Abstract
BackgroundThere is much debate in the hand surgery literature as to the management of fingertip amputations. Much research continues to be published in this area. Methods of reattachment include microsurgical and non-microsurgical (composite graft) replantation. The role of composite grafts lacks clarity in terms of outcomes, success rates and complications. Hence there is a need for an evidence synthesis, which can guide patient selection, the consent process and determine graft survival rates and functional outcomes to optimise patient outcomes. MethodsSearch of the databases OVID MEDLINE, PubMed, EMBASE, SCOPUS, The Cochrane Library and clinical trial registries from inception using terms “fingertip” “digital tip” “digit” “finger” “thumb” “amputation” “replantation” “reattachment” “reimplantation” and “composite graft” as key terms with “AND” selected as a Boolean operator, limited to humans will be conducted by two independent researchers. The patient population will include adults and children. Studies will be included if they report: (1) primary data; (2) outcomes of ‘composite grafts’ or ‘nonmicrosurgical replantations’; (3) graft survival, (4) 5 or more cases. Articles will be excluded if surgical techniques involve: (1) composite graft pocketing, or (2) microsurgical replantation or (3) additional flaps (pulp or local). Full exclusion and inclusion criteria are described within this protocol. Data extraction will include; demographic details, patient comorbidities, amputation nature and level, functional, and aesthetic outcomes, complications and need for secondary procedures. All data extracted will be cross-checked, and discrepancies resolved through consensus. DisseminationThis review will be published in a peer-reviewed journal and will be presented at national and international conferences to inform the practice of other clinicians.
Highlights
The fingertip is the segment distal to the insertion of the flexor and extensor tendons on the distal phalanx [1] (Fig. 1)
An electronic database search will be conducted on OVID Medline, PubMed, EMBASE, SCOPUS, The Cochrane Library and clinical trial registries using the terms ‘‘fingertip” ‘‘fingertips” ‘‘digital tip” ‘‘digital tips” ‘‘digit” ‘‘digits” ‘‘finger” ‘‘fingers” ‘‘thumb” ‘‘thumbs” ‘‘amputation” ‘‘amputations” ‘‘injury” ‘‘injuries” ‘‘replantation” ‘‘replantations” ‘‘reattachment” ‘‘reattachments” ‘‘reimplantation” ‘‘reimplantations” ‘‘composite graft” ‘‘composite grafts” as keywords combined with the Boolean logical operators ‘‘OR” and ‘‘AND”
Analysis of results according to the classification of amputation, patient age and type of amputation will be performed
Summary
There is much debate in the hand surgery literature as to the management of fingertip amputations. Much research continues to be published in this area. Methods of reattachment include microsurgical and non-microsurgical (composite graft) replantation. The role of composite grafts lacks clarity in terms of outcomes, success rates and complications. There is a need for an evidence synthesis, which can guide patient selection, the consent process and determine graft survival rates and functional outcomes to optimise patient outcomes. Studies will be included if they report: (1) primary data; (2) outcomes of ‘composite grafts’ or ‘nonmicrosurgical replantations’; (3) graft survival, (4) 5 or more cases. Articles will be excluded if surgical techniques involve: (1) composite graft pocketing, or (2) microsurgical replantation or (3) additional flaps (pulp or local). Data extraction will include; demographic details, patient comorbidities, amputation nature and level, functional, and aesthetic outcomes, complications and need for secondary procedures.
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