Long-term follow-up of one-stage artificial dermis reconstruction surgery for fingertip defects with exposed phalanx

Wang, Jingwei; Huang, Zhu-qing; Jumbo, Juan Carlos Cueva; Sha, Ke

doi:10.1016/j.hansur.2022.02.012

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…The treatment duration in the current study (45.29 days, SD = 17.53) was slightly longer than those reported by Namgoong et al [18] and Wang et al [12], who also used artificial dermis for fingertip defects with bone exposure. This prolonged duration may be attributed to the unique combination of artificial dermis and semi-occlusive dressing, which likely influences the complex regenerative processes within the wound bed.…”

Section: Discussioncontrasting

confidence: 54%

“…First, the absence of a surgical control group may affect the generalizability of the findings. This decision was guided by multiple factors: the inherent drawbacks of surgical interventions [6][7][8]10,13,33], encouraging outcomes from conservative approaches in prior studies [12,14,16,17,[21][22][23][24][34][35][36], and significant recruitment challenges due to patients' strong preference for less invasive treatments [37]. Moreover, based on the author's experience, the toe pulp free flap was identified as the most comparable surgical technique to the proposed conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…While these techniques aim to restore the soft tissue envelope and preserve finger length, they are often associated with donor site morbidity, prolonged immobilization, and the need for multiple surgeries [3,4,10]. Moreover, these surgical interventions may not adequately restore the intricate sensory and biomechanical properties of the native pulp tissue, leading to suboptimal functional outcomes [4,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Kang

2024

JCM

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Background Fingertip injuries with volar pulp tissue defects present a significant challenge in management. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressings for these injuries. Methods A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol included wound debridement, application of artificial dermis (Pelnac®), and a semi-occlusive dressing (IV3000®). The outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. Results The mean treatment duration was 45.29 days (SD = 17.53). Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score = 2.58, SD = 0.67). The sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean = 0.45, SD = 0.67), and cosmetic satisfaction was high (mean = 4.09, SD = 0.94). The overall patient satisfaction was high (mean = 4.41, SD = 0.67), regardless of injury severity. Conclusions The conservative treatment protocol using artificial dermis and semi-occlusive dressings is a promising strategy for managing fingertip injuries with volar pulp defects. This approach minimizes surgical morbidity and achieves excellent functional and aesthetic outcomes.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Kang

2024

JCM

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“…Nevertheless, it cannot be transferred to a dorsal defect, and the potential risk of creating a hook nail deformity should be appreciated by both the surgeon and the patients. Recently, the moist antiseptic dressings have received global use [ 20 , 21 ], some artificial dermal substitute could even circumvent the necessity of skin graft and yield satisfying aesthetic outcome [ 22 ]. However, the usage of these substitute on bone exposure is still controversial [ 23 ], while this exposure was present in most of the cases in present study; an option is nibbling the protruding bone, which yet creates a shortened finger length [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Double-pivot proper digital artery perforator flap for fingertip reconstruction

Liu,

Pan,

Gao

et al. 2023

J Orthop Surg Res

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Background Dorsal flap based on proper digital artery perforator has been commonly used in wound coverage of fingertip; yet a small diameter and short length poses a risk of pedicle kinking or occlusion. The present study aims to present our preliminary results of using a double-pivot perforator flap based on the end dorsal branch of proper digital artery to repair finger pulp defect. Methods We designed a double-pivot flap based on the end-dorsal perforator branch of proper digital artery, raised from the dorsal aspect of the middle phalanx, with inclusion of both the perforator and a section of the trunk of the artery. This modified procedure forms a pedicle with a larger diameter and length than traditional designs. Twelve patients (12 fingers) each with a soft-tissue defect of the fingertip were successfully treated and followed up in this retrospective study. Results All the flaps survived without showing any signs of necrosis; three cases presented with transient venous flow disorder, these self-resolving without requiring any additional treatment. At final follow-up (12–33 months, mean 20 months), mean static two-point discrimination on the flap was 7.0 mm (range, 6–9). Conclusion The double-pivot proper digital artery flap serves as a reliable option in fingertip reconstruction offering added benefits of having greater rotation flexibility, a lower risk of vessel kinking or occlusion, and good recovery of cutaneous sensation.

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“…2 Despite the increasing utilization of artificial dermal substitutes in clinical practice, there is limited evidence regarding their efficacy in the management of fingertip injuries with volar pulp defects. Previous studies have primarily focused on the use of artificial dermis for the coverage of fingertip amputations or dorsal skin defects [10,12,13]. Moreover, the optimal treatment protocol, the impact of injury characteristics on outcomes, and the long-term functional and aesthetic results remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Kang

2024

Preprint

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Background: Fingertip injuries with volar pulp tissue defects are challenging to manage due to the complex anatomy and critical role of the fingertip in sensory and motor functions. Traditional surgical approaches are associated with donor site morbidity, prolonged immobilization, and suboptimal functional outcomes. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressing for these injuries. Methods: A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol involved wound debridement, application of artificial dermis (Pelnac®), and semi-occlusive dressing (IV3000®). Outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. The impact of injury characteristics on outcomes and treatment duration was evaluated. Complications were recorded, and patient satisfaction was assessed. Results: The mean treatment duration was 45.29 days (SD=17.53), with no significant differences based on injury characteristics. Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score=2.58, SD=0.67), with slightly better scores in bone-exposed injuries. Sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean=0.45, SD=0.67), and cosmetic satisfaction was high (mean=4.09, SD=0.94). Overall patient satisfaction was high (mean=4.41, SD=0.67), regardless of injury severity. Discussion: This study demonstrates the efficacy of a conservative approach using artificial dermis and semi-occlusive dressing for fingertip injuries with volar pulp defects. The treatment protocol achieved favorable outcomes in tissue regeneration, sensory recovery, pain management, and cosmetic appearance while minimizing complications and morbidity associated with traditional surgical interventions. The high patient satisfaction across all injury types highlights the patient-centered nature of this approach. Conclusions: The conservative treatment protocol using artificial dermis and semi-occlusive dressing is a promising strategy for managing fingertip injuries with volar pulp defects. This approach harnesses the body's regenerative potential, minimizes surgical morbidity, and achieves excellent functional and aesthetic outcomes. Further research is needed to optimize treatment protocols and investigate long-term outcomes.

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Long-term follow-up of one-stage artificial dermis reconstruction surgery for fingertip defects with exposed phalanx

Cited by 5 publications

References 40 publications

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Double-pivot proper digital artery perforator flap for fingertip reconstruction

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

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