Salvage composite graft for an Allen’s IV right ring finger avulsion injury and delayed presentation in a 15-year-old boy

Background

Older age, proximal injuries avulsion-type injuries and delayed reattachment (>4.3hours) are poor prognostic factors for complete survival of composite grafting in fingertip amputations. It has been recommended that bone be removed from the graft to improve survival rate. We herein describe a case of an older paediatric patient who sustained an Allen’s IV right ring finger avulsion injury with a delayed presentation.

Case report

A 15-year-old boy sustained a dominant right ring finger traumatic avulsion amputation unsuitable for replantation. The digit was reattached as a composite graft. The bone united and nail bed partially reformed allowing preservation of some length. The remainder tissue necrosed, however. This was debrided and covered with a cross-finger flap from the middle finger. Ultimate cosmetic and functional outcome were good.

Conclusion

This experience brings forth the option of length preservation by way of reattachment of the severed bone or even a cortico-cancellous autograft and subsequent local flap for skin coverage.