Global Disparities in Fingertip Reconstruction: Are complex reconstructions a regional fad?
Kareem Hassan, MD1, Leonardo Kozian, BS1, Jill Froimson, MD1, Nicole Capdarest-Arest, MA(LIS), AHIP2 and Patrick Reavey, MD, MS1, (1)University of Chicago, Chicago, IL, (2)University of California Davis, Davis, CA
Global Disparities in Fingertip Reconstruction: Are complex reconstructions a regional fad?
Introduction: Traumatic fingertip injuries are one of the most common consultation for hand surgeons. Reconstructive approaches for these injuries were established in the 1960s-1980s with good functional outcomes. Recent literature has presented alternative options for fingertip reconstruction requiring a greater understanding of perforator anatomy and microsurgical techniques, without clear improvements in outcomes. This study examines the surgical literature to identify trends in management of fingertip injuries through time and by region
Materials & Methods: A systematic literature review was performed in Scopus from 1942 to December 2016. Search terms included finger, fingertip, repair, amputation, graft, flap, and replant. Duplicate or not applicable publications were excluded. Studies were classified by decade of publication, country of origin, and type of reconstruction. Two separate reviewers determined reconstruction type and any discordance was reviewed and resolved by a third author.
Results: 368 unique publications on the management of fingertip injuries were identified. From 2010-2016 there has been a nearly 400% increase in the number of papers compared to the 1980s The majority of early publications on the subject stemmed from North America and Europe, with Asia’s first publication in 1970 (Figure 1). By the 1990s Asia and Europe surpassed North America as the predominate regions responsible for publications. Asia was responsible for the majority of the publications on replants, free flaps, and local flaps (Figure 2). This correlates with the overall increase in publications on replantation and local flaps during the last two decades (Figure 3). Few papers directly compared surgical techniques and overall outcomes were irregularly reported.
Conclusions: There is an increasing emphasis on fingertip reconstruction in the hand surgery literature with a notable predominance in Asia. However, fingertip replantation and recent flap reconstruction techniques have not been widely adopted by surgeons in the United States and Europe. Further work is needed to directly compare outcomes of these techniques and identify reasons for the significant global disparity in the care of fingertip injuries.
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Figure 1. Number of publications by decade and region.
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Figure 2. Number of publications by reconstruction type and region.
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Figure 3. Number of publications per decade by reconstruction type
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