Experience with semi-occlusive dressing in

fingertip injuries: a case series report.

Azocar C., Luna E., Liendo R., Henriquez L., Valenzuela M.

Background

Objectives

Patients & Method

Results

Conclusion

Background• Distal phalanx fractures with fingertip injuries are common in our practice

though there is still controversy concerning its treatment. • Semi-occlusive dressing has been used with good and excellent outcomes,

where achieved esthetical results and tactile discrimination is superior to those obtained with surgical treatment and without further complications.

• This technique is based on providing an ideal environment that stimulates cellular migration, proliferation and neoangiogenesis, accomplishing optimum functional results through a simple, inexpensive, and minimally invasive technique.

Objectives

• Describe our experience with semi-occlusive dressing.

o Evaluate esthetic and functional results.o Evaluate time until complete coverage of the fingertip.o Evaluate clinical tolerance of the semi occlusive dressing.

Patients & Method• Study design: Cohort study

• Patients Inclusion criteria

o Distal phalanx fracture, Allen classification zones 1, 2 and 3o Long finger lesions

Exclusion criteriao > 6 hours of evolutiono > 3 fingers involvedo Fractures that require osteosynthesiso Lack of capacity to follow instructionso Diabetes Mellitus without treatmento Active tabaquism

La Main traumatique. L'Urgence. Michel Merle, Gilles Dautel. 3ºedition. Elsevier Masson, 2011

.

Patients & Method• Patients included

o 6 patients were treated with this method during a 3 month period; all male between 40 and 65 years old. Injuries were caused by saw (4), knifes (1) and one animal attack.

• Methodo Patients were evaluated in the emergency department; a dose of antibiotics

(Cefazoline 2gr IV) and antitetanic vaccine were administrated before the procedure.

o Fractures were confirmed with plain radiographs.o Surgical debridement with saline solution was performed and then the semi-

occlusive dressing (Tegaderm® 3M) was installed.o Patients were controlled weekly for 6 weeks without changing the initial semi-

occlusive dressing. After 6 weeks, bandages were removed and granulatory tissue was cleaned and covered.

o A week later all bandages were removed and patients were encouraged to full range movement exercises.

o Patients were controlled 3 months later to evaluate final results with QuickDASH score and K Johnson satisfaction scale.

Patients & Method

Patients & Method

Patients & Method

3 weeks

Patients & Method

6 weeks 7 weeks

Results• Good and excellent functional results were obtained.

• QuickDash: Average 4,5Patient Score

1 Complete Satisfaction

2 Complete Satisfaction

3 Sastisfaction with minimal complaints

4 Complete Satisfaction

5 Complete Satisfaction

6 Complete Satisfaction

• K Johnson scale

• Time until complete coverage: 6 weeks.

• Excellent treatment tolerance.

Patient Score

1 0,0

2 4,5

3 15,9

4 6,8

5 0,0

6 0,0

Results• Satisfactory cosmetic results were achieved in all patients

with minimal residual pain, all patients presented full range of motion at 3 months. No complications were observed.

Results

Conclusion

This treatment appears as an alternative to skin flaps in patients with fingertip injuries. Excellent

cosmetic and functional results were achieved with a standardized protocol that can be reproduced.