A successful case of postoperative evaluation for digital circulatory failure in secondary reconstruction of amputated finger by using the fish-mouth incision

Abstract

Fish-mouth incision on a fingertip is one method for preventing blood congestion after surgical reattachment of an amputated finger. Moreover, it is also reported to be useful for evaluating the patency of the finger arteries. In this case, the right index and the middle fingers were fully amputated due to injuries by a press machine, classified as Tamai zoneⅢ. Suturing the finger nerves was a challenge although replantation was possible. Temporary insufficient blood circulation in the index finger was observed during secondary reconstruction using the sural nerve. The fish-mouth incision was performed immediately after the operation. Consequently, direct continuous infusion of sodium heparin was started to evaluate postoperative blood flow, achieving finger survival. Thus, insufficient blood circulation was caused due to the use of a pneumatic tourniquet which resulted in temporary occlusion and ischemia of the finger arteries. Moreover, the use of an air tourniquet during surgery should be kept to a minimum. However, the fish-mouth incision and direct continuous administration of sodium heparin allow continuous direct observation and were useful for blood flow evaluation.