Academic Editor:Mohamed Elfahar, Pan-Arab Federation of Societies for the Surgery of the Hand, Egypt.
Checked for plagiarism: Yes
The use of Dermacell® in Fingertip Injury
Matrices or tissue scaffolds provide a collagen structure for tissue remodelling while the removal of viable cells aims to minimize or prevent inflammatory or immunogenic response.
Allograft collagen scaffold can support the patient’s own cellular ingrowth, ingeneered to minimize an immune response and to yeld a bio-compatible matrix and support incoming cellular growth. The decellyularized dermis retains its growth factors, native collagen scaffold, and elastin, thanks to a LifeNet Health proprietaryprocessin technology.
Fingertip injuries are defined as those distal to the insertion of the flexor and extensor tendons Primary goal of treatment is a painless fingertip with durable and sensate skin. 1 Methods of treatment include healing by secondary intention, skin grafting, shortening of the bone and primary closure, and coverage with local or regional flaps.
History and mechanism of the injury
Patient factors age, gender, handedness, occupation, and history of previous hand injuries
Function of flexor and extensor tendons
Antibiotics and tetanus prophylaxis
Soft-tissue loss without exposed bone
Soft-tissue loss with exposed bone
Nail bed injuries
For the treatment of fingertip injuries, the decision making process should proceed from the simpler techniques to the more complicated. When no bone is exposed, the open method is ideal for small or moderate sized wounds, and skin grafting should be considered for larger wounds . Distal transverse and dorsal oblique amputations with bone exposure can be treated with local advancement flaps. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14
Derma cell was able to provide protection for the wound while encouraging rapid healing without the disadvantages of donor site morbidity and increased patient pain from an autograft. The rapid wound closure was encouraging and supports further use of Derma Cell for treating soft tissue trauma wounds.
Case no. 2. 48 y/o, female. Laceration wound of right index finger; dorsal oblique soft tissue defect; nail bed defect; over DIPJ with bone and joint exposure. (Figure 5, Figure 6, Figure 7, Figure 8.)
Case 7. 40 y/o female. Crush injury of the right hand; amputation of right middle finger through DIPJ with volar oblique defect; amputation of right finger through middle phalanx with volar oblique defect; bone exposure. (Figure 22, Figure 23, Figure 24, Figure 25).
The wounds progressed steadily, with full wound closure being achieved (average 1 to 4 months) after initial implantation. There were no signs of infection observed and the patient did not experience any reaction to the graft. Although the wound began healing slowly initially, the authors felt that was due to the complexity of the traumatic wound.
We T reat R outinely Finertip Injuries with ADM ( Derma cell ) .