Factors predicting composite grafts survivability in patients with fingertip amputations; a systematic review and meta-analysis.

Background: Fingertip amputation is a commonly encountered injury in emergency settings. Composite grafting is a non-microsurgical alternative maintaining digit length with no donor site morbidities. This meta-analysis was conducted to retrieve factors associated with composite graft survivability among patients with fingertip amputations.

Methods: A literature review throughout twelve databases was performed on 24 July 2023. All clinical studies comparing the patients-related, trauma-related, or amputation-related variables among patients with survived and non-survived composite grafting were eligible for meta-analysis. Single-arm studies reported the potential predictors of composite graft survival among patients with fingertip injuries treated with composite grafting were included.

Results: This review included ten articles with 720 fingertips composite grafting. Of them, 526 grafts survived, with a pooled overall survivability of 72.8%. There was a significant association between younger age (OR 2.31,95%CI 1.10, 4.87, P = 0.03), level of amputation (I) (OR 0.31,95% CI 0.14 to 0.67, P = 0.003), and successful composite grafting. There was no statistically significant (P = 0.449) impact of time to composite grafting on the likelihood of composite graft survivability.

Conclusion: Composite grafting is a feasible and effective procedure for restoring aesthetically functional digits among patients with traumatically amputated fingertips. The composite graft survived among the majority of the patients, with a more significant survival pattern among younger populations and patients with more distal amputations.

Level of evidence: Level III.