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Revising the Amputated Finger: Role of the Spare Parts Skin Graft
Shawn J. Loder MD, Justine S. Kim MD, Elizabeth A. Moroni MD MHA, Alexander M. Spiess MD
University of Pittsburgh
2020-02-14
Presenter: Shawn J. Loder MD
Affidavit:
Certified
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Digital amputation results in significant soft-tissue deficits and while revision may address many defects inadequate soft-tissue coverage compromises final form and function. Patients often present with the amputated portions of their digit which, while often not replantable, may represent a viable donor site. In this study, we sought to identify whether these 'spare parts' skin grafts provides any additional benefit to the patient.
Methods: This is a retrospective analysis of 177 amputated digits (113 patient), evaluated between 2010-2019. 88 patients were managed solely in the emergency department without immediate operative intervention. Of these, 14 patients underwent 'spare parts' skin grafting. For each injury we assessed the level of amputation, intervention performed, length of follow-up, post-operative course, complications, and additional intervention. Revision level by anatomic subunit was tracked at time of each procedure.
Results: 64.3% of grafted patients underwent immediate revision amputations versus 74.4% of non-grafted. Digits were shortened by an average of 0.2 anatomic units for grafted patients versus 0.4 in non-grafted. 57.1% of grafted patients required later revision versus 48.6% revision amputation rate in the non-grafted group. Terminal digit shortening in the graft group was 0.6 anatomic units versus 0.55 anatomic units in the non-grafted group. Rates of infection, hypersensitivity, and dysesthesia were similar between groups.
Conclusions: Spare parts skin grafting provides an adequate option for soft tissue coverage to avoid excessive debridement in the acute setting. Thus, safely delaying further intervention until formal revision and reconstruction in the operating room.
