Composite grafts for fingertip amputations: a systematic review

Abstract

There is debate in the literature surrounding the management of fingertip amputations. The role of composite grafts lacks clarity in terms of outcomes and complications. Hence, there is a need for an evidence synthesis to guide practice. A search of the databases OVID MEDLINE, PubMed, EMBASE, SCOPUS, The Cochrane Library, and clinical trial registries was conducted, from 1946 to January 2020, using the key terms “fingertip,” “digital tip,” “digit,” “finger,” “thumb,” “amputation,” “replantation,” “reattachment,” “reimplantation,” and “composite graft.” Studies reporting primary data on the outcomes of composite grafts of 5 or more digits were included. The studies included in this systematic review ranged in year of publication from 1959 to 2019. Data extraction included demographic details, functional, esthetic and adverse outcomes. Twenty-three articles were included. Outcome data on composite grafts are heterogeneous and little standardization of measurements exists, making interpretation challenging. Identified factors associated with improved outcomes include lower age, distal amputation levels by cut mechanism and decreased time to operation. Smoking is associated with poorer composite graft outcomes. Although survival rates vary greatly, composite grafting may be useful in certain cases and provide good functional and sensation outcomes with good patient satisfaction.

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

“…In our study, the SDP group had a higher overall success rate of composite graft than did the composite graft-only group (70.59% vs 41.67%, P = 0.119). It was also higher than the average success rate of composite graft (around 50%) according to a recent systematic review 31 . Partial loss was 11.76% (2 of 17) in the SDP group, and all patients were treated conservatively without secondary surgery.…”

“…It was also higher than the average success rate of composite graft (around 50%) according to a recent systematic review. 31 Partial loss was 11.76% (2 of 17) in the SDP group, and all patients were treated conservatively without secondary surgery. Only 17.65% (3 of 17) of fingers encountered complete necrosis of composite grafts that needed revision amputations in the SDP group.…”

A Comparison of Outcomes between Finger and Pulp Replantation/Revascularization in a Single Center

“…Key complications include infection and necrosis. 3 Successful replantation/revascularisation can provide excellent aesthetic and functional outcomes for patients. Achieving such outcomes, however, is dependent on many factors, such as patient age, occupation, dominant hand, severity, and level of injury as well as clinical factors such as the stability of the patient.…”