Successful in situ replantation of fingertip amputation without vascular anastomosis: A case report

Rationale: Fingertip amputations at Tamai zone I, the most distal anatomical level, remain a reconstructive challenge. Although vascular anastomosis has been emphasized in replantations, viable outcomes may still be achieved without revascularization under specific conditions. Patient concerns: A 17-year-old female factory worker incurred a sharp oblique amputation of the distal left index finger due to a machine-related occupational injury. The amputation plane was located distal to the lunula, as confirmed by radiographic assessment, which demonstrated that less than one-third of the distal phalanx was involved. Diagnoses: Complete fingertip amputation classified as Tamai zone I, with no evidence of crush injury or contamination and a well-preserved distal stump. Interventions: In situ replantation was performed without vascular or nerve anastomosis, as the vessels and nerves were too small for reliable microsurgical repair. The distal phalanx was stabilized using a single K-wire. Postoperative management included strict bed rest, subcutaneous administration of low-molecular-weight heparin, and administration of prophylactic antibiotics. Outcomes: The replanted fingertip gradually regained perfusion without necrosis or infection. The patient was discharged uneventfully 1 week after surgery. By 12 weeks, the protective sensation had returned, nail growth was satisfactory, and radiographs confirmed the union of the distal phalanx. Lessons: Replantation without vascular anastomosis can achieve satisfactory functional and cosmetic outcomes in selected distal fingertip amputations, particularly in Tamai zone I. Careful patient selection is crucial, considering factors such as injury type, wound contamination, and patient age. This approach should be considered when feasible, especially in environments with limited medical resources or when vessel caliber precludes anastomosis.