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Early Experience of Negative Pressure Wound Therapy on Composite Graft Repair of Fingertip Amputation
Chung-Chen Hsu, MD; Cheng-Hung Lin, MD; Yu-Te Lin, MD; Chih-Hung Lin, MD; Chang Gung Memorial Hospital, Chang Gung University
Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose:

Negative pressure wound therapy (NPWT) has been proved to promote wound healing and secure skin graft by increased blood flow, oxygen tension and angiogenesis. The authors coupled the idea of negative pressure therapy to facilitate composite graft survival in fingertip amputation.

Methods:

A series of five fingertip amputations were treated with composite graft repair. The

vacuum gauze was placed over the amputee with continue negative pressure of 120

mm Hg via a central aspiration system.

All the finger amputations were caused by crush injury. The amputation level was at Tamai zone II (3 fingers) and Tamai zone I (2 fingers). There were two incomplete amputations with tiny volar skin connection. Surgical manipulation for microsurgical replantation had been performed on one amputee before the application of NPWT.

Dressing change interval was 2 days. The total NPWT time was 6-8 days. Puncture bleeding test was done while changing dressing to check the revascularization condition.

Results:

Slow active bleeding appeared at the first time dressing change (2 days) in four fingers. Three composite grafts survived without graft loss. One superficial gangrene change with secondary healing was noted in a patient who was a heavy smoker. The amputee which was surgical dissected for microsurgery was completely necrosis.

Conclusion:

There are many options for distal phalanx replantation. However, the procedures may be time consuming or require meticulous microsurgical skill. Composite graft repair could be finished quickly under local anesthesia. NPWT potentially allows early revascularization of composite graft, which might be an alternative method for fingertip reattachment.


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