We retrospectively reviewed the outcomes of 54 patients treated with occlusive dressings (OD) (27 patients) or local flap (LF) coverage (28 patients) for fingertip amputations with bone exposure. All patients healed completely within a mean of 5 weeks in the OD group and 3.5 weeks in the LF group. At a mean follow-up of 26 months (range 12–38), 2-point discrimination was significantly better in the OD group (4 mm) than the LF group (6 mm). Proximal interphalangeal joint (PIP) stiffness was more common in the LF group, affecting one-third of patients. A cost analysis showed that ODs were 6.5 times less expensive than LFs performed in the operating theatre. OD appears to be a reliable and more cost-effective alternative to LF for treating zone 2 and 3 fingertip amputations with exposed bone, with similar healing time, better tactile discrimination and a lower rate of PIP joint stiffness.
Abi-ChahlaMLAletJMFabreTPelissierP.Treatment of defects in the tip and palmar surface of the fingers. Hand Surg Rehabil. 2018,
37: 4–11.
2.
AtasoyEIoakimidisEKasdanMLKutzJEKleinertHE.Reconstruction of the amputated finger tip with a triangular volar flap. A new surgical procedure. J Bone Joint Surg Am. 1970,
52: 921–6.
3.
BoudardJLoiselFEl RifaïSFeuvrierDObertLPluvyI.Fingertip amputations treated with occlusive dressings. Hand Surg Rehabil. 2019,
38: 257–61.
4.
DumontierCMeningaudJPHervéC.Knowledge of flap complications in finger pulp surgery and patient education - ethical implications. Chir Main. 2001,
20: 122–35.
5.
FarrellRGDisherWANeslandRSPalmatierTHTruhlerTD.Conservative management of fingertip amputations. J Am Coll Emerg Physicians. 1977,
6: 243–6.
6.
GrahamBSchofieldM.Self-reported symptoms of cold intolerance in workers with injuries of the hand. Hand. 2008,
3: 203–9.
7.
HoignéDHugU.Amputations de la dernière phalange : régénération par film. Forum Med Suisse2014;
14: 356–60.
8.
HoignéDHugUSchürchMMeoliMvon WartburgU.Semi-occlusive dressing for the treatment of fingertip amputations with exposed bone: quantity and quality of soft-tissue regeneration. J Hand Surg Eur. 2014,
39: 505–9.
HutchinsonJJMcGuckinM.Occlusive dressings: a microbiologic and clinical review. Am J Infect Control. 1990,
18: 257–68.
12.
IrwinMSGilbertSETerenghiGSmithRWGreenCJ.Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms. J Hand Surg. 1997,
22: 308–16.
13.
IshikawaKOgawaYSoedaH.A new classification of the amputation level for the distal part of finger. Jpn Soc Microsurg. 1990;
3: 54–62.
14.
JoshiBB.A local dorsolateral island flap for restoration of sensation after avulsion injury of fingertip pulp. Plast Reconstr Surg. 1974,
54: 175–82.
15.
KannonGAGarrettAB.Moist wound healing with occlusive dressings. A clinical review. Dermatol Surg. 1995,
21: 583–90.
16.
LaiCSLinSDYangCC.The reverse digital artery flap for fingertip reconstruction. Ann Plast Surg. 1989,
22: 495–500.
17.
LasserreGBakkouchSPauchotJ, et al.
Fingertip reconstruction with occlusive dressing: clinical results and biological analysis of the dressing content's. Chir Main. 2010,
29: 315–20.
18.
LeeLPLauPYChanCW.A simple and efficient treatment for fingertip injuries. J Hand Surg. 1995,
20: 63–71.
19.
MacDermidJCTottenhamV.Responsiveness of the Disability of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther. 2004,
17: 18–23.
20.
MartinCGonzález del PinoJ.Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction. Clin Orthop. 1998,
353: 63–73.
21.
MennenUWieseA.Fingertip injuries management with semiocclusive dressing. J Hand Surg. 1993,
18: 416–22.
22.
MobergE.Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg Br. 1958,
40-B: 454–76.
23.
NgHJHSimJTeyVHTSelvaganeshSRebosuraCKPRajaratnamV.Experience with the use of splint caps for the management of fingertip amputation injuries. J Hand Surg Asian-Pac. 2020,
25: 199–205.
24.
O’BrienB.Neurovascular island pedicle flaps for terminal amputations and digital scars. Br J Plast Surg. 1968,
21: 258–61.
25.
OrdoschMMaucherV.The semi-occlusive dressing – development of the confidence of the patients in the treatment and the odour emission during the treatment period. Handchir Mikrochir Plast Chir. 2020,
52: 189–91.
26.
QuadlbauerSPezzeiCJurkowitschJ, et al.
The semi-occlusive dressing in treating Allen III and IV fingertip injuries as an alternative to local skin flaps. Unfallchirurg. 2017,
120: 961–8.
27.
QuellMNeubauerTWagnerM.Treatment of fingertip defect injuries with a semi-occlusive dressing. Handchir Mikrochir Plast Chir. 1998,
30: 24–9.
28.
SöderbergTNyströmÅHallmansGHulténJ.Treatment of fingertip amputations with bone exposure. A comparative study between surgical and conservative treatment methods. Scand J Plast Reconstr Surg. 1983,
17: 147–52.
29.
TangJBGiddinsG.Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016,
41: 365–6.
30.
Van den BergWBVergeerRAvan der SluisCKTen DuisHJWerkerPMN.Comparison of three types of treatment modalities on the outcome of fingertip injuries. J Trauma Acute Care Surg. 2012,
72: 1681–7.
WinterGD.Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962,
193: 293–4.
33.
XuJCaoJYGrahamDJLawsonRDSivakumarBS.Clinical outcomes and complications of primary fingertip reconstruction using a reverse homodigital island flap: a systematic review. Hand. 2021:
18: 264–71.
