Composite grafting for traumatic fingertip amputation in adults: Technique reinforcement and experience in 31 digits

Shih-Yi Chen, Chih-Hsin Wang, Ju-Peng Fu, Shun-Cheng Chang, Shyi-Gen Chen

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm2. 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. Conclusions: 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. Copyright © 2011 by Lippincott Williams &Wilkins.
Original languageEnglish
Pages (from-to)148-153
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number1
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Traumatic Amputation
Fingers
Amputation
Graft Survival
Esthetics
Wounds and Injuries
Taiwan
General Hospitals
Self Report
Hospital Emergency Service
Survival Rate
Hand
Reinforcement (Psychology)

Keywords

  • Composite graft
  • Fingertip amputation
  • Replantation
  • Trauma
  • adult
  • aged
  • article
  • clinical article
  • composite grafting
  • finger amputation
  • finger injury
  • graft survival
  • human
  • patient satisfaction
  • postoperative complication
  • priority journal
  • questionnaire
  • self report
  • surgical technique
  • suturing method
  • treatment outcome
  • Adult
  • Aged
  • Amputation, Traumatic
  • Female
  • Finger Injuries
  • Graft Survival
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Suture Techniques
  • Treatment Outcome
  • Young Adult

Cite this

Composite grafting for traumatic fingertip amputation in adults: Technique reinforcement and experience in 31 digits. / Chen, Shih-Yi; Wang, Chih-Hsin; Fu, Ju-Peng; Chang, Shun-Cheng; Chen, Shyi-Gen.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 70, No. 1, 2011, p. 148-153.

