Choosing Local Flaps Versus Occlusive Dressings in Fingertip Amputations: A Systematic Review and Meta-Analysis With Proposed Algorithm

IF 2.4 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2026-09-01 Epub Date: 2026-04-08 DOI:10.1016/j.jhsa.2026.02.029

Kasra Rahmati BS, Nirbhay S. Jain MD, Rashed Alananzeh BS, Lauren E. Wessel MD

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引用次数: 0

Abstract

Purpose

Fingertip amputations present a reconstructive challenge because of the varying degrees of tissue loss, bony exposure, and functional impact. Often, providers must decide between occlusive dressings and local flap reconstruction. This systematic review aims to analyze outcomes of both treatment modalities to determine the benefits and risks of each.

Methods

We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies directly comparing occlusive dressings and local flap reconstruction in fingertip injuries were included. A total of 220 studies were identified. After screening, three studies met the inclusion criteria.

Results

A total of 142 patients with 143 affected digits were found. Of the interventions, 72 cases (50%) were managed with occlusive dressings, whereas 71 cases (50%) underwent soft tissue reconstruction with flap coverage. Symptomatic neuroma formation was higher in the flap group (11%) as compared to local wound care (1%), especially with significant bone exposure (16%). Joint stiffness was also higher in the flap cohort (24%) than the dressing cohort (8%). Nail deformities and infections were equivalent in both treatment arms.

Conclusions

Although flap reconstruction offers immediate wound closure, it is associated with a higher incidence of formation of symptomatic neuromas and joint stiffness compared to occlusive dressings. Conversely, occlusive dressings provide a lower complication profile while maintaining comparable outcomes in nail deformities. These findings underscore the importance of balancing the benefits of rapid functional recovery against the potential risks of surgical complications.

Type of study/Level of evidence

Therapeutic III.

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选择局部皮瓣与封闭敷料在指尖截肢：系统回顾和荟萃分析与提出的算法。

目的：由于不同程度的组织丢失、骨暴露和功能影响，指尖截肢提出了重建的挑战。通常，医生必须在闭塞敷料和局部皮瓣重建之间做出决定。本系统综述旨在分析两种治疗方式的结果，以确定每种治疗方式的益处和风险。方法：我们按照系统评价和荟萃分析首选报告项目（PRISMA）指南进行了系统评价和荟萃分析。包括直接比较封闭敷料和局部皮瓣重建在指尖损伤中的研究。总共确定了220项研究。经筛选，有3项研究符合纳入标准。结果：共发现142例患者，143例患指。在干预措施中，72例（50%）采用闭塞敷料处理，而71例（50%）采用皮瓣覆盖进行软组织重建。有症状的神经瘤形成在皮瓣组（11%）高于局部伤口护理组（1%），特别是明显的骨暴露组（16%）。关节刚度在皮瓣组（24%）也高于敷料组（8%）。在两个治疗组中，指甲畸形和感染是相同的。结论：虽然皮瓣重建可以立即关闭伤口，但与封闭敷料相比，它与症状性神经瘤和关节僵硬的发生率较高有关。相反，闭塞性敷料提供较低的并发症，同时保持指甲畸形的可比结果。这些发现强调了平衡快速功能恢复的益处与手术并发症的潜在风险的重要性。研究类型/证据水平：治疗性III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.