Arch Hand Microsurg.  2019 Dec;24(4):335-344. 10.12790/ahm.2019.24.4.335.

Surgical Outcomes of Cooling Composite Graft for Fingertip Amputation

• Lim H
• Tak SW
• Chung CM
• Cho SH
• Lee JW
• Koh SH

• KMID: 2464469
• DOI: http://doi.org/10.12790/ahm.2019.24.4.335

Abstract

PURPOSE
This study aimed to report the surgical outcomes of postoperative management of ice-cooling combined with moist-open dressing and intravenous prostaglandin E1 (PGE1) injection. Ice cooling as postoperative management was also discussed.
METHODS
Forty-one fingertip amputation of 38 patients between January 2007 and December 2017 were investigated retrospectively. Fingertip amputations were managed with postoperative ice bag application for 72 hours followed by moist open dressing and PGE1 injection.
RESULTS
Twenty-five composite grafts (61.0%) survived with complete healing at 8 weeks after surgery, with favorable outcomes in cases with low injury level (type I, 82.3%) and guillotine injury (77.8%). A higher survival rate was significantly correlated with female sex, guillotine injury, injury without osseous tissue (type I), and cold outdoor temperature (p<0.05). Multivariate analysis revealed that differences between types I and III injuries, injury mode, and outdoor temperature were independent clinical parameters associated with composite graft survival.
CONCLUSION
The present study reported comparable results with postoperative ice cooling in cases with low injury level, guillotine injury, and low outdoor temperature. Prospective studies on the specific parameters of ice cooling and standards of manageable postoperative care should be conducted to enhance survival.

Keyword

Graft survival; Amputation stumps; Finger phalanges; Finger injuries; Tissue survival

MeSH Terms

Alprostadil
Amputation Stumps
Amputation*
Bandages
Female
Finger Injuries
Finger Phalanges
Graft Survival
Humans
Ice
Multivariate Analysis
Postoperative Care
Prospective Studies
Retrospective Studies
Survival Rate
Tissue Survival
Transplants*
Alprostadil
Ice

Figure

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  Fig. 1 Open moist dressing: (A) dorsal view, (B) palmar view, (C) fingertip view, and (D) fingertip view with ointment.

• 

  Fig. 2 Level I injury caused by crushing trauma on the right thumb of a 45-year-old male patient: (A) day of trauma day, (B) immediately postoperative, (C) postoperative day 2, and (D) postoperative day 31. The thumb showed complete survival.

• 

  Fig. 3 Level II injury caused by guillotine injury on the left third and fourth fingers of a 56-year-old male patient: (A) day of trauma, (B) immediately postoperative, (C) postoperative day 13, (D) postoperative week 8 (anteroposterior view), and (E) postoperative week 8 (fingertip view). The third finger showed complete survival, whereas the fourth finger had partial failure.

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