Composite Grafting for Traumatic Fingertip Amputation in Adults: Technique Reinforcement and Experience in 31 Digits

Abstract

Composite grafting is used to treat nonreplantable fingertip amputations. This procedure has a high success rate and good results in treating fingertip amputations in children, but a lower success rate in adults. From July 2007 to December 2008, 27 patients with 31 injured fingertips were admitted because of traumatic fingertip amputation at the emergency department of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. All 31 injured fingers had a nonreplantable distal amputated fingertip and underwent composite grafting. We refined the surgical technique by excising the bony segment, defatting, deepithelialization, tie-over suturing, and finger splinting to increase the graft survival. The patients' age, mechanism of damage, lesion size, surgical result, and postoperative complications were recorded. The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm. Twenty-one fingers (67.7%) had been injured by crushing injury and the other 10 fingers (32.3%) by cutting injury. The overall graft survival rate was 93.5% (29 of 31). The average 2-point discrimination was 6.3 mm in the sixth month after the operation. The esthetic outcome evaluated by self-report questionnaire was 93.1% satisfied, and 86.2% of the patients could use their injured finger normally in daily work. This easily performed and one-stage surgical procedure provided a reliable method for treating microsurgically nonreplantable fingertip amputations caused by hand trauma. The high overall success rate, satisfactory esthetic outcome, and good functional preservation helped patients return quickly to their daily life.