Semiocclusive Therapy Versus Full Thickness Skin Grafts Versus Reverse Flow Homodigital Island Flaps in Reconstruction of Volar Oblique Fingertip Injuries

Abstract

Background: Fingertip amputations are among the most common injuries seen in the hand. The mechanism, level, and direction of amputation are important factors in choosing the appropriate reconstructive option. Optimal management is a much-debated topic with advocates for operative and non-oper¬ative treatment. Aim of the Work: To compare the outcome of healing by secondary intention, full thickness skin grafts from the ulnar border of the hand, and reverse flow homodigital island flaps in the management of volar oblique fingertip amputations in the hand according to time of complete healing, aesthetic outcome, return to work timing and according to complications rate. Patients and Methods: This study was conducted on 75 patients who were presented to ER department, with volar oblique fingertip injury. Patients are classified into three equal groups, each group contain 25 patients. First group was managed conservatively with semiocclusive dressing. Second group was reconstructed with full thickness skin grafts. Third group was reconstructed with reverse flow homodigital island flaps. Results: In this study, we can confirm that surgical intervention with either technique, reconstruction with full thickness skin graft or reconstruction with reverse flow homodigital island flap is too much better than healing with secondary intention. With better results with full thickness skin grafts over homodigital island flaps specially in small defects with no exposed bones, a lesion represent most of fingertip cases in surgery. On the other hand homodigital island flaps are better in big defects and in cases with exposed bones.            Conclusion: Fingertip injuries are the most common injuries in hand trauma patients. The major cause for adult patients is occupational accidents etiology. There are several classifications for fingertip injuries. Treatment options vary depending on the injury mechanism, defect’s size and plane, surgeon’s intention, patient’s needs, condition of the stump and the amputated part. Despite ongoing publication of new flaps for fingertip reconstruction, there is a paucity of evidence to support improved healing and function in a surgically reconstructed fingertip compared to conservative wound management. Controlled trials are sorely needed to distill the truth as to whether surgery is superior to secondary healing or not