Occlusive dressing versus local flap coverage for the treatment of fingertip amputations with exposed bone: a comparative study.

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.Level of evidence: IV.

Fingertip injuries and their reconstruction, focusing on nails.

The fingertip is a complex anatomical structure that is frequently injured, especially in manual workers. Different classifications have been reported, considering injury orientation, level and geometry. To optimize treatment planning, the area of soft-tissue defect should be considered. Treatment aims to conserve as long a finger as possible, restore sensation (S3 + or more) and ensure a pleasant esthetic appearance. When amputation occurs, the best treatment is replantation when conditions allow. When this is not possible, the fingertip should be used as a composite graft or the nail complex can be grafted and soft tissue reconstructed, according to the preferred method. In defect without amputation or if the distal part of the finger is not present or not useful, many reconstructive techniques have been described. Depending on the injury, patient characteristics and requirements and the surgeon's skills and experience, the treatments vary from secondary healing to free flaps. In this paper, the various treatment options are described and discussed. Nowadays, considering most variables, the best treatment in fingertip injury is secondary healing with occlusive or non-occlusive dressing, even in case of bone exposure. This simple solution is able to restore a nearly normal fingertip with good sensation without further injuring the hand.

Secondary Intention Healing for Fingertip Amputations in a Tropical Climate.

Background: Various studies have examined occlusive dressings in fingertip amputations and reported good outcomes. Occlusive dressing preserves appropriate pH, cell accumulation and moisture for healing, thereby limiting scar formation and deformity. To our knowledge, no study was performed in tropical Asia. This study aims to demonstrate the viability of healing fingertip amputations through secondary intention using an effective dressing technique, even in warm tropical climates. Methods: All patients who presented to our institution with fingertip amputations from 1 July 2020 to 31 July 2022 were analysed retrospectively. Seventeen patients (15 male, 2 female) of mean age 37.2 ± 9.4 years old with 18 injured digits were retrospectively analysed. Twelve (66.7%) were Allen Type III injuries, and one patient required distal phalangeal K-wire fixation. During the patient's final review, static 2-point discrimination, pulp sensation, fingertip contour and nail deformities alongside the last measured range of motion (ROM) of the injured finger was recorded. Treatment duration and days of leave taken were also summed and assessed. Results: Patients were dressed with semi-occlusive dressing for an average of 20.1 ± 6.83 days. The average total duration of dressing is 36.78 ± 18.88 days over an average of 7.18 ± 4.03 dressing visits. Mean duration of follow-up was 108 ± 63.46 days. Good outcome measures in sensation, pulp contour, nail deformity and ROM similar to existing literature were reported. Conclusions: Occlusive dressing remains a viable and feasible treatment option for fingertip amputation even in a tropical climate. While this simple treatment method may require more effort from patient, wound healing was attained after 36.8 ± 18.9 days of dressing. Level of Evidence: Level IV (Therapeutic).

Treatment of fungal infection on left ventricle assist device driveline exit site: a case report and systematic review.

OBJECTIVE: The use of ventricular assist devices (VAD) is increasing; however, diagnosis and management of device complications, such as the driveline exit site (DES) being the portal of entry for fungal infection, is not well known. METHOD: A systematic review involving searching PubMed (2005 to July 2020) was conducted. The case of a 43-year-old female patient who had a left VAD (LVAD) (HeartMate 3, Abbott, US) is also reported. RESULTS: The patient was successfully treated with ketoconazole cream and oral fluconazole for likely superficial DES fungal infections. We included 36 studies that met our inclusion criteria; however, only one was included in our review. In the literature, five cases of DES fungal infection were reported, with Candida being the only fungal pathogen. CONCLUSION: LVAD fungal infections are uncommon but can be responsible for high mortality rates, require a prolonged period of treatment, and can present a huge problem when surgical alternatives are not available. However, Candida species are most common. Fungal infections can only produce clear discharge, and so the classic definition of driveline infection based on purulent secretion can vary. Negative skin culture does not exclude the diagnosis of infection of the DES, and so empirical diagnosis may only be clinically based.

Semi-occlusive dressing versus surgery in fingertip injuries: A randomized controlled trial.

