Composite grafting with pulp adipofascial advancement flaps for treating non‐replantable fingertip amputations

Abstract

In Hirase zone IIA traumatic fingertip amputation where replantation is difficult, our modified technique of composite grafting with pulp adipofascial advancement flap provided an alternative choice with high successful rate, acceptable functional and aesthetic outcomes. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2015 Wiley Periodicals, Inc. Microsurgery 36:651-657, 2016.

A case series study in new restorative surgery in thumb amputation: The Adiposofaciocutaneous flap technique for distal thumb amputation replantation

“…Composite grafting has been widely performed for distal fingertip amputations, but variable success rates are reported throughout the literature, with key complications being infection and necrosis [ 16 ]. While composite grafting has a high success rate and produces good results in treating non-replantable fingertip amputations in pediatric patients, its success rate in adults can be as low as approximately 20 % [ 17 ]. The Hirase technique cools the grafted stump at 4 °C in the first 72 h, without shortening it.…”

The Efficacy of Subdermal Pocket Procedure in Fingertip Replantation With Composite Graft

“…On the other hand, composite grafting seems to be a reasonable choice with easy technique and cost-effectiveness for this kind of distal fingertip amputation 11,12,14,15 . It seems to provide satisfactory survival, functional, and cosmetic outcomes especially among children, 16,17,28 but has a variable survival rate among adults 13,18,19 …”

“…11,12,14,15 It seems to provide satisfactory survival, functional, and cosmetic outcomes especially among children, 16,17,28 but has a variable survival rate among adults. 13,18,19 The pocket principle was first applied by Brent 22 using subcutaneous pocket over the anterior chest wall for replantation of an amputated fingertip with composite graft. It could provide extra blood supply for survival of the composite graft with enlarging area of vascular contact.…”

“…2,6 For these situations, composite grafting seems to be a reasonable treatment alternative. [11][12][13][14] Composite grafting has its advantages including simplicity of technique, cost-effectiveness, preservation of finger length, functionality and cosmetic outcomes, and preferable survival among young children. [15][16][17] However, a high failure rate requiring secondary revision and variable survival rate are noted in adults.…”

“…Moreover, microsurgical replantation is contraindicated in certain cases including lack of microsurgical capability, severe crushing or avulsive injuries, and lack of suitable vessels 2,6 . For these situations, composite grafting seems to be a reasonable treatment alternative 11–14 …”