Revascularisation and replant surgery occasionally produces sub-optimal results. We present two cases of near total amputation of the digits. The first patient was an 11-year-old boy with a middle finger avulsion injury sustained after the finger was caught in a washing machine with the flexor digitorum profundus still attached. The second patient was a 42-year-old male who sustained a machete attack and had near total amputation of his small and ring fingers with a 2 cm skin bridge still attached. All patients underwent revascularization with repair of only one digital artery for each finger as the opposite artery was non-viable. No digital veins were repaired. Relief of venous congestion was done by pin-prick six times a day up till one week. At one week post-surgery, the fingers were discoloured black but had good pulp turgor and full contour with arterial bleed on pin-prick. Inexperienced surgeons may view this as gangrene and amputate the fingers. However, we continued observation and at one month post-surgery, the black skin had desloughed and the underlying skin was pink.
A Black Finger Does Not Equal A Dead Finger
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Abstrak
Pembedahan revaskularisasi dan replant kadang-kadang memberi keputusan yang tidak memuaskan. Kami memaparkan dua kes amputasi jari separa. Kes pertama adalah pesakit lelaki berumur 11 tahun di mana jari hantu tengah telah terpintal di dalam mesin pembasuh baju dan tertarik putus hanya bersambung dengan otot flexor digitorum profundus. Kes kedua adalah pesakit lelaki berumur 42 tahun yang ditetak parang di tangan kirinya menyebabkan separa terputus jari kecil dan jari manis hanya bersambung dengan kulit selebar 2 cm. Kedua-dua pesakit menjalani pembedahan revaskularisasi satu arteri digital untuk setiap jari kerana arteri digital yang sepasang rosak. Vena digital tidak di perbaiki. Rawatan untuk kesesakan pendarahan vena dilakukan dengan mencucuk hujung jari dengan jarum enam kali sehari selama satu minggu. Pada 1 minggu selepas pembedahan, jari kelihatan hitam tetapi menpunyai bentuk yang baik dan kental bila dipicit serta mempunyai pendarahan merah arteri apabila dicucuk jarum. Pakar bedah yang kurang pengalaman mungkin menganggap ini adalah kematian jari dan ingin amputasi jari. Namun kami menunggu selama sebulan dan kelihatan kulit hitam jatuh dan di ganti kulit baru yang merah dan baik.
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