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Composite Grafting for Pediatric Fingertip Injuries: Good Outcomes Despite Poor Graft Take
Kyle R. Eberlin, MD1; Kathleen Busa2; Donald S. Bae, MD2; Peter Waters, MD2; Joseph Upton III, MD2; Brian I. Labow, MD2; Amir H. Taghinia, MD2
1Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Boston Children's Hospital, Boston, MA, Harvard Medical School, Boston, MA

Background: Due to purportedly high survival rates of grafts, composite grafting has become the accepted technique for distal fingertip amputations in children. We have observed that children do well following this intervention despite the poor objective viability of composite grafts.
Methods: A retrospective review was performed over a five-year period of all children presenting to a tertiary pediatric institution who underwent composite grafting of distal fingertip amputation injuries. Demographic information such as mechanism of injury and presence of nailbed involvement were recorded. Patients were evaluated post-operatively to determine graft viability and were characterized as no take (0-5%), partial take (5-95%), or complete take (95-100%). Other measured outcomes included number of secondary procedures and number and duration of follow-up appointments.
Results: Forty patients were identified. The mean age was 6.26 years (1-22 years); there were 25 males (62.5%) and 15 females (37.5%). The right hand was injured more commonly (n=23, 58%). The most commonly injured digit was the middle finger (n=15, 37.5%). Tuft fractures were present in 15 patients (37.5%), and 24 patients (60%) had nailbed involvement (Table 1). The most common mechanism of injury was caught in a door (n=24, 40%) followed by injury with a mechanical device (n=7, 17.5%). Twelve patients (30%) were taken to the operating room, while 28 patients (70%) underwent treatment in the emergency room. Thirteen patients had no graft take (32.5%), 23 patients had partial graft take (57.5%), and 4 patients had complete graft take (10%)(Table 2). Only four patients required secondary revision (10%); of these, two underwent debridement alone, one underwent revision amputation, and one underwent V-Y advancement flap closure. The median number of follow-up appointments was 3 and the average follow-up length was 4.5 months.
Conclusions: Despite poor objective viability of composite grafting for treatment of pediatric fingertip injuries, the majority of patients (90%) have acceptable aesthetic and functional results and do not require additional procedures. This may represent the benefit of using the composite graft as a "biologic dressing" and may substantiate the success seen in the literature. Table 1: Demographics

Table 2: Outcomes

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