Factors affecting composite graft outcomes in finger tip amputation
Ja Hea Gu, MD, PhD
Dankook University Hospital, Cheonan, Korea, Republic of (South)
Hypothesis Fingertip amputations are the most common type of upper extremity amputation injuries and a composite graft could have been one of treatment option. We report the outcomes and factors affecting graft outcomes in digital tip amputations to determine the efficacy of this treatment modality and present the evidence of its use.
Methods In the retrospective study, we analyzed data from 168 digital amputations in 163 patients operated for 7 years. At least 12 months follow up patients were included and other combined injuries inside the same hand were excluded. Age, level, pattern of injury, bony injury, injury type, injury and outcomes were reviewed. Outcomes were determined by the authors and these were divided into 4 groups: complete survival(grade4) partial survival and healed by secondary intention within 6 weeks(grade 3), partial flap survival and healed with surgical management or resulting complications (grade 2) and total flap loss (grade 1). Statistical analysis was performed for the injury category and overall final grade.
Results Of the 168 amputated digits, 33.93% survived completely. Partial survival (group 3 and 2) occurred in 35.12% and 26.8% respectively. Only 4.17% were resulted total necrosis. Statistically, age, injury type, injured level and bony involvement were statistically correlated with outcomes (p<0.05,Table 1). Logistic regression analysis showed that age, injury type, injury level, smoking and bony involvement were associated with complete graft survival. Young and non smoking patients with a distal injury and no bony involvement had uncomplicated grafts healing.
Conclusions Survival rates are increased in young, clear cut, non-involved bone and distally injured digits. Even when partial necrosis was occurred, the graft act as biological dressing with minimal risk until subsequent treatment is performed. Survival rates may be improved if certain criteria must be met to qualify for this treatment modality and composite tissue graft could be an alternative treatment option for such selected patients.
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