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

Abstract

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. 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. 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. 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. Therapeutic III.