Post-traumatic composite graft fingertip replantation in both adults and children

2.50
Hdl Handle:
http://hdl.handle.net/11287/620151
Title:
Post-traumatic composite graft fingertip replantation in both adults and children
Authors:
Urso-Baiarda, F.G.; Wallace, Christopher G ( 0000-0003-1897-9520 ) ; Baker, R.
Abstract:
Composite graft fingertip replacement (CGFR) can maintain digital length and a normal nail complex when microvascular replantation of traumatically amputated fingertips is unfeasible. However, there remains reluctance to perform CGFR in adults owing to perceived poor outcomes compared with children, despite a lack of supporting evidence. We report CGFR outcome in adults and children. A prospectively collated patient information database identified CGFR attempts over five consecutive years. Patient demographics and co-morbidities, injury mechanisms and details (including Ishikawa levels), timing of surgical interventions and outcomes were documented. One hundred thirty-one CGFRs were attempted in 130 patients (106 in children under 16). Ishikawa amputation level or CGFR outcome was not documented in 21 excluded cases. Despite a significant association between adulthood and smoking, complete or partial graft survival was excellent in both adults and children (86% and 89%, respectively). Adults and children were significantly more likely to sustain laceration and crush injuries, respectively. These results challenge the near-universal scepticism held against CGFR in adults. Partial graft survival can appear discouraging when mummified eschar conceals regenerating tissue beneath. We emphasise the importance of patience in the clinical management of fingertip injuries treated by CGFR with two representative cases where the graft was considered ‘completely necrotic’ but ultimately survived to generate normal nail growth with an excellent cosmetic and functional result.
Citation:
Post-traumatic composite graft fingertip replantation in both adults and children 2009, 32 (5):229 European Journal of Plastic Surgery
Publisher:
Springer
Journal:
European Journal of Plastic Surgery
Issue Date:
Oct-2009
URI:
http://hdl.handle.net/11287/620151
DOI:
10.1007/s00238-009-0346-3
Additional Links:
http://link.springer.com/10.1007/s00238-009-0346-3
Type:
Journal Article
Language:
en
ISSN:
0930-343X; 1435-0130
Appears in Collections:
Plastic & Reconstructive Surgery; Plastic & Reconstructive Surgery; pre-2014 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorUrso-Baiarda, F.G.en
dc.contributor.authorWallace, Christopher Gen
dc.contributor.authorBaker, R.en
dc.date.accessioned2017-01-12T14:26:08Z-
dc.date.available2017-01-12T14:26:08Z-
dc.date.issued2009-10-
dc.identifier.citationPost-traumatic composite graft fingertip replantation in both adults and children 2009, 32 (5):229 European Journal of Plastic Surgeryen
dc.identifier.issn0930-343X-
dc.identifier.issn1435-0130-
dc.identifier.doi10.1007/s00238-009-0346-3-
dc.identifier.urihttp://hdl.handle.net/11287/620151-
dc.description.abstractComposite graft fingertip replacement (CGFR) can maintain digital length and a normal nail complex when microvascular replantation of traumatically amputated fingertips is unfeasible. However, there remains reluctance to perform CGFR in adults owing to perceived poor outcomes compared with children, despite a lack of supporting evidence. We report CGFR outcome in adults and children. A prospectively collated patient information database identified CGFR attempts over five consecutive years. Patient demographics and co-morbidities, injury mechanisms and details (including Ishikawa levels), timing of surgical interventions and outcomes were documented. One hundred thirty-one CGFRs were attempted in 130 patients (106 in children under 16). Ishikawa amputation level or CGFR outcome was not documented in 21 excluded cases. Despite a significant association between adulthood and smoking, complete or partial graft survival was excellent in both adults and children (86% and 89%, respectively). Adults and children were significantly more likely to sustain laceration and crush injuries, respectively. These results challenge the near-universal scepticism held against CGFR in adults. Partial graft survival can appear discouraging when mummified eschar conceals regenerating tissue beneath. We emphasise the importance of patience in the clinical management of fingertip injuries treated by CGFR with two representative cases where the graft was considered ‘completely necrotic’ but ultimately survived to generate normal nail growth with an excellent cosmetic and functional result.en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.urlhttp://link.springer.com/10.1007/s00238-009-0346-3en
dc.rightsArchived with thanks to European Journal of Plastic Surgeryen
dc.subjectWessex Classification Subject Headings::Surgery::Plastic surgeryen
dc.titlePost-traumatic composite graft fingertip replantation in both adults and childrenen
dc.typeJournal Articleen
dc.identifier.journalEuropean Journal of Plastic Surgeryen
dc.type.versionPublisheden
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