Usefulness of Microscopic Procedures in Composite Grafts for Fingertip Injuries

Jo,  Dong In; Song,  Yu Kwan; Kim,  Cheol Keun; Kim,  Jin Young; Kim,  Soon Heum

doi:2017.26.1.9

Arch Hand Microsurg > Volume 26(1); 2017 > Article

Original Article

Archives of Hand and Microsurgery 2017;26(1):9-13.
Published online May 30, 2017.
DOI: https://doi.org/10.15596/ARMS.2017.26.1.9

Usefulness of Microscopic Procedures in Composite Grafts for Fingertip Injuries

Dong In Jo, Yu Kwan Song, Cheol Keun Kim, Jin Young Kim¹, and Soon Heum Kim^*

¹Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea. PSongsuture@outlook.com
²Department of Emergency Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea.

Received: 29 April 2017 • Accepted: 1 May 2017

Abstract

Purpose:

Fingertip amputations are the most common type of upper limb amputations. Composite grafting is a simple and cost-effective technique. Although many factors have investigated the success of composite grafting, the success rate is not high. Therefore, this study was conducted to investigate whether the microscopic procedure process during composite grafts improves the success rate.

Materials and Methods:

Thirteen cases of unreplantable fingertip amputation underwent a microscopic resection procedure for composite graft in the operating room. The principle of the procedure was to remove the least devitalized tissue, maximize the clean tissue preservation and exact trimming of the acral vessel and to remove as many foreign bodies as possible.

Results:

All fingertips in the thirteen patients survived completely without additional procedures.

Conclusion:

Composite grafting allows for the preservation of length while avoiding the donor site morbidity of locoregional flaps. Most composite grafts are performed as quickly as possible in a gross environment. However, we take noticed the microscopic resection. This process is thought to increase the survival rate for the following reasons. First, the minimal resection will maximize the junction surface area and increase serum imbibition. Second, sophisticated trimming of injured distal vessels will increase the likelihood of inosculation. Third, accurate foreign body removal will reduce the probability of infection and make it possible to increase the concentration and efficiency in a microscopic environment. Although there is a need for more research into the mechanisms, we recommend using a composite graft under the microscopic environment.

Key Words: Finger injuries, Amputation, Transplants, Survival rate