The semi-occlusive dressing in treating Allen III and IV fingertip injuries as an alternative to local skin flaps

Abstract

Fingertip injuries are very common in emergency departments. According to the literature, AllenIII andIV fingertip injuries should be treated with local skin flaps. Instead, we have treated these kinds of injuries in recent years with a semi-occlusive dressing. The main purpose of this study was to evaluate the outcome after semi-occlusive dressing therapy with respect to soft tissue cover, recovery of sensibility and duration of disability. We retrospectively analysed 77fingertip injuries (39AllenI, 25AllenII, 9AllenIII, 4AllenIV) from 2008-2011 in 23women and 54men who were treated with a semi-occlusive dressing. The mean age was 36± 14years and the mean follow-up was sevenmonths. The bone was not shortened even if the bone was exposed up to the wound level. The primarily occlusive dressing was left as long as possible and was sealed when necessary. Furthermore, the treatment time with the semi-occlusive dressing and the period of disability was recorded. Patient sensitivity recovery was also analysed. The mean treatment duration was 21± 10days and the mean duration of disability was 30± 17days. The mean duration of disability was 19± 8days for AllenI injuries, 36± 16days for AllenII, 45± 20days for AllenIII and 58± 7days for AllenIV. All patients developed satisfactory tissue cover and sensibility recovery. For amputation injuries of AllenIII andIV, we recorded anormal light-touch 2‑point discrimination in the Semmes-Weinstein Test in 77 % and diminished in 23 %. There were no complications like tissue infections, neuroma or osteitis. Also, no secondary flap supply was necessary. The semi-occlusive dressing is agood therapy for all kind of fingertip injuries, regardless of the amputation level. Even if the bone is exposed up to the wound level, satisfactory soft tissue cover can be achieved.