PubMed · 3919840
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D M Davies. 1985-03-23. Plastic and reconstructive surgery. Microvascular surgery.. https://doi.org/10.1136/bmj.290.6472.910
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A new classification of fingertip injuries is presented. The PNB classification separates the injury into its effect on the three components of the fingertip: pulp, nail and bone. This provides a three digit number that accurately describes the injury. This new classification can be used to record and document injuries, without having to resort to lengthy description. It could also be used to provide detailed instructions for treatment and indications for referral. Examples of the application of the classification are given.
Thenar function impairment or destruction is not uncommon in hand crush injury or thumb avulsion injury. Although complete evaluation of thenar muscle function is difficult during an emergency setting because of skeletal instability and pain, if left untreated the injured hand may result in deficiency of opposition and may require secondary reconstruction. When the palmaris longus tendon is available from the open wound, a Camitz opponensplasty can be performed in the emergency operation setting even as an augmentation procedure for opposition if there is any suspicion of thenar muscle impairment. Seven patients with such injuries who underwent immediate Camitz opponensplasty were assessed to have an 80% angle of separation, a 90% angle of circumduction, and an 88% Kapandji test of the normal opposite hand. An emergency Camitz procedure provided a reliable, immediate one-stage reconstruction of thenar function.
From January 1990 to December 1998, 631 consecutive single-digit replantations were reviewed retrospectively to determine the essential number of vascular anastomoses and the artery-to-vein ratio for successful finger replantation. The correlations between the number and the ratio of anastomosed vessels and the survival rate were examined according to the amputated digital levels, and all of the correlated results were compared with each other statistically. In zone I, the survival rate of the digits with a vein repaired was higher than that of digits treated with the external bleeding method. In zone II, repairing more arteries than veins led to venous congestion and resulted in a failure of replantation. Thus, the ratio of an equal or greater number of veins repaired to the arteries repaired was an important factor in successful replantation in zone II, which may be due to the large amount of arterial input relative to the small volume of venous drainage via small veins in the replanted digit. In zone III, the equal number of arteries and veins repaired was also an important factor in successful replantation. However, unlike zone II, even when more arteries were repaired than veins, venous congestion occurred rarely because the vein in this area was larger, providing sufficient venous drainage. In zone IV, repair of two veins was needed to yield good results. Because the volume of the amputated part in zone IV was larger than in other zones, it was desirable to repair both arteries, even though repairing one artery yielded good results. In conclusion, it is desirable to repair as many vessels as possible to increase the possibility of a good result. However, digital amputations and their conditions for replantation differ. Therefore, the number and ratio of vessels that need to be repaired should be modified and adjusted in each case.