Objective: The study is aimed to compare the success rate of fingertip replantation using composite graft with or without the application of subdermal pocket (SDP) procedure.
Material and Methods: From 2000 to 2020, a total of 32 fingertip amputations (31 complete amputations; 1 near-complete amputation) from 31 patients (19 male; 12 female) were collected. The average age of the patients was 35.6 years (range 4-62 years). Twelve of the fingertip amputations were guillotine amputation while the other 20 were crush amputation. Five of the fingertip amputations were classified as Ishikawa zone Ib, and the other 27 were classified as Ishikawa zone II. Eighteen fingers from 17 patients received replantation with composite graft plus SDP procedure, while the remaining 14 fingers from 14 patients received replantation with composite graft only.
Results: The overall success rate was 66.67% (12/18) in the SDP group and 50% (7/14) in the composite graft only group (p = 0.4727). In the subgroup of Ishikawa zone Ib fingertip amputations, the success rate was 100% ([2/2] and [3/3] in the SDP group and composite graft only group, respectively) in both groups (p = 1.0). In the subgroup of Ishikawa zone II fingertip amputations, the success rate was 62.50% (10/16) in the SDP group while 36.36% (4/11) in the composite graft only group without statistical significancy (p = 0.182, Odds ratio =2.92).
Conclusions: The subdermal pocket procedure could improve the success rate of Ishikawa zone II fingertip replantation with composite graft, although the result did not reach statistical significancy.

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