Title: Fingertip injuries: Analysis of functional outcomes of 813 cases

Biography:

Shruti Marhwa is currently a Senior Resident plastic surgeon at All India Institute of Medical Sciences. She has completed her Postgraduate ENT at Gtb hospital, Intern at Lok Nayak, GB Pant Hospitals & Guru Nanak Eye Centre, and Student at Maulana Azad Medical College All India Institute of Medical Sciences, University College of Medical Science & Guru Teg Bahadur Hospital, Maulana Azad Medical College. She is an experienced Senior Resident with a demonstrated history of working in the hospital & health care industry and skilled in medical education.

Abstract

A fingertip amputation is the most common type of amputation seen in the upper extremity. The management is characterized by a great deal of confusion as there are a variety of repairs described. Treatment options range from conservative management, local flaps to replantation of the amputated part each with its own advantages and disadvantages. The choice of appropriate treatment modality depends on various factors like age, comorbidities, occupation, and goals of the patient. Multiple studies have shown variable results and choice of the appropriate option is difficult.

Aim: To statistically analyses fingertip injuries management in patients presented at a tertiary care centre, to describe the epidemiology of fingertip injuries, to describe selection criteria of appropriate treatment modality in patients and to propose a new treatment algorithm for treatment of fingertip injuries.

Methodology: Data was recorded from January 2016 to January 2018 of 636 patients with 813 fingertip injuries (Allen type I,II,II,IV) presenting to a tertiary care trauma centre. The epidemiological data was collected and analyzed. The cases were classified according to Allen’s classification. The treatment modalities used were: conservative, primary closure, Split-thickness, Full-thickness, and Composite grafts, local flaps (homo-digital and hetero-digital) loco-regional flaps, revision and shortening, replantation. Follow-up assessment was done at 24 weeks and second at 24 months. The following functional goals were assessed after formulating a scoring system (percentage points were calculated) to be able to analyses the data statistically. Primary goals: Length of digit(s), Objective Sensation assessment (Revised Nottingham Sensory Assessment), Subjective sensation assessment, Total Active Movement, Cosmesis (Nail deformity and Patient satisfaction score). Secondary Goals: Minimum Hospital Stay.(< or > 24 hours), Minimum work days loss.(< or > 7 days), Donor Site morbidity. Exclusion criteria: All cases requiring secondary procedure due to failed primary procedure.

Data Analysis and Results: Data from 813 cases over a period of two years from January 2016 to January 2018 was analyzed by T-Test and linear regression using SPSS software and Microsoft Excel. Majority of the injuries were due to Door crush injuries (64%) with right side more affected than left and middle finger (42%) was most commonly involved. The best results for the primary goals (60%) were achieved for local flaps and were found to be statistically significant. The worst results (65%) in terms of secondary goals were seen in cases of replantation as can be attributed to prolonged hospital stay in cases requiring admission and/or re-look surgeries and heterodigital local flaps (62%) in view of loss of work days.

A treatment algorithm is thus proposed as per the injury classification and functional outcome assessment.