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Arch Hand Microsurg > Volume 24(4); 2019 > Article
Archives of Hand and Microsurgery 2019;24(4):335-344.
Published online December 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.4.335   
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. pshkoh@hanmail.net
Received: 23 August 2019   • Revised: 7 November 2019   • Accepted: 13 November 2019
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.
Key Words: Graft survival, Amputation stumps, Finger phalanges, Finger injuries, Tissue survival
 


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