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Composite grafting for pediatric fingertip injuries
Kyle R Eberlin1, Kathleen Busa2, Donald S Bae3
1Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA.
Insights
Composite grafting for pediatric fingertip injuries shows low complete take rates. However, most young patients achieve partial graft success, often avoiding further reconstructive surgery.
Area of Science:
- Pediatric surgery
- Hand surgery
- Regenerative medicine
Background:
- Fingertip injuries are prevalent in children.
- Composite grafting is a common treatment for pediatric distal amputations.
- This study evaluates early clinical outcomes of composite grafting for pediatric fingertip injuries.
Purpose of the Study:
- To assess the early clinical results of composite grafting for fingertip injuries in pediatric patients.
- To determine graft viability and the need for secondary procedures.
- To analyze the influence of age on graft take.
Main Methods:
- Retrospective review of 39 pediatric patients (≤18 years) undergoing fingertip composite grafting.
- Injuries were distal to the distal interphalangeal or thumb interphalangeal joint.
- Graft viability (no, partial, complete take), secondary procedures, and follow-up data were recorded.
Main Results:
- Mean age was 5.9 years; 61.5% were male.
- Graft take rates: 33.3% no take, 59.0% partial take, 7.7% complete take.
- Only 10% required secondary revision; age did not significantly impact graft take.
Conclusions:
- Complete graft take is uncommon in pediatric fingertip composite grafting.
- Most pediatric patients experience partial graft take, often without needing further surgery.
- Composite grafting can yield acceptable functional outcomes despite variable viability.
Background:
Fingertip injuries are common in the pediatric population. Composite grafting is a frequently used technique for distal amputations in children given the reported success rate. We sought to study the early clinical results of composite grafting for fingertip injuries in the pediatric population.
Methods:
A retrospective review was performed over a 5-year period at a tertiary care pediatric hospital to identify those patients who underwent composite grafting of fingertip injuries. Patients were included if they were 18 years old or younger and sustained an injury distal to the distal interphalangeal joint (or thumb interphalangeal joint). Demographic information was recorded. Graft viability was characterized as no take, partial take, or complete take. The number of secondary procedures and number and duration of follow-up appointments were recorded. Hypothesis testing was done using ordinal logistic regression analysis.
Results:
Thirty-nine patients underwent fingertip composite grafting. The mean age was 5.9 years (1-18 years); there were 24 males (61.5 %) and 15 females (38.5 %). Thirteen patients had no graft take (33.3 %), 23 patients had partial take (59.0 %), and three patients had complete take (7.7 %). Only four patients underwent secondary revision (10 %). The median number of follow-up appointments was 3 and the average follow-up time was 4.5 months. Age did not appear to have a statistically significant influence on graft take.
Conclusions:
Fingertip composite grafts rarely take completely even in young children. Despite poor viability, however, most patients will have at least partial graft take and do not undergo additional reconstructive procedures.
