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The Tissue Bank
Multidigit injuries are common. An amputated finger that is not replantable becomes a privileged donor site for harvesting tissue for the reconstruction of neighboring fingers. This is a unique opportunity that must be seized at the time of the emergent procedure. The morbidity of the harvested finger is zero, and all innovative techniques are indicated to allow the salvageable neighboring fingers to benefit from this tissue bank principle.
Possible Uses of the Tissue Bank
All types of tissues can be used according to this principle. Depending on the clinical scenarios, a tissue unit can be used as a conventional nonvascularized graft or as a flap with its own blood supply.
In the latter case, it may be an island flap or a free flap with microsurgical anastomoses.
Skin and Tissue Bank
Skin Grafts
This is the simplest illustration of this principle. All types of skin grafts can be harvested from a finger destined for amputation. Where possible, we choose skin with texture and thickness adapted to the recipient site. Note that the palmar skin of the fingers is a poor donor site because of its thickness. Despite thorough defatting, full-thickness skin grafts from the palmar surface of the fingers are difficult to apply.
Cheiroplasty
A finger can be filleted from its skin covering before being amputated. The skin flap thus obtained is used to cover a neighboring finger, the back of the hand, the first commissure and any neighboring area. The skin available will, however, only remain vascularized if the incisions respect the rules of flap harvesting, which depending on the case, will be an axial-pattern or random-pattern flap.
Island Flap
All island flaps described in Chapter 9 , whether dorsal or palmar islands, can be dissected on a finger destined for amputation.
Free Flaps
Similarly it is possible to dissect a free skin flap on a digital vascular pedicle. Most often they are free pulp flaps, but nothing prohibits use of the palmar skin of P1 or P2 or the dorsal skin of P2 as appropriate. To have a vein of sufficient size, we dissect the dorsal aspect of the finger. This requires inclusion of a dorsal skin paddle in the palmar flap, continuous with the vein.
Nail and Tissue Bank
An amputated finger is the ideal site for a nail bed graft. We can harvest thin or thick nail bed grafts here but also total matrix grafts. Finally, even if it is an opportunity we have never encountered in practice, we can consider harvesting a vascularized nail graft on an amputated finger.
Bone and Tissue Bank
Conventional Grafts
Part of a phalanx may be harvested to reconstruct a segmental defect on an adjacent finger. Such a graft must necessarily be inserted between two vascularized bone ends for optimal revascularization and avoidance of resorption. Given the long delays in consolidation observed in these circumstances, the osteosynthesis should be solid.
Vascularized Bone Grafts
It is possible to remove a phalangeal bone graft in continuity with a palmar vascular pedicle. The vascularized graft should then also include the soft tissues and the dorsal skin to include a dorsal vein for venous return. Such a graft would undoubtedly consolidate and integrate faster than a conventional graft. In fact, placed in a favorable tissue environment, small-sized conventional bone grafting used on the hand can be integrated without difficulty. The need for a vascular graft arises, especially with joints.
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