An innovative fingertip dressing following injuries.

1. IV3000 Dressing for Fingertip Injury: Management and Discussion
Susan Kurian, Meghan Davis, Alyssa Fazi
West Virginia University School of Medicine, Morgantown W.Va.
W. Thomas McClellan M.D., F.A.C.S.
Plastic and Reconstructive Surgery, West Virginia University, Morgantown W.Va.
Abstract:
An active, right hand dominant 86-year-old male presented with transverse amputation of the right ring finger just
distal to the DIP joint. Conservative management was recommended in order to preserve digit length, mobility, and
the DIP joint. The IV3000 semipermeable dressing was utilized as the primary treatment. The clear adhesive
dressing has a high moisture vapor transmission rate that facilitates creation of a suitable wound
microenvironment.1
The digit showed significant epithelialization and mobility at two weeks post-injury and was
healed with full range of motion at both the DIP and PIP joints by week six. There were no complications from use
of the IV3000 dressing, and both healing time and pain during dressing change are improved over alternative
dressings like gauze.
Introduction:
The IV3000 sandwich technique for fingertip injury
is a non-surgical alternative to the standard skin
grafts or flaps used by hand surgeons for distal
fingertip injuries. The clear IV3000 adhesive patch
was designed to reduce rates of infection during
central and peripheral venous catheterization. It
features a moisture vapor transmission rate (MVTR)
that is six times that of other dressings when placed
over a wet surface and better than all dressings except
gauze when placed over a dry surface.1
The IV3000
likely aids healing by creating a suitable wound
microenvironment with reduced moisture
accumulation on the injury site and the surrounding
normal skin. Other factors such as levels of GAGs,
proteoglycans, and growth factors, wound
temperature, and the antibacterial properties of the
dressing may also be involved.2
Since healing
depends upon avoiding wound disruption during
dressing changes, the minimally adherent grid pattern
of the IV3000 dressing is also implicated in the
reduction of pain during dressing removal and faster
re-epithelialization of the injury. Healing of an
amputated fingertip by secondary intention using
similar semi-permeable dressings has not been well
studied, and skin grafts remain the standard of care.
However, patients for whom surgery is unsuitable
may benefit from use of the IV3000 treatment.
Figure 1. A. Volar view of wound on day of injury. B. Direct view of wound on day of injury
A B

2. Case Presentation:
An 86-year-old male presented with a transverse
avulsion amputation of his right ring finger at the
distal phalanx. The injury was sustained when his
hand was caught in a lawnmower. The amputation
occurred just distal to the insertion site of the flexor
digitorum profundus and showed some protruding
bone (Figure 1). The wound was hemostatic upon
presentation, and the patient had good range of
motion. The history is significant for Parkinson’s
disease, hyperlipidemia, cardiovascular disease, and
atrial fibrillation. Surgery was deferred due to the
lack of available skin, which would likely require
removal of the DIP joint in order to recruit the
required tissue. The decision to utilize the IV3000
dressing was supported by the patient as he wished to
return to work the next day. Washout, minimal
debridement of the skin edges, and shortening of the
protruding distal phalanx was performed under local
anesthesia, and the IV3000 dressing was applied.
After two weeks using the dressing protocol,
significant epithelialization had occurred and the
patient had excellent range of motion with no signs of
infection (Figure 2). The wound was well healed in
six weeks, with full range of motion including the
distal interphalangeal joint (Figure 3). The patient
continued to work in his shop and yard throughout
the treatment period.
Figure 3. A. Volar view of injury at six weeks using IV3000 protocol.
B. Direct view of injury at six weeks using IV3000 protocol.
A
B
Figure 2. A. Volar view of injury at two weeks using IV3000
protocol. B. Direct view of injury at two weeks using IV3000
protocol.
A
B

3. Discussion:
Conservative management for fingertip injuries using
the IV3000 dressing has previously been reported by
our team. These cases demonstrated that secondary
intention healing via the dressing had good cosmetic
and functional outcomes. Patients were able to
change the dressings at home every three to four days
without the inconvenience of making multiple office
visits. The protocol is well suited to patients who will
not tolerate immobilization after surgery and elderly
patients wishing to preserve joint motion. The
treatment may also be used in rural locations where
surgeons are not immediately available. One key
advantage is that surgical options can still be pursued
if IV3000 treatment fails.
Alternative non-surgical options like gauze dressings
have a longer healing time,3
while Tegaderm and
similar clear synthetics have lower MVTR values
than IV3000,1
leading to complications like
maceration. The IV3000 dressing is also unique in
allowing full flexion of the PIP and DIP joints, which
prevents the stiffness associated with traditional
treatments.
Application of the dressing is very simple. Two
IV3000 patches are used to sandwich the digit distal
to the PIP joint, then the free edges are adhered to
each other, folded to the dorsum, and secured. This
equipment is readily available to ED physicians for
the initial dressing, and patients can be discharged
with simple analgesia. Importantly, the adhesive
does not traumatize the wound bed with each
dressing change. Epithelialization can therefore occur
without interruption, and pain during the change is
minimized. In our experience, some patients develop
excessive granulation tissue. However, simple silver
nitrate sticks have been effective in managing this in
clinic, and the overall result is highly favorable.
Conclusion:
The IV3000 dressing is not suited to all fingertip
injuries, and surgery is still necessary in cases where
there is contamination, tendon laceration, joint
exposure, or major protrusion of bone. For other
patients, conservative management with the IV3000
dressing is an option with excellent cosmetic and
functional results. Despite evidence of good
outcomes, management of fingertip injuries using
similar techniques has not been well studied or
described to patients.
References:
1. Lin YS, Chen J, Li Q, Pan KP. Moisture vapor transmission rates of various transparent dressings at different
temperatures and humidities. Chin Med J. 2009;122(8):927-930.
2. Irion G, editor. Comprehensive wound management. 2nd ed. Thorofare, NJ: Slack Incorporated; 2009.
3. Williamson DM, Sherman KP, Shakespeare DT. The use of semipermeable dressings in fingertip injuries. J
Hand Surg Br. 1987;12(1):125-126.