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. 2022 Apr 18;14(4):e24257.
doi: 10.7759/cureus.24257. eCollection 2022 Apr.

Second-Layer Palmar Graft for Fingertip Reconstruction: An Analysis of Aesthetic and Functional Outcomes

Subashini Rajendiran  1 , Karthikeyan Gomathinayagam  2 , Vishnubabu Gopalakrishnan  3
Affiliations

Second-Layer Palmar Graft for Fingertip Reconstruction: An Analysis of Aesthetic and Functional Outcomes

Subashini Rajendiran et al. Cureus. .

Abstract

Background: Fingertip injuries are very common and require a stable and durable cover. The end result after reconstruction must be a painless finger with good aesthetic appearance. Skin loss in fingertip, with or without partial loss of pulp fat, is often managed with a split-thickness skin graft, which causes a poor aesthetic result due to color mismatch of the grafted skin in the glabrous volar skin of fingertip. The full-thickness and partial-thickness skin graft harvested from palmar skin provide color match but may cause donor site morbidity in the form of painful scar or contour deformity. Harvest of the second layer from the palm (intermediate part of dermis) allowed the first layer (epidermis with superficial part of dermis) to be reposed over the remaining dermis in palm, thus allowing closure of donor defect without any tension. This technique provides a good color match for the primary defect, along with reduced donor site morbidity.

Aim: The study aims to analyze the outcomes of second-layer palmar graft (SLPG) in patients with fingertip injuries.

Materials and methods: The retrospective study was conducted in January 2012 on 40 patients who underwent SLPG.

Result: The graft take was 100% in 36 patients with an average static two-point discrimination (2PD) of 6 mm. The average cosmetic visual analog score for the donor area was 100 and recipient site was 80.

Conclusion: The SLPG is a good surgical procedure for reconstructing fingertip defects, providing excellent aesthetic appearance and optimal function.

Keywords: fingertip injuries; glabrous dermal grafting; glabrous skin grafting; keratin sparing split skin graft; second layer palmar graft; skin graft.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The harvested first layer (a) is held by toothed forceps. Harvest of second-layer palmar graft (b) at the donor site using manual dermatome.
Figure 2
Figure 2. Diagrammatic representation of second-layer palmar graft harvest
Figure 3
Figure 3. Anchorage of the second-layer palmar graft to the recipient site
Figure 4
Figure 4. Analysis of age distribution of patients
Figure 5
Figure 5. Recipient site after healing
Figure 6
Figure 6. Donor site late follow-up
See this image and copyright information in PMC

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