OBJECTIVES: No gold-standard treatment has been established for the management of distal digital amputation in Ishikawa zones II and III. The objective of this study was to compare the results of management of fingertip amputation by semi-occlusive dressing versus surgery. The principal hypothesis was that a semi-occlusive dressing results in better recovery of sensory function than a digital flap. METHODS: We conducted a prospective, randomized, multicenter study of 44 patients: 23 managed conservatively with semi-occlusive dressing, and 21 surgically with digital flap. RESULTS: Mean follow-up was 12 months. Mean healing time was 4.9 weeks in the semi-occlusive dressing group and 3.6 weeks in the surgery group. There was no significant difference between groups for sensory recovery of fine touch (p = 0.198) or 2-point discrimination (p = 0.961). No infections were reported in either group. Hook-nail deformity was more frequent in the semi-occlusive dressing group, particularly in case of amputation in zone III. CONCLUSIONS: Semi-occlusive dressing enabled satisfactory healing and sensitivity recovery without increasing the risk of infection. However, in zone III amputation, we advocate surgical treatment with a digital flap, due to poor trophicity and the frequency of hook-nail deformity seen with conservative management. LEVEL OF EVIDENCE: II.

Aloe vera-loaded natural rubber latex dressing as a potential complementary treatment for psoriasis.

Psoriasis is a disease that causes keratinocytes to proliferate ten times faster than normal, resulting in chronic inflammation and immune cell infiltration in the skin. Aloe vera (A. vera) creams have been used topically for treating psoriasis because they contain several antioxidant species; however, they have several limitations. Natural rubber latex (NRL) has been used as occlusive dressings to promote wound healing by stimulating cell proliferation, neoangiogenesis, and extracellular matrix formation. In this work, we developed a new A. vera-releasing NRL dressing by a solvent casting method to load A. vera into NRL. FTIR and rheological analyzes revealed no covalent interactions between A. vera and NRL in the dressing. We observed that 58.8 % of the loaded A. vera, present on the surface and inside the dressing, was released after 4 days. Biocompatibility and hemocompatibility were validated in vitro using human dermal fibroblasts and sheep blood, respectively. We observed that ~70 % of the free antioxidant properties of A. vera were preserved, and the total phenolic content was 2.31-fold higher than NRL alone. In summary, we combined the antipsoriatic properties of A. vera with the healing activity of NRL to generate a novel occlusive dressing that may be indicated for the management and/or treatment of psoriasis symptoms simply and economically.

Semi-occlusive dressing therapy versus surgical treatment in fingertip amputation injuries: a clinical study.

OBJECTIVES: Treatment of fingertip amputations is subject of controversial debates. Recently, semi-occlusive dressings have increased in popularity in these injuries. AIMS: To compare clinical outcomes of conservative semi-occlusive dressing therapy versus surgical treatment of fingertip amputations. METHODS: Eighty-four patients with fingertip amputations were re-examined clinically after a mean follow-up of 28.1 months (range 9.6-46.2). Sixty-six patients (79%) were treated with semi-occlusive dressings (group 1) and 18 (21%) underwent surgery (group 2). Range of motion, grip strength, and two-point discrimination were measured at the final follow-up. Furthermore, VAS score, Quick-DASH score, subjective aesthetic outcome and loss of working days were obtained. RESULTS: Group 1 demonstrated healing in all 66 patients (100%) while in Group 2 5 out of 18 patients (28%) failed to achieve healing after a mean of 17 days (range 2-38) due to graft necrosis. Group 1 showed significantly lower VAS scores and significantly lower loss of two-point discrimination compared to Group 2. Work absence was significantly shorter in Group 1 versus Group 2. Trophic changes in finger (46%) and nail (30%) were significantly lower in Group 1 compared to Group 2 (44% and 70%, respectively). Disturbance during daily business activities (14%) and cold sensitivity (23%) were significantly lower in Group 1 compared to Group 2 (86% and 77%, respectively). CONCLUSIONS: Semi-occlusive dressing therapy for fingertip amputations demonstrated excellent healing rates. Compared to surgical treatment, it resulted in significantly better clinical outcomes, lower complication rates and significantly higher reported satisfaction rates. Therefore, semi-occlusive dressing for fingertip injuries is a very successful procedure and shall be preferred over surgical treatment in most cases. LEVEL OF EVIDENCE: III therapeutic.

IV3000 semi-occlusive dressing use in simple and complex fingertip injuries: efficacy and affordability.

