Secondary Autologous fat Grafting as a Novel Method to Improve Pain and Appearance of the Residual Fingertip After Amputation

Ashley Ignatiuk, MD; Amanda Chow, BA; Nikita O Shulzhenko, MD; John Cece, MD; Haripriya Ayyala, MD; Ramazi Datiashvii, MD, PhD

Disclosures

ePlasty. 2022;22(e48) 

In This Article

Abstract and Introduction

Abstract

Background: 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.

Methods: 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.

Results: 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 (P = .005), 2.8 (P = .09), 3.7 (P = .003), and 3.6 (P = .036), respectively. No intraoperative or postoperative complications were reported.

Conclusions: 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.

Introduction

Fingertip amputation is a common problem faced by the hand surgeon. It is estimated that fingertip amputations account for approximately 4.8 million emergency department visits annually in the United States, most commonly because of work-related lacerations and crush injuries.[1,2] Current treatment algorithms focus on minimizing time to recovery and return to work, as well as maximizing postinjury function.[3–5] After fingertip injury, function can be inhibited by over-shortening of the digit, residual stiffness, and pain.[6,7]

Chronic pain after fingertip amputation can have a lasting impact on function and patient well-being. Factors leading to pain among these patients include neuroma, scar sensitivity, and loss of adequate soft tissue over the bone.[2,3] Neuroma pain is multifactorial, and a variety of surgical and nonsurgical treatment options have been described in order to prevent neuroma formation or address them secondarily.[8] Scar contracture leads to hypersensitive fingertips because of the lack of pulp thickness on the fingertip.[6]

Maintenance of adequate soft tissue coverage is a challenging dilemma, as the hand surgeon must balance the desire to maintain length of the digit with the available amount of viable skin and fat. Various techniques have been described in the literature, including further shortening of the digit, using flaps to reconstruct the defect, and allowing the digit to heal by secondary intention.[6] An ideal technique would allow the surgeon the replace or restore the fat pad of the distal segment to maintain maximum length on the digit without shortening the bone, thereby preserving the distal insertion of the flexor digitorum profundus tendon and hand function.

Fat grafting has shown promise in a variety of cosmetic and reconstructive procedures. It has shown efficacy in applications such as contour resurfacing, wound healing, and restoration of soft tissue in lower extremity residual limbs following amputation.[9–11] The application of fat grafting as a secondary treatment of fingertip amputation pain has not yet been described in the literature. This study presents 7 patients treated with secondary fat grafting to address fingertip pain. It was hypothesized that secondary fat grafting improves patient-reported hyperesthesia, cold sensitivity, fingertip contour, and scarring following distal phalanx amputations.

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