When will a Surgeon Consider Treating a Fingertip Amputation with a Composite Graft when Microsurgical Reconstruction is Difficult?

如眾皆知，指尖截肢佔了手部外傷的絕大多數，由於指尖有其特殊功能，因此必須盡量保持指尖的完整，當然，顯微手術重接是最理想的重建方式，但是當顯微手術困難甚至不可能時，以複合移植物重建便提供了另一個可行的方法。何時考慮以複合移植物重建呢？文獻上對於這個主題的討論並不多見，在過去的七年中，我們研究馬偕醫院以複合移植物做指尖重建的病人，發現了三個影響移植物存活的不利因子，它們是： (1)複合移植物長度大於1.2公分 (2)吸煙史 (3)壓碎傷我們建議是： ●移植物長度是影響最大的因子，最好不要大於1.2公分。 ●患者若同時存在有大於兩個的不利因子，最好不要考慮以複合移植物作重建。

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Because of the location, traumatic amputation of fingertips are the most frequent injuries in the hands. Due to the functional importance of the fingertip, the patients should be left with most ideal fingertip possible. When microsurgical replantation is not possible, composite grafting is an alternative method. This method, however, has a significant failure rate. Previous reports have not reported correlation of graft failure with risk factors. We designed this study to investigate risk factors that influence composite graft survival. We retrospectively reviewed our experience with compostie grafting of fingertip amputations at Mackay Memorial Hospital from January, 1991 to December, 1997. Thirty patients with a total of 35 injuried fingers were treated with composite grafts. The overall survival rate was 42.9%. Risk factors associated with poor graft survival included graft length＞1.2cm, history of smoking, and a crush injury. We conclude that: 1. The length of the graft is the most important factor.(should be≤1.2cm) 2. The presence of more than two risk factors suggests a very poor graft prognosis, and composite grafting should probably not be considered under these circumstances.

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