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Outcomes of Composite Grafts for Pediatric Fingertip Amputations: A Systematic Review
Noemi Jester1,2, Seunghee Han3, Manwi Singh1,2
1Birmingham Women's and Children's Hospital, Birmingham, United Kingdom.
Insights
Composite grafting is a useful treatment for pediatric fingertip amputations, with 81.6% achieving successful graft take. Common complications include infection and nail abnormalities, particularly in more proximal injuries.
Area of Science:
- Pediatric surgery
- Hand surgery
- Regenerative medicine
Background:
- Fingertip amputations are common in children, often resulting from crush injuries.
- Composite grafts offer a reconstructive option for pediatric fingertip injuries.
Purpose of the Study:
- To evaluate the outcomes of composite grafts in pediatric fingertip amputations.
- To identify factors influencing graft success and complications.
Main Methods:
- A comprehensive literature search was performed across six databases in March 2022.
- Twelve studies involving 735 composite grafts in children were included in the review.
Main Results:
- Overall successful graft take (complete or partial) was observed in 81.6% of cases.
- Complete graft take was reported in 17.3% of cases.
- Distal amputations had a lower failure rate; infection and nail abnormalities were the most frequent complications.
Conclusions:
- Composite grafting is a viable treatment for pediatric fingertip amputations.
- Awareness of potential complications like infection and nail issues is crucial.
- More proximal amputations may require alternative surgical approaches.
Abstract:
Introduction The aim of this study was to explore the outcomes of composite grafts in fingertip amputations in children as well as the contributing factors that may affect outcomes. Methods Literature search was conducted across six databases in March 2022 to select studies on the use of composite grafts on fingertip amputations in the pediatric population. Results Twelve articles with 735 composite grafts were identified for review. Most fingertip injuries occurred in the less than 5-year age group and were due to crush type injuries. In studies that reported "complete" graft take as a separate outcome measure, 17.3% of fingertips with this result were observed. In the studies that reported "complete" and "partial" graft take together as an outcome measure, 81.6% of fingertips achieved this outcome. A lower proportion of failed graft take was observed in more distal fingertip amputations. Infection (3.8%) and nail abnormalities (3.4%) were the most common complications following composite grafting. Conclusion Composite grafting can be considered as a useful method of treatment in this population. Clinicians should be aware of the potential complications following this method of treatment such as infection and nail abnormalities. More proximal fingertip amputations may warrant other surgical interventions (beyond Level II on the modified Ishikawa/Ishikawa classification). Significant heterogeneity was observed within the studies, mainly due to lack of standardization in assessment and reporting of outcomes.
