Analysis of the risk factors that determine composite graft survival for fingertip amputation

The composite graft is the only surgical method that is able to maintain digital length and provide soft tissue coverage without donor site morbidities in microsurgically non-replantable fingertip amputations. This study aimed to explore the risk factors that determine the survival of composite grafts. Clinical characteristics associated with graft survival were retrospectively analysed by a comparison between the graft survival and failure groups. Of 94 patients who underwent a composite graft for fingertip amputation, the graft survived in 84 (89%). Surviving grafts showed reperfusion within 1 week. Multivariate analysis revealed that graft failure was independently associated with a crushing injury. Based on the risk factors from the comparison analyses and a review of previously published studies, a cutting injury, grafting the injured finger within 5 hours of injury, and being a non-smoker are associated with good results. In these circumstances, excellent outcomes with a high success rate can be achieved by composite graft in most adult patients as an alternative treatment to microsurgical replantation. Level of evidence: IV.