to the IP joint. The nature of the injury precluded microvascular repair, and an amputation-revision would have necessitated removing the IP joint (above). The amputated segment including nail plate, underlying nail bed, and pulp (below).
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F1
The avulsed segment of thumb included the nail bed, both sterile and germinal matrix, hyponychium as well as approximately 3 to 4 mm of distal phalanx (DP) (Fig 1).
Intraoperative X-ray showing approximately 2- to 3-mm loss of distal phalanx, and adequate reduction of the proximal phalanx fracture after pinning.
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F2
A closed reduction and pinning of the proximal phalanx fracture was accomplished under fluoroscopic guidance using two 0.045" K wires (Fig 2).
One-month postoperative result showing survival of composite graft with stable soft tissue coverage (left). A comparison of the repaired and noninjured thumb (right). A slight loss of length is noted, which is attributed to the loss of length of the distal phalanx and the fact that, at 1 month, the nail plate had not regrown fully.
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F3
At one month, the composite graft maintained stable soft tissue coverage and showed signs of nail plate regrowth (Fig 3).