Experience with semi occlusive dressing in fingertip injuries

1. Experience with semi-
occlusive dressing in fingertip
injuries: a case series report.
Azocar C., Luna E., Liendo R., Henriquez
L., Valenzuela M.

2. Background
Objectives
Patients & Method
Results
Conclusion

3. 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.

4. 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.

5. Patients & Method
• Study design: Cohort study
• Patients
Inclusion criteria
o Distal phalanx fracture, Allen classification zones 1, 2 and 3
o Long finger lesions
Exclusion criteria
o > 6 hours of evolution
o > 3 fingers involved
o Fractures that require osteosynthesis
o Lack of capacity to follow instructions
o Diabetes Mellitus without treatment
o Active tabaquism
La Main traumatique. L'Urgence. Michel Merle,
Gilles Dautel. 3ºedition. Elsevier Masson, 2011
.

6. 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.
• Method
o 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.

7. Patients & Method

8. Patients & Method

9. Patients & Method
3 weeks

10. Patients & Method
6 weeks 7 weeks

11. Results
• Good and excellent functional results were obtained.
• QuickDash: Average 4,5
Patient 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

12. 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.

13. Results

14. 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.