Replantation of middle fingertip following complete Tamai Zone 2 amputation and eschar development: A clinical case report.

INTRODUCTION

Fingertip injuries are common, and proper management depends on the type of injury and the long-term function. This case report presents a challenging fingertip replantation of the middle finger with single artery anastomosis, which was complicated by an eschar and progressed to healing after six months of post-operative care.

CASE PRESENTATION

A 27-year-old man came with a left middle fingertip amputation distal to the distal interphalangeal joint (Tamai zone 2). After careful assessment, replantation was done with anastomosis of one digital artery and no venous anastomosis. The follow-up period ranged from 1 to 6 months. At one month, the nail plate fell, and eschar developed. Subsequently, eschar fell, and a new nail had grown after 3 months of repair. A follow-up after 6 months revealed a healed middle finger with good cosmetic and functional outcomes.

CLINICAL DISCUSSION

Replantation of Tamai zone 2 fingertip amputation of the middle finger can be challenging, especially with damaged digital veins like in our case. However, we opted for replantation with one arterial anastomosis only, to preserve the length and function of the digit. In the literature, there were cases of artery-only replantations that had successful outcomes. However, an eschar complicated our case, and smoking contributed to its development.

CONCLUSION

This case shows a successful replantation with one arterial anastomosis and no venous anastomosis after eschar development. Also, it underscores the importance of post-operative care, anatomical knowledge, and physician's expertise to achieve a successful replantation.