Fingertip Reconstruction

A fingertip injury is a fairly common type of hand injury, one often caused by an accident, such as slamming a finger in a door, that occurs during everyday activities. A fingertip injury can involve the skin, bone, nail, nail bed or pulp, which is the soft padding on the back of the fingertip. A fingertip can be cut, crushed, torn or cut off completely. Because it contains more nerve endings than many other parts of the body, a fingertip is extremely sensitive, making injury to it particularly painful.

An serious injury to the fingertip should be evaluated by a physician in order to ensure that the function of the finger, as well as that of the hand itself, is not permanently affected. Before it is evaluated by a physician, an injured fingertip should be iced and elevated to keep swelling and bleeding to a minimum, and a sterile bandage should be applied. In addition to those treatments, if a finger has been cut off, the amputated piece should be cleaned with a sterile solution, wrapped in gauze, and put in a watertight bag that is then placed on ice.

Examination by a physician includes a thorough cleaning of the wounded area; an injection of anesthetic is often given to relieve pain. The physician checks to see if bone is exposed, tissue is missing, and/or the nail is injured. An antibiotic may be prescribed and/or a tetanus shot given. Most fingertip injuries can be treated by suturing the wound. It takes several weeks for a finger to fully heal, during which time it is wrapped in a dressing or supported in a splint. Whether or not a cut-off fingertip is reattached during replantation surgery, which is extremely complex, is subject to many variables.

The Neurovascular Pedicle Advancement Flap

Dr. Coleman specializes in a unique method of fingertip reconstruction. The procedure is not a new one, previously introduced in 1983 at the Kleinert institute.

For any one of a number of reasons, most orthopedically trained surgeons will not elect to perform this procedure either because of its technical difficulty, or because they have not been educated in the technique.

It does require particularly delicate technique and experience with microsurgery, even though no true microsurgical procedures are performed.

In the right circumstances, this spiraling type flap will advance, healthy skin, subcutaneous tissue, and fat to cover the fingertip, and sensation is almost completely restored. This provides a considerable improvement in the ability for patients to use their fingers as opposed to the conventional methods of simply suturing the wounds and leaving a painful scar that patients will have to live with for the rest of their lives.

Dr. Coleman has been performing this procedure, since he learned it at the Kleinert institute in 1986. In the past 30 years, he has performed over 300 of these flaps without any failures. He has made several refinements in the technique, improving its overall appearance and practicality. He also published a teaching video on the procedure which was presented at the American Society of Reconstructive Microsurgery, and is kept in their video archives.

The operation rarely takes more than 1-1/2 hours to perform, and is done on an outpatient basis.

In poling a number of physicians and patients, as far as his known, Dr. Coleman is the only specialist in the state of Texas who performs this procedure on a routine basis, and has treated patients from all over the nation.

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