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In this paper, we report on the advanced technique of distal tendon stump repair of a digit. A K-wire is used lengthwise to fix the distal and medium phalanxes, with the pull-out suture fixed on it. None of the cases repaired using this method was complicated with regional necrosis or tendon re-laceration. The advantages of advanced pull-out suture tied on a K-wire is that finger-tip pressure, which can lead to tissue necrosis, is avoided.

When tendons, bones or joints are exposed in infected digits, functional and cosmetic sequelae are frequent. We propose continuous negative pressure therapy with irrigation (NPI) for an infected digit with an open wound. Continuous NPI was evaluated in vitro and subsequently applied to a clinical case. Acceptable functional and cosmetic results were obtained without any problems when continuous NPI was performed in the clinical case. Continuous NPI may be a useful alternative for treatment of an infected digit with an open wound.

We recently developed continuous negative pressure therapy with irrigation (NPI) and successfully applied it to an infected digit with a narrow wound. With this technique, however, the dressing circumferentially wraps the digit or hand, and the pressure that the digit or hand receives and the influence on peripheral circulation are unclear. In this report, we evaluated the external pressure that a digit and hand received during NPI in vitro. Under circumferential NPI dressing, the skin perfusion pressure (SPP) of the peripheral portion was measured. Pressure was maintained at 1.3 mm Hg, and suction pressure ranged from -50 to -200 mm Hg. The pressure that a digit or hand receives during NPI is much lower than that at which tissue may be damaged (40–50 mm Hg). The SPP of the peripheral portion was much higher than 40 mm Hg, which is the pressure at which wound healing may be predicted. In clinical cases, NPI has been useful for wound bed preparation.

Finger tourniquets are used in a variety of operative procedures in both the trauma and elective setting. A wide range of methods are used in clinical practise as there is no standardised method. Many of the methods in use have significant drawbacks such as the inability to exsanguinate the digit or the more concerning problem of inadvertently leaving the tourniquet on the digit on completion of the procedure. We discuss two techniques that are quick, cheap and easy that do not have these drawbacks. There is a brief discussion of the literature assessing the various attributes of published methods. We feel that the adoption of these methods could result in easier and safer finger exsanguination and haemostasis.

A liposarcoma is extremely rare in the digits. A 73-year-old woman was diagnosed with a lipoma in her middle finger 10 years ago. As this tumor increased in size and presented with imaging findings that were atypical of lipomas, careful marginal resection biopsy outside the pseudo-capsule was performed, and the tumor was diagnosed as a well-differentiated liposarcoma. At the 5-year follow-up, the patient showed no evidence of local recurrence or metastasis, with no loss of hand function. The findings from this case suggest that even for a lipomatous tumor in the digits, further imaging examination and resection biopsy should be considered if the tumor presents with features that are atypical of lipomas.

Background: Traumatic digital amputations require early replantation, and proper surgical technique is a critical factor for a successful digital replantation. Non-surgical factors can also effect the digital survival rate. Previous studies have used univariate analysis and logistic regression which could not identify the various complex associations of patient-related and digit-related factors. This study aimed to identify the determinants of digital survival after replantation, using multi-level analysis.

Methods: A retrospective analysis of 209 patients with 272 finger revascularizations and replantations performed from the metacarpophalangeal joint to the end of the finger. Demographic data, place of injury, mechanism of injury, level of amputation, and success rate were examined.

Results: The overall survival rate of digital replantation during the study period January 2004–December 2017 was 64%. Surgeon’s experience 3–5 years (OR 13.04), type of injury as guillotine (OR 6.79) and number of venous anastomoses for two veins (OR 6.83) were the most important pre-operative and intra-operative factors affecting the survival rate as clarified by a multi-level hierarchical model.

Conclusions: Although successful replantation involved many factors, the most important factors that directly affected the survival of the amputated digit were surgeon’s experience, venous anastomosis and type of injury.

Chronic embedded-ring injury is a rare and uncommon presentation. This is also known as “chronic ring erosion” or “embedded ring syndrome” in the literature. Injury of this type has been associated with psychological impairment causing neglect of such injury. We herein describe a case of double embedded rings on the right ring finger in a 30-year-old healthy construction worker. A primary amputation at the metacarpophalangeal joint was performed in view of the chronicity of his condition and associated neurovascular damage. Early removal of ring is of paramount importance in any ring-associated injuries. However, fear of losing a digit has been the reason of delay in seeking medical treatment, which in turn ended up in dire consequences.