One-stage Integra coverage for fingertip injuries

Abstract

Background: We hypothesize that one-stage Integra skin coverage is an effective treatment modality for the treatment of fingertip defects.

Methods: Nine patients who sustained fingertip injuries were treated with one-stage Integra coverage. In all cases, Integra was placed directly on bone. Static two-point discrimination and the Semmes-Weinstein Monofilament Test (SWMFT) were used to determine the sensations of the affected and opposite unaffected digit. The QuickDASH, Cold Intolerance Symptom Severity (CISS), visual analog scale (VAS), and a 0-10-point pain scale were administered to assess patient function, satisfaction, and pain levels.

Results: The mean age was 53.1 years (39-61). There were 8 males and 1 female. The average area covered was 2.3 cm(2) (1.0-3.2). The mean follow-up duration was 16 months (8-46). The median QuickDASH, CISS score, VAS patient satisfaction, and 0-10 pain score were 9.1 (2.3-40.9), 18 (4-30), 10 (most satisfied) (7-10), and 0 (0-3), respectively. Five patients were evaluated for their digital sensory perception. The mean static two-point discrimination was 9.6 mm for the affected digit and 4.6 mm for the opposite unaffected digit. The median SWMFT was 4.31 for the affected digit and 3.61 for the opposite unaffected digit.

Conclusion: For small soft tissue and bone defects involving the fingertip, the use of Integra without further skin grafting appears to be effective, avoids the morbidity of the donor site, and avoids a second surgery. Despite mild sensory deficits, patients were satisfied with the results and fully functional during short-term follow-up.

Keywords: Fingertip; Hand; Integra; Tissue reconstruction.

Figures

Fig. 1

Patient #1: a middle fingertip transverse amputation with exposed bone; b oblique view of the injury; c, d Integra BMWD applied to the injury site and sutured in place with 5–0 chromic sutures; e, f 9 months following treatment, the patient demonstrates complete healing of the fingertip, with some regrowth of the fingerprint at the Integra site

Fig. 2

Patient #6: a, b lateral photographs demonstrating the extent of the fingertip defect after debridement of an infection; c Integra BMWD applied to the injury site and sutured in place with 5–0 chromic sutures; d, e 18 months following treatment, the fingertip is well healed; however, a hook nail deformity has developed