OBJECTIVE: This study aimed to explore the efficacy of the IV3000 semi-occlusive, transparent adhesive film dressing in the non-surgical management of simple as well as more complex fingertip injuries. METHOD: In this qualitative study, patients with fingertip injuries were prospectively recruited and treated conservatively with the dressing between 2015 and 2017. Inclusion criteria included any fingertip injury with tissue loss and patient consent for non-surgical treatment consistent with the study protocol. Exclusion criteria included injuries needing surgical intervention for tendon injury or exposure, joint dislocations, distal phalangeal fractures requiring fixation, bone exposure, isolated nail bed lacerations and any patients eligible for surgical repair who did not wish to be managed conservatively. RESULTS: A total of 64 patients took part in the study. The patients treated with the dressing were asked to rate functional outcome, of whom 40 (62.5%) patients reported the outcome as 'excellent', 19 (29.7%) as 'satisfactory', five (7.8%) as 'indifferent' and none (0%) as 'unsatisfactory'. A reduced pulp volume at completion of healing was felt by 21 (32.8%) patients, but all patients were 'satisfied' with the aesthetic appearance of their fingertips at final clinical review. Average healing time was 4.5 weeks across the group, with the average time for return to work being just under one week. We estimate a 60% reduction in cost with the conservative versus the surgical management option. CONCLUSION: This study showed that, for participants, the IV3000 dressing was an affordable and effective option for the conservative treatment of simple fingertip injuries and in the management of more complex fingertip injuries.

Semi-occlusive dressing as non-operative treatment vs. operative treatment for fingertip amputations: A retrospective cohort study

INTRODUCTION@#Treatment of fingertip amputations have demonstrated good outcomes with both surgical and nonsurgical management.@*OBJECTIVE@#The objective of this study was to compare non-operative treatment with semi-occlusive dressing with any surgical treatment for fingertip amputations in adult fingers, Allen types I-III in a retrospective cohort review.@*METHODS@#A retrospective chart review was done on adult patients with fingertip amputations Allen types I-III from January 1, 2018 to December 31, 2020. Patients included in the studies were distributed into two treatment groups: non-operative and operative groups. Outcomes to be measured were time to full healing, range of motion, nail deformities, Tinel’s sign, and discoloration of the reconstructed fingertip.@*RESULTS@#A total of 38 patients with 40 digits were included (19 patients with 20 digits for each treatment group). The results showed a larger defect for the operative group (3 cm2 vs 2.1 cm2), with shorter time to healing (1.4 months vs 2.2 months). There were more complications in the operative group like the Tinel’s sign, nail deformity and discoloration, as well as joint contractures. Range of motion was better for patients treated non-operatively.@*CONCLUSION@#Treatment with semi-occlusive dressing showed similar results in terms of wound healing but takes a longer time and less complications compared to operative treatment.

Nail Regeneration of an Allen III Fingertip Amputation After a Dog Bite Using the Semi-occlusive Dressing Technique: A Case Report and Literature Review.

There is ongoing controversy regarding the best treatment of fingertip amputations, conservative treatment with secondary healing or surgical intervention. Healing by secondary intention has been proven to offer satisfactory recovery and function. More extensive wounds are treated surgically. However, even in Allen III and IV amputations, there is a lack of evidence to support enhanced healing and function of fingertips after surgical treatment compared to conservative management. Regarding fingertip amputations after animal bites, thorough debridement is the preferred treatment due to various micro-organisms, while there is no consensus about the primary closure of the wound. Inclusion cri-teria are complete amputations even with bone involvement at all levels. Exclusion criteria are skeletonized distal phalangeal bone, not surrounded by soft tissues, joint involvement and exposed tendon. It offers complete regeneration of the fingertip without signs of infection, even in animal bites wounds. There are few reports in the literature regarding the semi-occlusive dressing for treating fingertip amputations-only one report uses this technique after an animal bite in a two-year-old girl. In this case report, an Allen III fingertip amputation caused by a dog bite in a 64-year-old female was managed successfully using the semi-occlusive dressing technique. At the final follow up three months after the injury, the aesthetic results were satisfactory. The fingertip with the nail complex was almost normal with no nail hook deformity. The pad skin regenerated with no signs of infection. The functional results were excellent, with no joint stiffness or disability. The sensibility was satisfactory with two-point discrimination of 4 mm, and there was no tenderness, cold intolerance, or neuroma. The patient was satisfied and able to participate in all daily activities.  The semi-occlusive dressing technique is an alternative treatment option for Allen III fingertip amputations after animal bites. It promotes regenerative healing, and despite bacterial colonization, no infection has been reported.

Wound fluid under occlusive dressings from diabetic patients show an increased angiogenic response and fibroblast migration.

