First Insights into Human Fingertip Regeneration by Echo-Doppler Imaging and Wound Microenvironment Assessment

Paris Jafari, Camillo Muller, Anthony Grognuz, Lee Ann Applegate, Wassim Raffoul, Pietro G di Summa, Sébastien Durand, Paris Jafari, Camillo Muller, Anthony Grognuz, Lee Ann Applegate, Wassim Raffoul, Pietro G di Summa, Sébastien Durand

Abstract

Fingertip response to trauma represents a fascinating example of tissue regeneration. Regeneration derives from proliferative mesenchymal cells (blastema) that subsequently differentiate into soft and skeletal tissues. Clinically, conservative treatment of the amputated fingertip under occlusive dressing can shift the response to tissue loss from a wound repair process towards regeneration. When analyzing by Immunoassay the wound exudate from occlusive dressings, the concentrations of brain-derived neurotrophic factor (BDNF) and leukemia inhibitory factor (LIF) were higher in fingertip exudates than in burn wounds (used as controls for wound repair versus regeneration). Vascular endothelial growth factor A (VEGF-A) and platelet-derived growth factor (PDGF) were highly expressed in both samples in comparable levels. In our study, pro-inflammatory cytokines were relatively higher expressed in regenerative fingertips than in the burn wound exudates while chemokines were present in lower levels. Functional, vascular and mechanical properties of the regenerated fingertips were analyzed three months after trauma and the data were compared to the corresponding fingertip on the collateral uninjured side. While sensory recovery and morphology (pulp thickness and texture) were similar to uninjured sides, mechanical parameters (elasticity, vascularization) were increased in the regenerated fingertips. Further studies should be done to clarify the importance of inflammatory cells, immunity and growth factors in determining the outcome of the regenerative process and its influence on the clinical outcome.

Keywords: Doppler imaging; angiogenesis; clinical assessment; fingertip regeneration.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative images of amputated fingers. (a) At admission and before the application of occlusive dressing; (b) Three months post-trauma and at clinical and morphological evaluation.
Figure 2
Figure 2
Representative echo-doppler images of regenerated (upper row) and un-injured collateral (lower row) fingertips. (a) Ultrasound b-mode imaging for the measurement of the pulp thickness; (b) b-mode imaging with superimposed share wave mapping for the measurement of the pulp elasticity. The white circle has a diameter of 5 mm; (c) b-mode imaging with superimposed power Doppler for the measurement of vascularity.
Figure 3
Figure 3
Morphologic, mechanical and vascular characteristics of regenerated fingertips compared to control collateral healthy finger. (a) Soft tissue coverage, (b) Elasticity, (c) vascularization. Data are presented as mean ± SD for five patients (* p < 0.05).
Figure 4
Figure 4
Measured levels of (a) growth factors, (b) cytokines and chemokines in fingertip exudate samples (FT) and burn wound exudate samples (B), seven days post-trauma.

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