Digital Amputation

Indications

Finger/Thumb Amputations, radiograph of a hand after finger amputations, world war i era
Radiograph of a hand after finger amputations, World War I era. Image by , Wikimedia Commons, CC BY-SA 3.0.
  • Unsalvageable crush or replantation not indicated
  • Tumour and uncontrolled infection
  • Painful stiff finger after failed reconstruction
  • Fingertip injuries with exposed bone where flaps are not suitable
  • Patient occupation, hand dominance and preferences guide the level

Position

  • Supine, hand table, digital or forearm tourniquet

Operative Steps

  1. Preserve length, above all in the thumb
  2. Volar flap preferred for padding
  3. Shorten bone to allow tension free closure and smooth the condyles
  4. Pull digital nerves distally, cut sharply and allow retraction
  5. Do not suture flexor to extensor tendons
  6. Amputation distal to the FDS insertion keeps active PIP flexion
  7. Ray amputation for proximal index amputations
  8. Fingertip injuries are classified by the angle and level of loss to choose closure or flap
  9. Remove the nail bed remnant to prevent nail spikes when distal to the lunula
  10. Amputation through the DIP joint, remove the condyle prominences and the volar plate

Postoperative Care

  • Early motion and desensitisation
  • Hand therapy
  • Dressings until the wound heals at 2 to 3 weeks
  • Return to work depends on occupation
  • Prosthetic fingers for cosmesis

Complications

  • Painful neuroma and cold intolerance
  • Quadriga, limited flexion of adjacent fingers from a tethered FDP
  • Lumbrical plus finger, paradoxical extension from a retracted FDP
  • Nail spike and hook nail deformity
  • Infection and wound breakdown
  • Stiffness of adjacent fingers

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.