Treatment Of Fingertip Amputation In AD Ults By A Composite Graft With SUBC Utaneous Pocketing

Objective:To explore the clinical application of subcutaneous pocketing method following a composite graft in complete distal finger amputations of adult patients,and explore its factors affecting survival.Methods: From February 2013 to February 2015,the method of the subdermal pocket procedure was Applied to 50 complete finger amputations in 48 patients.All patients were adults who sustained a completed fingertip amputation from the tip to DIP in a digit.In all of these patients,the amputation occurred due to a crush,guillotine or avulsion-type injury,and a microsurgical replantation was not feasible.We used the subcutaneous pocketing method followinga composite graft in these patients and prepared the pocket in the subcutaneous layer of the palm or abdomen.After the nail of amputated parts was removed,fractured bonesegments fixed with K-wires and amputated part de-epithelialized to the middermal layer,the reattached parts were separately inserted into the subcutaneous pocket of the palm or abdomen.After 3 to 4 weeks,the reattached parts were removed carefully from the subcutaneous pocket.Results: Postoperative follow-up time from six months to twenty four months(averaged eleven months).In 50 fingers amputations of 48 cases,35 fingers(70.00%)survived completely.Partial survival and no survival occurred in 10 fingers(20.00%)and 5 fingers(10.00%).The survival rates for amputations in guillotine type injury and crush or avulsion type injury were 85.19%、 47.62%.The survival rates for amputations in Tamai I zone and Tamai II zone were 84.62%,54.17%.According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the static two-point discrimination was 7.5±1.4mm,the mean motion range of the distal interphalangeal joint,proximal interphalangeal joint,metacarpophalangeal joint was 80.4±6.7 degrees,92.1±7.7 degrees and78.8±3.7 degrees.The severity of soft tissue injury of amputated fingers was the significant factor that had a strong,independent association with finger loss,followed by the level of fingertip amputation.Respectively,there were no infections or serious complications,even in those grafts that failed.The replanted fingers had satisfactory appearance,sensation and functions,and no effect on work,dailyactivities.Conclusion:In all complete fingertip amputations of adult patients and a microsurgical replantation was not feasible,Using a composite graft and palmar pocketing method cases of fingertip injury constitute a simple,reliable operation for digital amputation extending from the tip to the DIP.Especially,These methods had satisfactory results for fingertip amputations when the soft tissue of amputated fingers damaged lighter and the level of fingertip amputation in Tamai I zone.The soft tissue of amputated fingers damaged serious and the level of fingertip amputation in Tamai II zone were the significant factors that had a strong association with finger loss.