title: The "cap" technique: nonmicrosurgical reattachment of fingertip amputations.
abstract: With the exception of children, amputations at the level of the lunula survive poorly by direct reattachment. Microsurgical replantation is costly and often fails because of poor venous drainage. In a series of seven adult patients the severed tip was filleted and replaced as a "cap" over the skeletonized distal phalanx of the stump. A 2 mm remnant of germinal matrix was preserved for nail regrowth. The reconstructed digits, although shortened by an average of 6 mm, give the "illusion" of a normal finger. All were successful with small areas of tip necrosis in two, healing by secondary reepithelialization. Mean static two-point discrimination was 6.5 mm (range, 3 to 10 mm) and pulp pinch was 67% of normal. The "cap" technique of nonmicrosurgical reattachment is a simple, reliable method of functional preservation of pulp tissue, as well as normal esthetic appearance of the nail complex.
authors.affiliation: Division of Plastic Surgery, Stanford University School of Medicine, Calif.
authors.forename: E H
authors.initials: EH
authors.lastname: Rose
authors.forename: M S
authors.initials: MS
authors.lastname: Norris
authors.forename: T A
authors.initials: TA
authors.lastname: Kowalski
authors.forename: A
authors.initials: A
authors.lastname: Lucas
authors.forename: E J
authors.initials: EJ
authors.lastname: Fleegler
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D012092:Replantation / Q000379:methods*