Approach to Fingertip Injuries

Foo, Anthony

doi:10.1016/j.cps.2019.02.001

Cited by 23 publications

(16 citation statements)

References 40 publications

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“…SLPG, described as glabrous dermal grafting by Wu et al [3] and keratin sparing dorso-ulnar split skin graft by Goutos et al [10], is a good alternative procedure with less donor site morbidity and good aesthetic outcome. We do agree with Martin-Playa et al in avoiding the ulnar aspect of the hand as a donor site because it is often the surface on which the hand rests during activity [6].…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…The goal of treatment of any injured fingertip should be the restoration of a stable interface for object manipulation while looking as normal as possible [6]. When a wound is less than 1 cm 2 without exposed barebone or tendon, healing by secondary intention is considered [6]. The other fingertip wounds require reconstruction in the form of split-thickness skin graft, full-thickness skin graft, composite grafts, dermal substitutes, or flaps.…”

Section: Discussionmentioning

confidence: 99%

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

Rajendiran¹,

Gomathinayagam²,

Gopalakrishnan³

2022

Cureus

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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 fullthickness 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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Rajendiran¹,

Gomathinayagam²,

Gopalakrishnan³

2022

Cureus

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“…Many reconstructive options can be chosen for fingertip injuries with bone exposure. Martin-Playa et al [6] and Tang et al [10] had reviewed the use of skin graft, composite graft, adipofascial flap, local advancement flap, V-Y flap, first dorsal metacarpal artery flap, and reverse digital artery flap for fingertip defects. For large defects, free tissue transfer with a vascularized toe pulp or partial toe transfer may be selected [10].…”

Section: Discussionmentioning

confidence: 99%

“…However, local wide excision for digital malignancy often results in total nail bed and germinal matrix loss with large area of distal phalanx exposure. For bone exposure fingertip defects, several reconstruction options have been discussed in the literature, including skin grafts, composite grafts, bone shortening with local advancement flap, V-Y flap, reverse digital artery flap, adipofascial flap, cross-finger fascial flap, and free vascularized toe transfer [6][7][8][9][10][11][12][13]. These reconstruction strategies are usually accompanied by considerable donor site morbidity and postoperative body contour changes.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction for Defects of Total Nail Bed and Germinal Matrix Loss with Acellular Dermal Matrix Coverage and Subsequently Skin Graft

et al. 2020

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Background and Objectives: Nail bed and germinal matrix loss due to wide excision for fingertip tumors or malignancy are occasionally encountered complications. These defects also result from severely comminuted fingertip crush injuries. Large-area dorsal finger or toenail bed defects, which usually present with phalangeal bone exposure, remain challenging regardless of the usage of different reconstruction strategies. This study aimed to evaluate the clinical outcome of a staged operation with an acellular dermal matrix coverage and subsequent skin graft as reconstruction for defects of total nail bed, germinal matrix loss, and bone exposure. Materials and Methods: From April 2018 to October 2019, four patients with total nail bed, germinal matrix, and bone exposure loss after surgery were enrolled in our series. A staged operation of the acellular dermal matrix coverage with subsequent skin graft was performed on these patients. Skin graft take rate, oncological prognosis, and cosmetic outcome were evaluated. Patients were followed up for 5–13 months. An excellent skin graft take rate with a satisfying aesthetic result without local malignancy recurrence was noted. Minimal functional deficit and donor site morbidity were reported. Results: A staged operation with acellular dermal matrix coverage and subsequent skin graft proves to serve as a feasible strategy for patients who experience total nail bed, germinal matrix loss, and bone exposure after surgery. Conclusions: This reconstruction method provides a reliable repair result, satisfying aesthetic outcomes, as well as having minimal functional deficits and donor site morbidity.

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Controversies in the Treatment of Fingertip Amputations in Adults: Conservative Versus Surgical Reconstruction

Bravo¹,

Rodríguez-Merchán²

2022

Controversies in Orthopedic Surgery of the Upper Limb

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Approach to Fingertip Injuries

Cited by 23 publications

References 40 publications

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

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

Reconstruction for Defects of Total Nail Bed and Germinal Matrix Loss with Acellular Dermal Matrix Coverage and Subsequently Skin Graft

Controversies in the Treatment of Fingertip Amputations in Adults: Conservative Versus Surgical Reconstruction

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