Nonmicrovascular Restoration through Graft Reposition over Flap Technique in Fingertip Amputations

Introduction: Fingertip injuries are the commonest injuries of the hand. Replantation of fingertips is considered the gold standard treatment; however, it is not always possible because of lack of surgical expertise, or severe crush amputation. Graft on reposition flap (GRF) is a novel, relatively simple and reliable technique which can be used as an alternative for fingertip reconstruction. Methods: All Allen type IV fingertip amputations managed by the graft reposition over flap technique between 2019 to 2022 were included in the study. The data, including demography, mechanism of injury, hand dominance, tissue loss, morphology of amputation and local flap cover used were analysed by comparing photographs and radiographs of the involved digit. The functional outcomes were measured with VAS, range of motion, donor site complications and fingertip sensitivity. Categorical variables were represented with counts and percentage and analysed with Chi-square test; continuous variables were represented with means and SD and analysed with ANOVA and t -test. Results: A total of 13 flaps were done in 12 patients. The most common mechanism of injury was work place related injury in adults and accidental crush injury in children. The mean age was 26.1 years (5-51yrs) with male preponderance (11:2). The cross-finger flap (CFF) and thenar flaps (9:4) were the only reconstructive options used in our study. The sensory recovery was found to be good in our series. The mean static 2 PD was 4.91 mm (3.0 – 6.0 mm). Conclusion: GRF is a relatively simple, inexpensive surgical technique that does not demand microsurgical skills or instruments, prolonged immobilisation and can be performed by surgeons at centres which lack microsurgical facilities and training.