Choosing Local Flaps Versus Occlusive Dressings in Fingertip Amputations: A Systematic Review and Meta-Analysis With Proposed Algorithm.
Kasra Rahmati, Nirbhay S Jain, Rashed Alananzeh et al.
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In 30 seconds
This systematic review and meta-analysis compared occlusive dressings with local flap reconstruction for fingertip amputations. Three comparative studies included 142 patients with 143 affected digits; 72 cases received dressings and 71 underwent flap coverage. Symptomatic neuromas were reported in 11% of flap cases versus 1% with local wound care, and joint stiffness in 24% versus 8%, respectively. Nail deformities and infections were similar between groups. The review concludes that dressings had a lower complication profile, while flaps provided immediate wound closure. Evidence was graded Therapeutic Level III.
Key findings
- Symptomatic neuroma formation was 11% after flap coverage versus 1% with local wound care.
- Joint stiffness occurred in 24% of the flap cohort versus 8% of the dressing cohort.
- Nail deformities and infections were equivalent between treatment groups.
- With significant bone exposure, symptomatic neuroma formation in the flap group was 16%.
Why it matters
The findings highlight a trade-off in fingertip reconstruction: flap coverage achieves immediate closure, but the included studies reported more symptomatic neuromas and stiffness than with occlusive dressings. These comparative outcomes can inform discussion of potential complications and recovery goals, while the small evidence base means the results should be interpreted cautiously.
What to keep in mind
Only three comparative studies met inclusion criteria, comprising 142 patients and 143 digits; the evidence was classified as Therapeutic Level III.