The graft-reposition-on-flap technique for fingertip amputations: a patient-reported outcomes study of 111 patients

Graft-reposition-on-flap (GRF) is a reconstruction method described for non-replantable fingertip amputations. We hypothesised that this technique provides acceptable outcomes for such an injury, as measured by a patient-reported survey.

This retrospective study evaluated 111 patients [118 digits], operated between January 2019 and March 2023 for Allen 3 or 4 fingertip amputations. All patients had crush avulsion amputations not fit for replantation and had undergone flap cover with grafting of the amputated nail bed and bone. 80 digits had undergone a flap with bone and nail bed graft, while 38 digits received only a nail bed graft with the flap. The flaps used were based on the defect, including local and pedicle flaps. Outcomes were assessed using an original patient-reported questionnaire administered telephonically at least 1 year after injury. The survey contained six items rated on a 1-10 Likert scale, with higher scores indicating better outcomes.

Nail growth was present in 105 of the 118 digits (89%). 107 patients of 111 (96%) were willing to undergo a similar procedure again if indicated. The median rated score for the Length of the finger was 9 [Interquartile range (IQR) 8-10], for Fingertip shape 8 [IQR 7-9], for Donor appearance 9 [IQR 8-10], for Nail appearance 8 [IQR 5-10], and for Sensibility 9 [IQR 7.5-10]. The median Overall Satisfaction score was 9 [IQR 8-10], while the median Total score was 51 [IQR 44-56]. The presence of a nail significantly improved the Total score and Overall Satisfaction score [Mann-Whitney test (MW), p = 0.0001 and 0.0051, respectively]. Similarly, those who had only a nailbed graft had higher Total scores [MW, p = 0.027]. Injuries with germinal matrix avulsion had significantly worse Total and Satisfaction scores [MW, p = 0.0099 and 0.0351, respectively]. The cross-finger flap [CFF] showed worse Total and Donor scores compared to other glabrous flaps [MW, p = 0.0244 and 0.0002, respectively]. The thenar flap had a better Donor score than the CFF [MW, p = 0.0003]. The questionnaire used for the study showed acceptable internal consistency [Cronbach's 𝛼 = 0.7719], and all six items were valid.

The GRF technique is a viable option for non-replantable Allen 3 or 4 amputations, with reasonable patient satisfaction. The original questionnaire developed in this study demonstrated acceptable reliability and item validity, and was easy to administer.