Paediatric composite fingertip grafts: a comparative 7-year experience from a tertiary plastic surgery unit and a proposed management algorithm

BackgroundPaediatric digital tip injuries are a common presentation. Controversy exists in the use of composite grafts as a method of repair regarding the time of inset and likelihood of graft survival. We sought to determine our experience of composite graft as a method of fingertip reconstruction, and compare the time of graft replacement to viability with the traditionally accepted five-hour mark from injury to graft inset.MethodsDemographics, cause and level of injury, time to replacement and graft survival were analysed from the clinical notes of 40 complete amputations. Statistical analysis was performed to determine the outcomes of graft viability from the time of injury to graft inset. Secondary measures included rates of infection, wound problems, nail deformities and the requirement for a secondary operation.ResultsNo significant differences in graft survival were found for those inset before or after five hours, or within in our range of data. There were no significant adverse events or secondary revisions.ConclusionsWe conclude that composite grafting of injured paediatric digital tips can be delayed until normal working hours if the patient presents out with this time. We propose an algorithm that has been implemented in our department. .Level of evidenceLevel III, Therapeutic