Improved Abdominal Hypodermal Pocket for Salvage of the Amputated Fingertip (Tamai Zone I)

We aim to explore the clinical efficacy of a new surgical approach called improved abdominal hypodermal pocket for salvage of the amputated fingertip distal to the lunula (Tamai Zone I). From September 2015 to June 2017, we treated 18 fingertips of 15 patients with abdominal hypodermal pocket after all fingertips were completely amputated and finger replantation could not be attempted. After 3 weeks, all fingertips were removed from the abdomen. After 1 year, outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, static two-point finger discrimination and Chinese Medical Association upper limb function evaluation trial standard. All 18 fingertips survived. Two fingertips developed partial necrosis, and the scar healed with dressing changes. All patients were satisfied with the appearance of the fingertips except one woman who was not satisfied due to ischaemic atrophy. The DASH score ranged from 35–46 (average 38), and static two-point discrimination was 6–14 mm (average 8 mm). When vascular anastomosis is not feasible in fingertip replantation, improved abdominal hypodermal pocket is an alternative that can meet the needs of good appearance, such as length, plump finger pulp and nail integrity, with a high survival rate, low technical difficulty and minimal complications.