Ignatiuk Ashley, Chow Amanda, Shulzhenko Nikita O, Cece John, Ayyala Haripriya, Datiashvii Ramazi
Rutgers The State University of New Jersey, West Orange, NJ.
Rutgers New Jersey Medical School, Newark, NJ.
Eplasty. 2022 Oct 24;22:e48. eCollection 2022.
Adequate soft tissue coverage following distal phalanx amputation remains challenging. The purpose of this study was to evaluate patient-reported outcomes following secondary autologous fat grafting after reconstruction of distal phalanx amputations with tissue flaps.
A retrospective review of patients who underwent autologous fat grafting to reconstructed fingertips following distal phalanx amputation with flaps from January 2018 to December 2020 was conducted. Exclusion criteria included patients who had amputations proximal to the distal phalanx or repair of distal phalanx amputations without flap closure. Data collected included patient demographics, mechanism of injury, complications, overall satisfaction, and outcomes of hyperesthesia, cold sensitivity, fingertip contour, and scarring reported using the Visual Analog Scale (VAS) before and after fat grafting.
Seven patients (10 digits) with fat grafting after transdistal phalanx amputations were included in the study. The average age was 45.1 ± 15.2 years. The mechanism of injury was crush in 6 patients and laceration in 1 patient. The average time between injury and fat grafting was 25.4 ± 20.6 weeks, and mean follow-up time after fat grafting was 2.9 ± 2.6 months. The mean improvement in VAS for hyperesthesia, cold sensitivity, fingertip contour, and scarring were 3.9 ( = .005), 2.8 ( = .09), 3.7 ( = .003), and 3.6 ( = .036), respectively. No intraoperative or postoperative complications were reported.
This study demonstrates that secondary fat grafting after distal phalanx amputations previously reconstructed with flap closure is a safe method to improve patient- reported outcomes by decreasing hyperesthesia and cold sensitivity as well as improving scarring and patient perception of contour.
指骨远端截肢术后获得足够的软组织覆盖仍然具有挑战性。本研究的目的是评估在采用组织瓣重建指骨远端截肢术后进行二期自体脂肪移植后的患者报告结局。
对2018年1月至2020年12月期间接受指骨远端截肢并采用皮瓣修复后进行自体脂肪移植至重建指尖的患者进行回顾性研究。排除标准包括指骨远端近端截肢或指骨远端截肢未行皮瓣闭合修复的患者。收集的数据包括患者人口统计学资料、损伤机制、并发症、总体满意度，以及使用视觉模拟量表（VAS）报告的脂肪移植前后感觉过敏、冷敏感、指尖轮廓和瘢痕形成的结局。
本研究纳入了7例（10指）指骨远端截肢后进行脂肪移植的患者。平均年龄为45.1±15.2岁。损伤机制为挤压伤6例，撕裂伤1例。损伤至脂肪移植的平均时间为25.4±20.6周，脂肪移植后的平均随访时间为2.9±2.6个月。感觉过敏、冷敏感、指尖轮廓和瘢痕形成的VAS平均改善分别为3.9（P = .005）、2.8（P = .09）、3.7（P = .003）和3.6（P = .036）。未报告术中或术后并发症。
本研究表明，对于先前采用皮瓣闭合重建的指骨远端截肢患者，二期脂肪移植是一种安全的方法，可通过减轻感觉过敏和冷敏感以及改善瘢痕形成和患者对轮廓的感知来改善患者报告结局。
