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Semi-occlusive Dressing for the Management of Fingertip Amputations

机译：半封闭敷料管理指尖截肢

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Objective: The objective of the study was to present an alternative therapeutic option that could replace local skin flaps in the management of fingertip amputations and to report the results from a functional, aesthetic, and general satisfaction point of view. Method: Descriptive study in adult population which included patients with fingertip amputations treated with semi-occlusive dressing consisting of a polyurethane adhesive. The injuries were classified according to the Allen classification. All lesions received a 3 liters of saline solution wash, debridement, administration of single dose of prophylactic antibiotic, tetanus vaccination by hospital policy, and application of a semiocclusive dressing under transient ischemia of the affected finger. There was no intervention in the exposed bone even though its exposition might be located at the level of amputation or beyond. At the time of discharge, all cases were studied with radiograph and ultrasound, measuring the thickness of soft tissue distal to the bone level. The 400 Points Test and QuickDASH, validated for the Chilean population, were applied 1 month after discharge. All patients were presented with the option of psychological check. For the data analysis, Stata 12.1 was used. Results: A total of 67 injuries were obtained. The average age of treated patients was 43 years old (SD = 14.7). According to Allen’s classification, lesions were: level 1 35.82%, level 2 37.31%, level 3 25.37%, and level 4 1.49%. All cases achieved full healing in the injured finger. The mean time of disability was 60.58 days (SD = 16.66). The length of soft tissue growth distal to the bone level as measured by ultrasound had an average of 3.66 mm (SD = 0.72). All patients achieved full functional and aesthetic satisfaction, with a median for 400 Points and QuickDASH Test of 90 and 12.6, respectively. There were no complications such as infection, scarring, neuroma, or osteitis. No supplementary flap or additional therapeutic action was required. Conclusions: Semi-occlusive dressing for the treatment of fingertip amputations is a valid option for obtaining satisfactory results from a functional, aesthetic, and global point of view. It is a very easy method to execute in emergency rooms and has a very low cost and a high reproducibility. No complications have been recorded, and it is an excellent alternative to local skin flaps. However, we believe that future studies that incorporate more complex methodological designs should be made to be able to present a greater external validity.
机译：目的：本研究的目的是提出一种替代性治疗方案，该方案可替代指尖截肢术中的局部皮瓣并从功能，美学和总体满意度的角度报告结果。方法：对成年人群的描述性研究，其中包括使用由聚氨酯粘合剂组成的半封闭敷料治疗的指尖截肢患者。受伤根据艾伦分类。所有病变均接受3升盐水溶液清洗，清创术，单剂预防性抗生素的施用，医院政策的破伤风疫苗接种以及在受影响手指的短暂性缺血下应用半闭塞敷料。即使暴露的骨头可能位于截肢水平或更高水平，也没有干预。出院时，所有病例均进行了X射线照片和超声检查，测量了远端骨水平的软组织厚度。出院后1个月进行了针对智利人口的验证的400点测试和QuickDASH。所有患者均接受了心理检查。对于数据分析，使用了Stata 12.1。结果：共获得67伤。治疗患者的平均年龄为43岁（SD = 14.7）。根据艾伦的分类，病变为：1级35.82％，2级37.31％，3级25.37％和4级1.49％。所有病例均在受伤的手指上完全康复。平均残疾时间为60.58天（SD = 16.66）。超声测量到骨水平远端的软组织生长的长度平均为3.66毫米（SD = 0.72）。所有患者均获得了完全的功能和美学满意度，中位数分别为400分和QuickDASH测试分别为90和12.6。没有并发症，如感染，疤痕，神经瘤或骨炎。无需补充皮瓣或其他治疗作用。结论：半封闭敷料治疗指尖截肢是从功能，美学和整体角度获得满意结果的有效选择。这是在急诊室执行的一种非常简单的方法，并且成本非常低且可重复性很高。没有并发症的记录，它是局部皮瓣的绝佳替代品。但是，我们认为，应该进行包含更复杂方法设计的未来研究，以便能够表现出更大的外部有效性。

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