A New Method for Non-Replantable Fingertip Amputation

Abstract

INTRODUCTION: Composite grafting is used to treat nonreplantable fingertip amputations. Though success rates and outcome are good in children, lower success rates were reported in literature. Several methods, including surgical technique reinforcement, pharmacologic enhancement, and hyperbaric oxygenation have been reported to improve survival of composite grafts. In this study, we performed modified composite grafting with pulp adipofascia advance flap for fingertip amputations. MATERIAL AND METHODS: From September, 2012 to September, 2015, 14 patients with 16 digits were included in our study. All of our cases had traumatic fingertip amputated with Hirase zone IIA. All of our patients underwent this procedure under local anesthesia. We performed pulp adipofascia advance flap first for better soft tissue cover of stump, and the amputated parts were deepithelized, defatted and reattached as composite graft. Age of patients, injured finger, mechanism of trauma, average graft survival area at 6 week, length of shortening of finger, two-point discrimination(mm) at six-month, DASH(Disabilities of the Arm, Shoulder, and Hand) symptom/disability score, and subjective self-evaluation questionnaire at 6 moth were recorded. RESULTS: Totally Mean age of patients was 43.9 years(20-71 years). Seven digits(43.8%) were injured by crushing mechanism and the other nine digits(56.2%) were injured by cutting injury. Mean graft survival area was 89%. Two-point discrimination at 6 month after surgery was 6.3 mm in average. Twelve patients(85.7%) were very satisfied, one patients(7.1%) was moderately satisfied, and the other one patients(7.1%) was slightly satisfied. Average DASH score at 6 month was 1.48.Figure 1: A 54-year-old woman had a right middle finger cutting amputation inflicted by a knife (Hirase IIA)(1a). Immediate postoperative photo is shown as figure 1b. The graft healed well postoperatively with a satisfactory aesthetic outcome at 14 months (1c).CONCLUSIONS: In Hirase zone IIA traumatic amputation, our modified technique of composite grafting with pulp adipofascial advance flap provided an alternative choice with high success rate, acceptable functional and aesthetic outcomes not inferior to replantation. Also, simplicity and cost-effectiveness can be achieved simultaneously.