Successful composite graft for fingertip amputations using ice-cooling and lipo-prostaglandin E1.
In distal fingertip amputations where microanastomosis may not be possible, composite grafting might offer the possibility of maintaining digital length and function using the patient's own tissue. Many trials such as ice-cooling, pharmacologic enhancement and hyperbaric oxygenation have been reported to improve the survival rate of the composite graft. Twenty-four cases of unreplantable fingertip amputation were classified as types I to III according to the level of injury. We performed the composite grafting followed by immediate ice-cooling for 2 weeks and intravenous lipo-prostaglandin E(1) (lipo-PGE(1)) injection for 8.8 days each on average. Twenty-two fingertips in 24 patients survived completely with acceptable appearance and sensibility over the 8 month follow-up period. Confirming that therapeutic angiogenesis using ice-cooling and lipo-PGE(1) can increase the survival rate of the composite graft in unreplantable fingertip amputation, we describe the procedures and postoperative care in detail.
Eo
SuRak
S
Department of Plastic and Reconstructive Surgery, DongGuk University International Hospital, Ilsan, South Korea. surakeo@yahoo.com
Hur
GiYeun
G
Cho
SangHun
S
Azari
Kodi K
KK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D000673:Amputation, Traumatic / Q000601:surgery*; D043925:Angiogenesis Inducing Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply; D006085:Graft Survival; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D011182:Postoperative Care / Q000379:methods; D012092:Replantation / Q000379:methods*; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
D043925:Angiogenesis Inducing Agents; D014665:Vasodilator Agents; D000527:Alprostadil