INTRODUCTION: Metabolic diseases like diabetes mellitus often show prolonged healing and chronic wounds. Occlusive wound dressings are known to support wound closure by creating a moist environment which supports collagen synthesis, epithelialization and angiogenesis. We aimed to assess the effect of occlusion on diabetic wound fluid on the cellular level regarding fibroblast activity and angiogenetic response. MATERIAL AND METHODS: 22 split skin donor sites from 22 patients (11 patients with diabetes mellitus) were treated with occlusive dressings intraoperatively. On day 3, fluid and blood serum samples were harvested while changing the dressings. The influence of wound fluid on fibroblasts was assessed by measuring metabolic activity (Alamar Blue assay, Casey Counter), cell stress/death (LDH assay) and migration (in vitro wound healing assay) of fibroblasts. Angiogenesis of endothelial cells (HUVEC) was analyzed with the tube formation assay. Furthermore, a Magnetic Luminex Assay for multi-cytokines detection was performed focusing on inflammatory and pro-angiogenetic cytokines. RESULTS: The influence of wound fluid under occlusive dressings from diabetic patients showed a significantly increased angiogenic response and fibroblast migration compared to the non-diabetic patient group. Additionally, cell stress was increased in the diabetic group. Cytokine analysis showed an increase in VEGF-A in the diabetic group. CONCLUSION: Occlusive dressings may stimulate regenerative effects in diabetic wounds. Our in-vitro study shows the influence of wound fluid under occlusive dressings from diabetic patients on angiogenesis, migration and proliferation of fibroblasts, which are essential modulators of wound healing and scar modulation.

Clobetasol propionate 0.05% under occlusion for alopecia areata: Clinical effect and influence on intraocular pressure.

Topical corticosteroids are known to be effective in the treatment of alopecia areata, but the potential effects on intraocular pressure are a concern. The purpose of this retrospective study is to evaluate the effect of clobetasol propionate 0.05% under occlusion on patients with active phase alopecia areata and to examine the effects on intraocular pressure. We also wished to see if reducing the frequency of application of clobetasol increased the safety with respect to intraocular pressure. Elevation of intraocular pressure due to topical corticosteroids is unlikely to occur at the dose of 9.8 g or less per week used in this study; however, ophthalmologic examination at the start of treatment was thought to be worthwhile in identifying patients with latent glaucoma.

An influence study of the different types of wound dressings on red light transmittance / 中华老年医学杂志

Objective:To investigate the influence of different types of wound dressings on red light transmittance.Methods:A treatment environment for wounds exposed to red light was simulated.Red light transmittance of four types of 19 dressings commonly used in clinic were detected respectively and compared.The transmittance was calculated as the ratio of the intensity of the red light through the dressing to the intensity of the injected red light.Results:The red light transmittance for each dressing was the following: (1)Cotton gauze and pad: 29.4% for one piece of coarse gauze, 10.5% for one cotton pad; (2)Oil dressings: 73.0%~79.1% for light-color oil dressings, 41.7% for dark-color oil dressings-Atrauman ?; (3)Hydrocolloid dressings: 87.8%~90.2%; (4)Foams: 74.7% for light-color ultra-thin foam-Mepilex ? sheet, 0.8% for black-color thicker foam dressings-Mepilex ? Ag dressing, and 20.5%-54.2% for the other foam dressings. Conclusions:The red light transmittance of hydrocolloid dressing, light-colored oil gauze dressing and light-colored ultra-thin foam dressing is higher, with less red light-blocking effect, and the dark-color or thicker dressings had more blocking effect, which showed different therapeutic effect on wound.Gauze and cotton pad have great blocking influence on red light transmittance, and are not suitable for temporary covering of wound during red light treatment.Hence, the effect of wound dressing on red light transmittance should be taken into account when the wound is treated with red light.

Preparation and characterization of a novel antimicrobial film dressing for wound healing application

Antibacterial activity and good mechanical properties are some of the characteristics required for an appropriate film dressing. A novel polymer blend was developed for wound healing application. Twenty-four formulations using the polymers chitosan, poly(vinyl alcohol) and/or ɛ-Polylysine and the plasticizer glycerol were designed using factorial design and then the films were prepared by the casting/solvent evaporation method. Seventeen films were obtained among the twenty-four proposed formulations that were characterized by Field Emission Scanning Electron Microscopy (FE-SEM) and Fourier Transform Infrared Spectroscopy (FTIR). Mechanical properties, such as tensile strength (σ), elongation at break (ɛ) and Young's modulus (Y) as well as antibacterial properties were determined. The best candidate was then further analyzed with regard to porosity, Water Vapor Transmission Rate (WVTR), swelling and cytotoxicity experiments. The results showed a film with semi-occlusive characteristics, good mechanical properties and no toxic. Incorporation of ɛ-Polylysine increased antibacterial activity against gram-negative (Escherichia coli) and gram-positive (Staphylococcus aureus) bacteria

Fingertip amputations treated with occlusive dressings.

