Les auteurs rapportent les résultats obtenus dans 6 cas avec la technique de « reposition lambeau » pour les amputations digitales distales. Les 6 patients furent opérés en urgence.

A la révision, l'aspect trophique général était satisfaisant, mais la mobilité de l'interphalangienne distale était toujours altérée ; la sensibilité était cotée à 6 mm par le test de Weber ; par ailleurs, on a noté une déformation en griffe de l'ongle chez deux patients. Sur le plan osseux, la consolidation a été constante sans notion d'ostéolyse. La réimplantation reste la méthode de choix ; la « reposition lambeau » représente une alternative à l'amputation en cas d'impossibilité ou d'échec de la réimplantation digitale distale et surtout lorsque le patient n'accepte pas la régularisation.

The purpose of this study was to evaluate an alternative procedure for amputations distal to the distal interphalangeal joint: the reposition flap.

The reposition flap was used for 6 patients who underwent fingertip amputations in an emergency setting. Pulp was excised on the amputated segment and the ramaining bone and nail bed were reattached to the proximal stump with a Kirschner wire. The pulp was reconstructed with a local advancement and sensitive flap. The patients were aged 18 to 44 years and had been victims of work accidents. All refused finger shortening.

The fingers showed good scaring and good trophicity. Two-point discrimination was 6 mm. Bony fusion was constant but all distal interphalangeal joints remained stiff. Cosmetic results were correct except for two cases of claw nail formation.

Fingertip amputations have been widely reported. Methods have varied from directed scarring to partial toe transfer. These situations present two types of challenge: insensitivity of the volar aspect or an overly sensitive pulp; cosmetic presentation and function of the dorsal aspect due to the complex role of the nail. Distal reimplantation remains the best technique, but the reposition flap offers an interesting alternative in case of failure or for patients who do not accept finger shortening. The advantage of the reposition flap is that it preserves finger length and the nail. Work stoppage and intolerance to cold can be an inconvenience due to the long time required for wound healing.