Arch Hand Microsurg 2019; 24(4): 335-344  
Surgical Outcomes of Cooling Composite Graft for Fingertip Amputation
Hyoseob Lim1, Seung Wan Tak1, Chan Min Chung1, Sang Hun Cho1, Jong Wook Lee2, Sung Hoon Koh3
1Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
2Department of Plastic and Reconstructive Surgery, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
3Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
Correspondence to: Sung Hoon Koh
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea
TEL: +82-2-2680-7637, FAX: +82-2-2615-7218, E-mail:, ORCID:
Received: August 23, 2019; Revised: November 7, 2019; Accepted: November 13, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Graft survival, Amputation stumps, Finger phalanges, Finger injuries, Tissue survival

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