Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap using Nail Bed Graft for Fingertip Amputation with Replantation.

BACKGROUND: Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF.

METHODS: Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa's subzone II or III) at our hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test (S-W), fingertip injuries outcome score (FIOS), and Hand20 scores.

RESULTS: Overall, for 74 analyzed cases (40, replantation; 34, DAF), the median operation time and the median length of hospital stay in replantation was longer than that in DAF (188 vs. 126 min, p<0.01; 15 vs. 4 days, p<0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening in replantation was significantly lower than that in DAF (42.5% vs. 82.4%; p<0.01). There were fewer nail deformities in replantation than in DAF (45.0% vs. 67.6%, p=0.06). The proportion of patients who achieved excellent or good FIOS and the median Hand20 scores was not significantly different between the groups (89.5% vs. 85.3%, p=0.61; 8.0 vs. 13.5, p=0.42). The median postoperative S-W values were similar between the groups (3.61 vs. 3.61, p=0.23).

CONCLUSIONS: In this retrospective study, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stay, but worse aesthetic appearance compared with replantation.