My husband was involved in a sledding accident this morning. We are in the ER waiting for the hand surgeon as I send this to you. The tip of his middle and ring fingers were both sliced off. He says he doesn't need them. Just sew the end closed and be done with it. Should I insist he have them put back on? I know people seem to get along fine without fingers. I can't tell if he's in shock or just being a macho guy. What do you think we should do? We have to make the decision so please hurry with a reply.
Making the decision of whether to accept the amputation or try for replantation of the finger tip can be difficult. Hand surgeons say this is a challenging procedure with many pitfalls.
The hand surgeon will be the best person to advise you on this. Patient preference is certainly part of the decision. But surgeon expertise and the availability of a microvascular surgeon is important.
Experts in this area suggest the procedure is not possible when the injury involves crushing or contamination. But for children, young women, musicians, or others who truly need the tip of the finger, distal finger replantation should be attempted.
There are other factors to consider. For example, full function of the finger is not possible without the tip but this may not be as important for a manual laborer as for a musician.
Amputation without replantation can lead to the development of painful neuromas (growth or tumor of nerve tissue). The cosmetic effect of replantation is preferred by most people but at the moment it doesn't sound like this is of prime importance to your husband.
Again, the surgeon will help you walk through this decision. After he or she examines your husband, your options will be clearer. Don't be afraid to speak up and ask any questions you may have or think should be asked. This is especially important if you suspect your husband may not make the same decision if he was able to think clearly and not under the potential influence of blood loss and shock.
Luis R. Scheker, MD, and Giles W. Becker, MB BChir. Distal Finger Replantation. In The Journal of Hand Surgery. March 2011. Vol. 36A. No. 3. Pp. 521-528.
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