Research output: Contribution to journalArticle

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title = "Composite grafting for traumatic fingertip amputation in adults: Technique reinforcement and experience in 31 digits",
abstract = "Background: 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. Methods: 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. Results: The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm2. 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. Conclusions: 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. Copyright {\circledC} 2011 by Lippincott Williams &Wilkins.",
keywords = "Composite graft, Fingertip amputation, Replantation, Trauma, adult, aged, article, clinical article, composite grafting, finger amputation, finger injury, graft survival, human, patient satisfaction, postoperative complication, priority journal, questionnaire, self report, surgical technique, suturing method, treatment outcome, Adult, Aged, Amputation, Traumatic, Female, Finger Injuries, Graft Survival, Humans, Male, Middle Aged, Patient Satisfaction, Suture Techniques, Treatment Outcome, Young Adult",
author = "Shih-Yi Chen and Chih-Hsin Wang and Ju-Peng Fu and Shun-Cheng Chang and Shyi-Gen Chen",
note = "被引用次數:10 Export Date: 21 March 2016 CODEN: JOTRF 通訊地址: Chen, S.-Y.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, No. 325, Section 2, Cheng-Gung Road, Taipei, 11490, Taiwan 參考文獻: Allen, M.J., Conservative management of finger tip injuries in adults (1980) Hand, 12, pp. 257-265; Hattori, Y., Doi, K., Sakamoto, S., Yamasaki, H., Wahegaonkar, A., Ad-Dosooki, A., Fingertip replantation (2007) J Hand Surg [Am], 32, pp. 548-555; Moiemen, N.S., Elliot, D., Composite graft replacement ofdigital tips. 2. A study in children (1997) J Hand Surg [Br], 22, pp. 346-352; Uysal, A., Kankaya, Y., Ulusoy, M.G., An alternative technique for microsurgically unreplantable fingertip amputations (2006) Ann Plast Surg, 57, pp. 545-551; Eo, S., Hur, G., Cho, S., Azari, K.K., Successful composite graft for fingertip amputations using ice-cooling and lipo-prostaglandin E1 (2009) JPlast Recon-str Aesthet Surg, 62, pp. 764-770; Dautel, G., Barbary, S., Mini replants: Fingertip replant distal to the IP or DIPjoint (2007) JPlast Reconstr Aesthet Surg, 60, pp. 811-815; Yamano, Y., Replantation of the amputated distal part of the fingers (1985) J Hand Surg [Am], 10, pp. 211-218; Merle, M., Dautel, G., Advances in digital replantation (1997) Clin Plast Surg, 24, pp. 87-105; Louis, D.S., Palmer, A.K., Burney, R.E., Open treatment ofdigital tip injuries (1980) JAMA, 244, pp. 697-698; Russell, R.C., Casas, L.A., Management of fingertip injuries (1989) Clin Plast Surg, 16, pp. 405-425; Goitz, R.J., Westkaemper, J.G., Tomaino, M.M., Sotereanos, D.G., Soft-tissue defects of the digits. Coverage considerations (1997) Hand Clin, 13, pp. 189-205; Brown, R.E., Zook, E.G., Russell, R.C., Fingertip reconstruction with flaps and nail bed grafts (1999) J Hand Surg [Am], 24, pp. 345-351; Kim, K.S., Yoo, S.I., Kim, D.Y., Lee, S.Y., Cho, B.H., Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery (2001) Ann Plast Surg, 47, pp. 263-268; Wilson, A.D., Stone, C., Reverse digital artery island flap in the elderly (2004) Injury, 35, pp. 507-510; Netscher, D.T., Repair of fingertip amputations with local digital flaps and perionychial composite grafts from the amputated part (2005) Plast Reconstr Surg, 115, pp. 1217-1218. , author reply 1218; Ozyigit, M.T., Turkaslan, T., Ozsoy, Z., Dorsal V-Y advancement flap for amputations of the fingertips (2007) Scand J Plast Reconstr Surg Hand Surg, 41, pp. 315-319; Paterson, P., Titley, O.G., Nancarrow, J.D., Donor finger morbidity in cross-finger flaps (2000) Injury, 31, pp. 215-218; Hirase, Y., Salvage of fingertip amputated at nail level: New surgical principles and treatments (1997) Ann Plast Surg, 38, pp. 151-157; Lee, T.P., Liao, C.Y., Wu, I.C., Yu, C.C., Chen, S.G., Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction (2009) J Trauma, 66, pp. 1173-1179; Lee, P.K., Ahn, S.T., Lim, P., Replantation of fingertip amputation by using the pocket principle in adults (1999) Plast Reconstr Surg, 103, pp. 1428-1435; Hirase, Y., Postoperative cooling enhances composite graft survival in nasal-alar and fingertip reconstruction (1993) Br J Plast Surg, 46, pp. 707-711; Hartman, D.F., Goode, R.L., Pharmacologic enhancement of composite graft survival (1987) Arch Otolaryngol HeadNeck Surg, 113, pp. 720-723; Fann, P.C., Hartman, D.F., Goode, R.L., Pharmacologic and surgical enhance-ment of composite graft survival (1993) Arch Otolaryngol Head Neck Surg, 119, pp. 313-319; Li, E.N., Menon, N.G., Rodriguez, E.D., The effect of hyperbaric oxygen therapy on composite graft survival (2004) Ann Plast Surg, 53, pp. 141-145; Zhang, F., Cheng, C., Gerlach, T., Kim, D.Y., Lineaweaver, W.C., Buncke, H.J., Effect of hyperbaric oxygen on survival of the composite ear graft in rats (1998) Ann Plast Surg, 41, pp. 530-534; Rose, E.H., Norris, M.S., Kowalski, T.A., Lucas, A., Fleegler, E.J., The {"}cap{"} technique: Nonmicrosurgical reattachment of fingertip amputations (1989) J Hand Surg [Am], 14, pp. 513-518; Converse, J.M., Uhlschmid, G.K., Ballantyne Jr., D.L., {"}Plasmatic circulation{"} in skin grafts. The phase of serum imbibition (1969) Plast Reconstr Surg, 43, pp. 495-499; Tomita, K., Hosokawa, K., Yano, K., Takada, A., Kubo, T., Kikuchi, M., Dermal vascularity of the auricle: Implications for novel composite grafts (2009) J Plast Reconstr Aesthet Surg, 62, pp. 1609-1615; Converse, J.M., Filler, M., Ballantyne Jr., D.L., Vascularization of split-thickness skin autografts in the rat (1965) Transplantation, 3, pp. 22-27; Adams, D.C., Ramsey, M.L., Grafts in dermatologic surgery: Review and update on full-and split-thickness skin grafts, free cartilage grafts, and composite grafts (2005) Dermatol Surg, 31 (8 PART 2), pp. 1055-1067; Heistein, J.B., Cook, P.A., Factors affecting composite graft survival in digital tip amputations (2003) Ann Plast Surg, 50, pp. 299-303; Dagregorio, G., Saint-Cast, Y., Composite graft replacement ofdigital tips in adults (2006) Orthopedics, 29, pp. 22-24",
year = "2011",
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volume = "70",
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journal = "Journal of Trauma and Acute Care Surgery",
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TY - JOUR

