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Factors affecting composite graft survival in digital tip amputations
Jonathan B Heistein1, Paul A Cook
1Ohio State University Hospital, Division of Plastic Surgery, Columbus, OH, USA.
Annals of Plastic Surgery
|June 13, 2003
Summary
Composite tissue replantation is effective for distal fingertip amputations. Non-smoking patients have better outcomes, with smoking being the primary factor in graft loss.
Area of Science:
- Hand Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Distal fingertip amputations are common injuries with various treatment options.
- Composite tissue replantation aims to preserve digital length and function.
- Evaluating the efficacy of composite tissue grafting is crucial for treatment selection.
Purpose of the Study:
- To determine the efficacy of composite tissue grafting for distal fingertip amputations.
- To identify factors influencing the success of composite tissue grafts.
- To support the use of composite tissue replantation in select cases.
Main Methods:
- Prospective evaluation of 53 patients with 57 digital tip amputations.
- Amputations were distal to the distal interphalangeal (DIP) joint.
- Minimal defatting was performed during composite tissue grafting.
Main Results:
- Graft survival rates were 58% distal to the eponychium and 43% between the DIP joint and eponychium.
- Smoking was the only significant independent factor associated with graft loss.
- Diabetes and crush injuries may increase failure risk, requiring further study.
Conclusions:
- Composite tissue replantation is recommended for fingertip amputations distal to the DIP joint in non-smokers.
- Smoking cessation is critical for successful outcomes.
- The procedure demonstrated a low complication rate.