Bilayer Wound Matrix for the Management of Transverse Fingertip Injuries CASE STUDY

The Use of Integra® Bilayer Wound Matrix for the Management of Transverse Fingertip Injuries Michael W. Kessler, MD, MPH Assistant Professor Center for Hand & Elbow, Department of Orthopaedic Surgery Medstar Georgetown University Hospital Abstract: Fingertip soft tissue injuries are the result of a sharp amputation or crush injury and can be challenging to treat. For transverse fingertip injuries up to the distal phalanx, multiple treatment methods have been described to allow the wounds to heal by secondary intention. However, only one study has documented the effectiveness of an acellular dermal...

Case One: A 39-year old female presented to our clinic one week after slicing the distal tip of her right long finger with a mandolin while cutting zucchini. She was seen in an emergency room at that time and was treated with silver nitrate to help control bleeding. She followed up with her primary care physician 5 days later because she noticed some green exudate from the wound and was then started on Augmentin at that time. The initial physical examination revealed an open wound approximately 2 cm by 1 cm through the tip of the finger, obliquely radially, with a deficit in the nail bed. Purulent...

Surgical Technique : Each patient underwent an irrigation and debridement of the right long finger with placement of Integra Bilayer Wound Matrix . At surgery, the tip of each patient’s finger had a significant amount of fibrinous exudate, granulation tissue, and purulent discharge present. After debridement of the necrotic soft tissue, healthy bleeding tissue was found, with prominence of the distal phalanx, which was debrided with a rongeur. In each case, the nail plate was originally sliced in an irregular fashion so it was trimmed with scissors for a more cosmetic appearance. Finally, a 2...

Each wound was still clean with granulation tissue 2 weeks later. Both patients were then allowed to keep the wound open to air and to go about activity as tolerated. The second patient had a degree of digital stiffness due to the splint, which was alleviated with occupational therapy [Figure 11-13]. Patient 2 Figure 11. Dorsal view of digit 4 weeks postoperatively. Figure 12. Palmer view of digit 4 weeks postoperatively. Figure 13. Close up view of digit 4 weeks postoperatively. Patient 1 had the most recent follow-up at 12 weeks and Patient 2 at 10 weeks. Each patient presented to clinic at...

Discussion: Fingertip injury treatments vary widely when these injuries have loss of soft tissue with or without exposure of underlying bone. Promoting healing by secondary intention can produce excellent results as Mennen and Wise have shown in a series of 200 fingertip injuries8. Both Halim et al and Lee et al found success using a Hyphecan (a biological polymer made of chitin) cap, although the wounds in this study took a mean of 32 days to heal4, 6. Buckley and Das found favorable results in patients with transverse, volar oblique, and dorsal oblique fingertip injuries using silver sulphadiazine...

1. Allen MJ. Conservative management of finger tip injuries in adults. Hand 1980;12:257-65 2. Aydin U, Ozbek S, Akin S, et al. Custom Subatmospheric Dressing for Fingertip Injuries. Techniques in hand & Upper Extremity Surgery. 2011;15(2):104-5 3. Buckley SC, Scott S, Das K. Late review of the use of silver sulphadiazine dressings for the treatment of fingertip injuries. Int. J. Care Injured. 200031: 301-304 4. halim, A. S., Stone, C. A., and Devaraj, v. S. The hyphecan cap: A biological fingertip dressing. Injury 29: 261, 1998 6. Lee, L. P., Lau, P. Y., and Chan, C....

Integra Bilayer Wound Matrix Reference Size Quantity 10 cm x 12.5 cm (4 inch x 5 inch) 1 unit/box 10 cm x 12.5 cm (4 inch x 5 inch) 5 unit/box Indications: Integra Bilayer Wound Matrix is indicated for the management of wounds including: partial and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic vascular ulcers, surgical wounds (donor sites/grafts, post-Moh’s surgery, post-laser surgery, podiatric, wound dehiscence), trauma wounds (abrasions, lacerations, second-degree burns, and skin tears) and draining wounds. The device is intended for one-time...