The aim of this study was to analyze a series of patients who suffered a distal finger amputation and who were treated with occlusive dressings. A retrospective study was done of 19 patients from a single hospital. At the review, an independent examiner evaluated the time required for wound healing, the number of occlusive dressings used, fingertip trophic skin changes, epicritic sensitivity using the Weber two-point discrimination (2PD) test, sensitivity based on the monofilament test, complications, the presence of dysesthesia or cold intolerance, and the QuickDASH score. The mean follow-up was 12.6 months (6-25). A mean of 3.2 occlusive dressings (3-5) were used per patient, and the mean healing time was 4.3 weeks (4-5). The skin texture, fingertips and nail bed were good or excellent in 18 cases. The 2PD test was good or normal in 16 cases. Eighteen patients were satisfied or very satisfied with the outcome. The mean QuickDASH score was 5.53 (0-20.45). In the literature, the recovery of tactile sensation is good after use of occlusive dressings (2PD of 2.5 to 4.0mm). The mean sensitivity reported in various studies is better than that observed after use of a skin flap. While the sample size in our study was small, the functional outcome and appearance were good. Thus we prefer using occlusive dressings in Zone 1 and 2 fingertip amputations, and flaps in zones 3 and 4 to ensure better fingertip viability and sensation.

Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes.

We review recent developments in using occlusive dressings, dermal templates, and venous flaps for less invasive approaches to treat soft tissue defects of the forearm and fingers. Occlusive dressings can be used for thumb tip or fingertip trauma with soft tissue defects of small or moderate sizes. They permit skin regeneration without use of skin graft or a flap transfer. This is currently a popular way to treat tip soft tissue defects in European countries. Extensive soft tissue defects in the thumb, fingers, hand and forearm require flap transfers traditionally, but in recent years, surgeons use dermal templates to cover the defect site to allow regeneration of subcutaneous tissues, over which a skin graft is used in lieu of a flap. Transfer of a venous flap is currently a reliable procedure and is less invasive compared with conventional flaps, which usually damage a named artery in the donor. We advocate that less invasive methods should be considered for soft tissue defects in the hand and forearm.

Performance of Bio-Occlusive Dressing as Barrier Protection from Presurgical Chlorhexidine Skin Preparation.

Purpose/Aim of the study: Chlorhexdine has been shown to provide excellent and cost-effective presurgical antisepsis. However, standard presurgical concentrations of chlorhexidine (2-4%) are known to cause ocular injury, even in cases in which a bio-occlusive dressing (Tegaderm™) was applied beforehand to the closed eye. MATERIALS AND METHODS: Three experiments were conducted to assess the barrier performance of Tegaderm™ to chlorhexidine skin prep in vitro and on non-ocular skin. The experiments used water as a control group. RESULTS: In the first in vitro experiment, the chlorhexidine group showed penetration at the edges of the Tegaderm™ at 5 minutes while the water (control) group never penetrated the Tegaderm™. A subsequent experiment testing the central permeability of the tegaderm showed it to be impermeable to both chlorhexidine and water after 90 minutes. In the in vivo experiment, the chlorhexidine group showed penetration at 10 minutes, while the water (control) group never penetrated the Tegaderm™. CONCLUSIONS: These data suggest Tegaderm™ is permeable at the edges to chlorhexidine but not water. Based on this, along with reports of ocular injury from chlorhexidine skin preparation of the head despite prior application of Tegaderm™ over the eyes, we advise against using bio-occlusive adhesive dressing to protect the ocular surface from chlorhexidine exposure. We suggest an alternative presurgical antiseptic agent such as povidone-iodine be employed whenever possible.

Mapping biopsy for Buruli ulcer self-medicated with occlusive dressing.

Buruli ulcer is the third most common mycobacterial infection next to tuberculosis and leprosy caused by Mycobacterium ulcerans. Although it affects the skin, subcutaneous tissues, muscles and sometimes bones, there is no reliable evidence to determine the extent of debridement. We present here a case of Buruli ulcer treated successfully with a preoperative mapping biopsy procedure, which had been self-medicated with occlusive dressing. Because Buruli ulcer is accompanied by subtle pain, patients and clinicians tend to initially treat the ulcer with occlusive dressing therapy, which leads to the misdiagnosis of Buruli ulcer as a common bacterial infection only judging from bacterial culture of the surface of the ulcer. We propose the efficacy of mapping biopsy for treating Buruli ulcer.