Graft Reposition on Flap: Mid-Term Result in Allen Type IV Amputation

Abstract

Background: The preferable reconstructive surgical options for Allen type IV finger amputation is replantation. The viable alternate option is bone and nail bed graft repositioning on local flaps. The wider scope of this “graft reposition on flap” (GRF) technique was introspected.Methods: Fifteen patients who sustained type IV amputations of finger tip were operated between 2013 and 2017 by GRF technique. The results, range of motions, functional out come and its feasibility were analyzed and evaluated. A technical modification of GRF was also described within this series of patients.Results: All patients had good nail bed survival and well settled local flaps. Static two-point discrimination (2PD) was of 6.4 mm (average). 14/15 patients had an acceptable shortening of 4mm (average). Overall patients were happy after surgery and returned back to their work. All had excellent range of movements and 0 VAS. The follow up was 1 to 5 years (mean 2.8 years). Wound infection was seen in one patient whom after debridement developed gross shortening and thick nail. None developed nail deformity.Conclusions: The GRF provided an alternative option for Allen type IV amputations of finger tip. It can be well executed in all reconstructive surgical units and in those with a learning curve for replantations surgeries. The results of GRF were proportionate with the available surgical options in terms of appearance, function and outcomes.