Abstract
Over the past several decades there has been a profound increase in the understanding of tissue regeneration, driven largely by the observance of the tremendous regenerative capacity in lower order life forms, such as hydra and urodeles. However, it is known that humans and other mammals retain the ability to regenerate the distal phalanges of the digits after amputation. Despite the increased knowledge base on model organisms regarding regenerative paradigms, there is a lack of application of regenerative medicine techniques in clinical practice in regard to digit tip injury. Here, we review the current understanding of digit tip regeneration and discuss gaps that remain in translating regenerative medicine into clinical treatment of digit amputation.
Highlights
The human hand plays numerous critical roles in everyday function
Since the function of the hand relies on its intricate anatomy, complete restoration of injured tissues would be the ideal treatment to preserve the functional capacity of the hand
The germinal matrix of the nail bed contains Wnt-active nail stem cells (NSCs). The reaction of these NSCs to amputation is required for the formation of the regenerative blastema with Wnt signaling in the ectoderm appearing critical for a mesodermal response [22]
Summary
The human hand plays numerous critical roles in everyday function. The hand is used for labor, sensation, communication, and intimacy; injury to the hand profoundly affects almost every aspect of a person’s life. Other than in select tissues containing functionally relevant stem cells, such as the liver, bone marrow, and intestinal mucosa, epimorphic regeneration is replaced by a fibrotic “patch” response in adult mammals [4,5,6]. This patch repair restores the barrier between the body and the external environment but is largely devoid of native tissue properties. We review the current understanding of extremity regeneration and explore clinical approaches to the care of hand injuries in the context of regenerative treatment paradigms
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