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Background: The preferable reconstructive surgical options for Allen type IV finger amputation is replantation. The viable alternate option is bone and nail bed graft repositioning on local flaps. The wider scope of this “graft reposition on flap” (GRF) technique was introspected.

Methods: Fifteen patients who sustained type IV amputations of finger tip were operated between 2013 and 2017 by GRF technique. The results, range of motions, functional out come and its feasibility were analyzed and evaluated. A technical modification of GRF was also described within this series of patients.

Results: All patients had good nail bed survival and well settled local flaps. Static two-point discrimination (2PD) was of 6.4 mm (average). 14/15 patients had an acceptable shortening of 4mm (average). Overall patients were happy after surgery and returned back to their work. All had excellent range of movements and 0 VAS. The follow up was 1 to 5 years (mean 2.8 years). Wound infection was seen in one patient whom after debridement developed gross shortening and thick nail. None developed nail deformity.

Conclusions: The GRF provided an alternative option for Allen type IV amputations of finger tip. It can be well executed in all reconstructive surgical units and in those with a learning curve for replantations surgeries. The results of GRF were proportionate with the available surgical options in terms of appearance, function and outcomes.

Backpack carrying is a considerable daily "occupational" load among schoolchildren. Most of the research on children's backpacks have focused on gait pattern and trunk forward lean; only a few researches have investigated the impact of backpack carrying on children using the measurements of static posture and gait kinetics. This study investigated the changes in ground reaction force (GRF) and trunk inclination among primary students when carrying heavy backpacks. A randomized controlled experimental study was conducted on seven boys aged between 9 and 11 years old with a similar body mass index. Observations were done when the boys were carrying school bags of 0% (as control), 10%, 15%, and 20% of their own body weight while walking normally. Data acquisition was carried out using force platforms and a 3D motion analysis system. A significant difference in GRF at a load of 20% of body weight was found: the vertical GRF increased almost three times when loads increased up to 20% of body weight compared to 10% of body weight. The anterior–posterior GRFs were asymmetrical when loads were increased. When carrying a load of 15% of body weight, all of the seven subjects adopted a compensatory trunk inclination. The emphasis on GRF and trunk inclination suggests that the safest load applied does not exceed 15% of body weight.

Background: Replantation of digital tip amputations, especially Allen III and IV, is challenging for hand surgeons as it requires a high level of microsurgical expertise and fine instruments. The graft repositioning over flap (GRF) technique is a simple and reliable procedure that provides length, sensation and nail growth and GRF has become popular in the last few years. The aim of this study is to report the short-term outcomes of the GRF technique.

Methods: This is a prospective study of all patients who underwent a GRF reconstruction for Allen III and IV digital amputations at our hospital over a 12-month period. In addition to demographic data and injury details, we collected outcomes data with regard to flap and nailbed graft survival, capillary refill time, nail growth, sensation (2-point discrimination), bone union and gain in length of digit compared to length at injury.

Results: Twenty patients underwent GRF reconstruction of digital amputation. They included 18 men and 2 women with an average age of 29 years. The thumb was the most frequently injured digit (n = 7). Electric saws (n = 5) and industrial machines (n = 5) accounted for 50% of injuries. Twelve amputations were Allen IV. Five patients were lost to follow-up and outcomes data was available for 15 patients. There was loss of flap and nail bed in three patients. There was no growth of nail in three patients. The distal phalanx graft was lost in six patients and united in the remaining nine patients.

Conclusions: The GRF technique is a simple and reliable option in patients in whom replantation is not possible. It restores length, provides sensation and nail growth in the reconstructed fingers.

Level of Evidence: Level IV (Therapeutic)