Composite Cap Grafting for Fingertip Amputations in Pediatric Patients: Does Patient Age Matter?

BACKGROUND: Fingertip avulsions are one of the most common pediatric hand injuries with composite "cap" grafting being a typical intervention. However, composite grafting can be unpredictable, and little is published on its expected clinical course. Therefore, we sought to determine if there is an age cutoff for superior graft outcomes. We hypothesized that graft success would be highest in children under 8 years old. Secondarily, we aimed to characterize a postoperative timeline for graft failure versus success.

METHODS: A retrospective chart review was performed with the following inclusion criteria: patients < 18 years old with complete or near-complete amputation at or distal to the DIP joint in the fingers or IP joint in the thumb. Graft success, defined clinically, was the primary outcome. Secondary outcomes included complications and time to graft failure. Univariate logistic regression was performed to identify predictors of graft success.

RESULTS: Sixty-one fingertips were included in this study. The cohort's average age was 6.4 ± 4.7 years. The long finger was the most commonly affected (30.0%, n = 18), often due to blunt force trauma (82%, n = 50). Composite graft success rate was 67% (n = 41). Age did not significantly predict graft failure (OR: -0.04, 95% CI: -0.17-0.08, P value: .5).

CONCLUSIONS: Composite grafting for pediatric fingertip amputations remains a viable treatment option with a 67% success rate in this cohort. Although no significant age threshold was identified, graft failure generally occurred 2 weeks after the index procedure, which provides a timeline for the clinical course for pediatric composite grafts.