Clinical analysis of composite graft replacement of amputated digital tips

Composite grafting remains a technique which is used reluctantly and without great hope of success. In the recent two years, unexpectedly good result of composite graft was gained from 30 cases. The purpose of our study is to identify factors influencing success and to overlook long-term problems from a cosmetic and a functional view point. A retrospective review and a questionnaire about 30 fingers of 29 patients which were operated for composite graft at Kyongju hospital of Dongguk university from March 1997 to February 1999 were carried out. In all cases of composite grafting, tie-over dressing and heat lamp were applied and left for five days. And following result and conclusion were obtained. 1. 24(80%) of 30 finger tips replaced as composite graft were survived completely or partially. 2. At children with an age range 1 to 14, the survival rate (100%) of composite grafted tips was higher than that (75%) at adults. So, patient's age was important factor for success. 3. The type of injury was more important factor than the level of amputation. The survival rate(100%) of tips to cutting injury was higher than that(75%) of tips to crushing injury. 4. The delay in time from amputation and replacement did not significantly correlate with the survival rate. But, all tips replaced within 3 hours were survived completely or partially. 5. Even if partial necrosis on grafted tips was present, a result of long-time conservative treatment with minimal debridrement was excellent. Especially in children, the tips with conservative treatment showed normal appearance, several months later. 6. Cosmetic and functional results were better in child group and in groups with higher survival rate. Most common problem in cosmetic aspect was a short digit and that in functional aspect was a tender tip. 7. As a heat lamp increased blood supply, we could obtain better outcome.

The effects of the different tissue layer implantation of the vascular tissues on the survival of prefabricated flaps

The prefabrication by vascular induction into random patterned flaps is a method creating axial donor flap by implantation of nourishing pedicles prior to harvesting random patterned flaps. The purpose of this study was to evaluate the viability of a thin prefabricated flap prepared by the subdermal implantation of fasciovascular pedicles without subcutaneous tissue or muscular layer, by comparing with the prefabrication by the subpanniculus carnosus implantation of vascular pedicles, which is well known to a predictable survival rate by many authors. In the left abdomen of 40 Sprague-Dawley rats, the fasciovascular pedicles were implanted in the subdermal layer in group I(n=20) and sub panniculus carnosus layer in group II(n=20), respectively. 5 weeks later, 4 x 6 cm sized abdominal flap was elevated with implanted vascular pedicle as an island and reposed immediately. At the same time, in the right abdomen, conventional island flap was elevated and reposed. After 3 days later, the evaluation of the survival area was carried out in each side, in both groups. The mean proportions of the survival areas in group I were 74.2 and 91.8% in the prefabricated and conventional flap, respectively. And those in group II were 76.4 and 91.2% in the prefabricated and conventional flap, respectively. These results showed that there is no difference in the proportion of survival area between two types of prefabrication. In conclusion, it is possible to prefabricate a thin axial-patterned fascioutaneous flap without subcutaneous tissue and the viability of this prefabricated flap is reliable as much as that of other prefabricated flaps having subcutaneous or muscular tissue.