Treatment of fingertips amputation using the Hirase technique

The management of very distal finger amputations when the amputated part is saved is still difficult and controversial. Both re-attachment of the amputated portion as a composite graft and microvascular anastomosis can fail in this distal location. Replantation is, in fact, associated with certain problems, such as technical difficulty, risk of failure because of the poor venous drainage, and costs. With the exception of children, amputations at the level of the lunula poorly survive direct re-attachment. Hirase has described a new replantation model without vascular anastomosis and used ice water and aluminium foil to enhance survival of the composite graft. Cooling the entire recipient site retards cellular degeneration in the graft until neovascularisation occurs. The present authors applied this method to seven cases in which a digit had been amputated between the tip and the lunula. In four cases the method proved to be completely successful, whereas in two an area of tip necrosis was observed. The Hirase method has proven to be a simple and reliable surgical technique for fingertip re-attachment.