JCCIJournal of Clinical Case Reports and Images2641-5518Open Access PubUnited States10.14302/issn.2641-5518.jcci-19-2626JCCI-19-2626case-reportThe use of Dermacell® in Fingertip InjuryWu,Tsung-Hsuan1GiampietroBertasi2*Land Seed Hospital, TaiwanUniversity of Padua, ItalyCorresponding authorMohamedElfahar1Pan-Arab Federation of Societies for the Surgery of the Hand, Egypt.
Giampietro Bertasi, University of Padua, Email: gbertasi@bertasi-consulting.it
The authors have declared that no competing interests exist.
Matrices or tissue scaffolds provide a collagen structure for tissue remodelling while the removal of viable cells aims to minimize or prevent inflammatory or immunogenic response.
Allograft collagen scaffold can support the patient’s own cellular ingrowth, ingeneered to minimize an immune response and to yeld a bio-compatible matrix and support incoming cellular growth. The decellyularized dermis retains its growth factors, native collagen scaffold, and elastin, thanks to a LifeNet Health proprietaryprocessin technology.
Finger tip injuryADMDermacellIntroduction
Fingertip injuries are defined as those distal to the insertion of the flexor and extensor tendons Primary goal of treatment is a painless fingertip with durable and sensate skin. 1 Methods of treatment include healing by secondary intention, skin grafting, shortening of the bone and primary closure, and coverage with local or regional flaps.
Evaluation
History and mechanism of the injury
Patient factors age, gender, handedness, occupation, and history of previous hand injuries
Function of flexor and extensor tendons
Rx
Antibiotics and tetanus prophylaxis
Soft-tissue loss without exposed bone
Soft-tissue loss with exposed bone
Amputation
Nail bed injuries
Treatment
For the treatment of fingertip injuries, the decision making process should proceed from the
simpler techniques to the more complicated. When no bone is exposed, the open method is ideal
for small or moderate sized wounds, and skin grafting should be considered for larger wounds . Distal transverse and dorsal oblique amputations with bone exposure can be treated with local advancement flaps. 234567891011121314
Conclusion
Derma cell was able to provide protection for the wound while encouraging rapid healing without the disadvantages of donor site morbidity and increased patient pain from an autograft. The rapid wound closure was encouraging and supports further use of Derma Cell for treating soft tissue trauma wounds.
Case no. 1. 32 y/o, male. Crush injury with tip amputation of right middle finger. (Figure 1, Figure 2,Figure 3, Figure 4.)
Post-op
4 days post-op
2 wks postr-o
a-b: 4 wks post-op
Case no. 2. 48 y/o, female. Laceration wound of right index finger; dorsal oblique soft tissue defect; nail bed defect; over DIPJ with bone and joint exposure. (Figure 5, Figure 6, Figure 7, Figure 8.)
Post-op
4 wks post-op
8 wks post-op
11 wks post-op
Case no 3. 42 y/o, male. Crush injury with soft tissue defect of volar side of the left thumb. (Figure 9, Figure 10, Figure 11, Figure 12, Figure 13.)
4 days post-op
15 days post-op
2 months post-op
3 months post-op
4 months post-op
Case 4. 44 y/o female. Laceration wound of the left thumb; dorsal oblique soft defect; nail bed defect. Over D IPJ with bone and joint exposure. (Figure 14, Figure 15.).
4 days post-op
3 months post-op
Case 5. 24 y/o male. Contact full thickness burn wound of right thumb; soft tissue defect of dorsal side of the IPJ; tendon exposure. (Figure 16, Figure 17, Figure 18)
2 weeks post-op
6 weeks post-op
10 weeks post-op
Case 6. 54 y/o male. Chemical burn, full thickness burn wound of right middle finger; tendon exposure. (Figure 19, Figure 20, Figure 21).
8 days post-op
2 months post-op
4 months pos-op
Case 7. 40 y/o female. Crush injury of the right hand; amputation of right middle finger through DIPJ with volar oblique defect; amputation of right finger through middle phalanx with volar oblique defect; bone exposure. (Figure 22, Figure 23, Figure 24, Figure 25).
8 days post-op
2 weeks post-op
2 months post-op
3 months post-op
Result
The wounds progressed steadily, with full wound closure being achieved (average 1 to 4 months) after initial implantation. There were no signs of infection observed and the patient did not experience any reaction to the graft. Although the wound began healing slowly initially, the authors felt that was due to the complexity of the traumatic wound.
We TreatRoutinelyFinertip Injuries with ADM (Derma cell).
ZookE GAnatomy and physiology of the perionychium1990Hand Clin617ChowS PHoEOpen treatment of fingertip injuries in adults1982J Hand Surg [Am]7470476LouisD SPalmerA KBurneyR EOpen treatment of digital tip injuries1980JAMA244697698SchenckR RCheemaT AHypothenar skin grafts for fingertip reconstruction1984J Hand Surg [Am]9750753RosenthalE ATreatment of fingertip and nail bed injuries1983Orthop Clin North Am14675697KappelD ABurechJ GThe cross-finger flap: An established reconstructive procedure1985Hand Clin1677683MobergEAspects of sensation in reconstructive surgery of the upper extremity1964J Bone Joint Surg Am46817825GaulJS JrRadial-innervated cross-finger flap from index to provide sensory pulp to injured thumb1969J Bone Joint Surg Am5112571263VlastouCEarleA SBlanchardJ MA palmar cross-finger flap for coverage of thumb defects1985J Hand Surg [Am]10566569RussellR CVanBeek ALWavakPAlternative hand flaps for amputations and digital defects1981J Hand Surg [Am]6399405LittlerJ WNeurovascular skin island transfer in reconstructive hand surgery, in Wallace AB (ed):1960Transactions of theInternational Society of Plastic Surgeons. London: E & S Livingstone175178VanBeek ALKassanM AAdsonM HManagement of acute fingernail injuries1990Hand Clin62335ZookE GGuyR JRussellR CA study of nail bed injuries: Causes, treatment, and prognosis1984J Hand Surg [Am]9247252ShepardG HManagement of acute nail bed avulsions1990Hand Clin63958