T1 - Composite grafting for traumatic fingertip amputation in adults: Technique reinforcement and experience in 31 digits

AU - Chen, Shih-Yi

AU - Wang, Chih-Hsin

AU - Fu, Ju-Peng

AU - Chang, Shun-Cheng

AU - Chen, Shyi-Gen

N1 - 被引用次數:10 Export Date: 21 March 2016 CODEN: JOTRF 通訊地址: Chen, S.-Y.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, No. 325, Section 2, Cheng-Gung Road, Taipei, 11490, Taiwan 參考文獻: Allen, M.J., Conservative management of finger tip injuries in adults (1980) Hand, 12, pp. 257-265; Hattori, Y., Doi, K., Sakamoto, S., Yamasaki, H., Wahegaonkar, A., Ad-Dosooki, A., Fingertip replantation (2007) J Hand Surg [Am], 32, pp. 548-555; Moiemen, N.S., Elliot, D., Composite graft replacement ofdigital tips. 2. A study in children (1997) J Hand Surg [Br], 22, pp. 346-352; Uysal, A., Kankaya, Y., Ulusoy, M.G., An alternative technique for microsurgically unreplantable fingertip amputations (2006) Ann Plast Surg, 57, pp. 545-551; Eo, S., Hur, G., Cho, S., Azari, K.K., Successful composite graft for fingertip amputations using ice-cooling and lipo-prostaglandin E1 (2009) JPlast Recon-str Aesthet Surg, 62, pp. 764-770; Dautel, G., Barbary, S., Mini replants: Fingertip replant distal to the IP or DIPjoint (2007) JPlast Reconstr Aesthet Surg, 60, pp. 811-815; Yamano, Y., Replantation of the amputated distal part of the fingers (1985) J Hand Surg [Am], 10, pp. 211-218; Merle, M., Dautel, G., Advances in digital replantation (1997) Clin Plast Surg, 24, pp. 87-105; Louis, D.S., Palmer, A.K., Burney, R.E., Open treatment ofdigital tip injuries (1980) JAMA, 244, pp. 697-698; Russell, R.C., Casas, L.A., Management of fingertip injuries (1989) Clin Plast Surg, 16, pp. 405-425; Goitz, R.J., Westkaemper, J.G., Tomaino, M.M., Sotereanos, D.G., Soft-tissue defects of the digits. Coverage considerations (1997) Hand Clin, 13, pp. 189-205; Brown, R.E., Zook, E.G., Russell, R.C., Fingertip reconstruction with flaps and nail bed grafts (1999) J Hand Surg [Am], 24, pp. 345-351; Kim, K.S., Yoo, S.I., Kim, D.Y., Lee, S.Y., Cho, B.H., Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery (2001) Ann Plast Surg, 47, pp. 263-268; Wilson, A.D., Stone, C., Reverse digital artery island flap in the elderly (2004) Injury, 35, pp. 507-510; Netscher, D.T., Repair of fingertip amputations with local digital flaps and perionychial composite grafts from the amputated part (2005) Plast Reconstr Surg, 115, pp. 1217-1218. , author reply 1218; Ozyigit, M.T., Turkaslan, T., Ozsoy, Z., Dorsal V-Y advancement flap for amputations of the fingertips (2007) Scand J Plast Reconstr Surg Hand Surg, 41, pp. 315-319; Paterson, P., Titley, O.G., Nancarrow, J.D., Donor finger morbidity in cross-finger flaps (2000) Injury, 31, pp. 215-218; Hirase, Y., Salvage of fingertip amputated at nail level: New surgical principles and treatments (1997) Ann Plast Surg, 38, pp. 151-157; Lee, T.P., Liao, C.Y., Wu, I.C., Yu, C.C., Chen, S.G., Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction (2009) J Trauma, 66, pp. 1173-1179; Lee, P.K., Ahn, S.T., Lim, P., Replantation of fingertip amputation by using the pocket principle in adults (1999) Plast Reconstr Surg, 103, pp. 1428-1435; Hirase, Y., Postoperative cooling enhances composite graft survival in nasal-alar and fingertip reconstruction (1993) Br J Plast Surg, 46, pp. 707-711; Hartman, D.F., Goode, R.L., Pharmacologic enhancement of composite graft survival (1987) Arch Otolaryngol HeadNeck Surg, 113, pp. 720-723; Fann, P.C., Hartman, D.F., Goode, R.L., Pharmacologic and surgical enhance-ment of composite graft survival (1993) Arch Otolaryngol Head Neck Surg, 119, pp. 313-319; Li, E.N., Menon, N.G., Rodriguez, E.D., The effect of hyperbaric oxygen therapy on composite graft survival (2004) Ann Plast Surg, 53, pp. 141-145; Zhang, F., Cheng, C., Gerlach, T., Kim, D.Y., Lineaweaver, W.C., Buncke, H.J., Effect of hyperbaric oxygen on survival of the composite ear graft in rats (1998) Ann Plast Surg, 41, pp. 530-534; Rose, E.H., Norris, M.S., Kowalski, T.A., Lucas, A., Fleegler, E.J., The "cap" technique: Nonmicrosurgical reattachment of fingertip amputations (1989) J Hand Surg [Am], 14, pp. 513-518; Converse, J.M., Uhlschmid, G.K., Ballantyne Jr., D.L., "Plasmatic circulation" in skin grafts. The phase of serum imbibition (1969) Plast Reconstr Surg, 43, pp. 495-499; Tomita, K., Hosokawa, K., Yano, K., Takada, A., Kubo, T., Kikuchi, M., Dermal vascularity of the auricle: Implications for novel composite grafts (2009) J Plast Reconstr Aesthet Surg, 62, pp. 1609-1615; Converse, J.M., Filler, M., Ballantyne Jr., D.L., Vascularization of split-thickness skin autografts in the rat (1965) Transplantation, 3, pp. 22-27; Adams, D.C., Ramsey, M.L., Grafts in dermatologic surgery: Review and update on full-and split-thickness skin grafts, free cartilage grafts, and composite grafts (2005) Dermatol Surg, 31 (8 PART 2), pp. 1055-1067; Heistein, J.B., Cook, P.A., Factors affecting composite graft survival in digital tip amputations (2003) Ann Plast Surg, 50, pp. 299-303; Dagregorio, G., Saint-Cast, Y., Composite graft replacement ofdigital tips in adults (2006) Orthopedics, 29, pp. 22-24

PY - 2011

Y1 - 2011

N2 - Background: 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. Methods: 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. Results: The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm2. 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. Conclusions: 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. Copyright © 2011 by Lippincott Williams &Wilkins.

AB - Background: 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. Methods: 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. Results: The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm2. 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. Conclusions: 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. Copyright © 2011 by Lippincott Williams &Wilkins.

KW - Composite graft

KW - Fingertip amputation

KW - Replantation

KW - Trauma

KW - adult

KW - aged

KW - article

KW - clinical article

KW - composite grafting

KW - finger amputation

KW - finger injury

KW - graft survival

KW - human

KW - patient satisfaction

KW - postoperative complication

KW - priority journal

KW - questionnaire

KW - self report

KW - surgical technique

KW - suturing method

KW - treatment outcome

KW - Adult

KW - Aged

KW - Amputation, Traumatic

KW - Female

KW - Finger Injuries

KW - Graft Survival

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Satisfaction

KW - Suture Techniques

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1097/TA.0b013e3181cc8553

DO - 10.1097/TA.0b013e3181cc8553

M3 - Article

VL - 70

SP - 148

EP - 153

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -