Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol
Abstract
:1. Introduction
- Assess the regeneration of volar pulp tissue, including the restoration of fingerprint pattern, sensory function, and cosmetic appearance.
- Evaluate the impact of injury characteristics, such as bone or tendon exposure, on treatment outcomes and duration.
- Investigate the incidence of complications and patient-reported outcomes, including pain, sensory disturbances, and overall satisfaction.
- Compare the treatment duration and outcomes with those reported in previous studies utilizing artificial dermis or semi-occlusive dressings separately for fingertip reconstruction.
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Treatment Protocol
2.3. Outcome Measures
- Cosmetic satisfaction: rated on a scale from 1 to 5, with higher scores indicating greater satisfaction with the appearance of the treated finger.
- Sensory impairment: rated on a scale from 0 to 5, with lower scores indicating less sensory loss.
- Sensory hypersensitivity: rated on a scale from 0 to 5, with lower scores indicating less discomfort or abnormal sensations.
- Pain: assessed using a visual analog scale (VAS) ranging from 0 to 5, with lower scores indicating less or no pain.
- Overall satisfaction: rated on a scale from 1 to 5, with higher scores indicating greater satisfaction with all aspects of the treatment and recovery process.
2.4. Statistical Analysis
- Patients with and without bone exposure.
- Patients with and without tendon exposure.
- Patients with both bone and tendon exposure versus those with neither.
3. Results
3.1. Participant Demographics and Injury Characteristics
3.2. Treatment Protocol and Healing Duration
3.3. Complications and Clinical Outcomes
3.4. Fingerprint Regeneration
3.5. Sensory Assessment
3.5.1. Hypoesthesia
3.5.2. Hyperesthesia
3.6. Pain Assessment
3.7. Cosmetic Assessment
3.8. Overall Satisfaction
4. Discussion
Study | Sample Size | Injury Type | Method | Treatment Duration (days) | Key Outcomes |
---|---|---|---|---|---|
Current Study | 31 | Volar pulp defects with bone and/or tendon exposure | Pelnac® | 45.29 ± 17.53 | High patient satisfaction, good sensory recovery, and cosmetic outcomes |
Wang et al., 2022 [12] | 24 | Fingertip defects with bone exposure | Pelnac® | 28~42 | Improves appearance and function, and decreases the need for stump trimming in amputated fingers. |
Namgoong et al., 2020 [18] | 23 | Fingertip defects with bone exposure | Tissue-engineered artificial dermis | 34.0 ± 4.9 | Superior functional and aesthetic outcome compared to artificial dermis graft |
Hoigné et al., 2014 [23] | 19 | Fingertip amputations(Ishikawa zones II–III) | OpSite® Flexifix® (Richardson Healthcare Ltd., Borehamwood, UK) dressing | 21~56 | Good sensory recovery and cosmetic outcomes |
Boudard et al., 2019 [38] | 19 | Fingertip amputations (M and D * zones I–III) | Semi-occlusive dressing (Tegaderm®, 3M Company, St. Paul, MN, USA) | 30.1 ± 7 | Good functional and cosmetic outcomes |
Mennen and Wiese, 1993 [36] | 200 | Various fingertip injuries | Semi-occlusive dressing (OpSite®) | 20–30 | Good functional and cosmetic outcomes, low complication rate |
- Conducting well-designed, randomized controlled trials comparing conservative treatments with surgical interventions, using standardized outcome measures and longer follow-up periods to assess long-term efficacy, durability, pain levels, and nerve recovery.
- Performing comparative studies on different dermal substitutes and dressing materials to identify the most effective combinations that minimize treatment time while maximizing regenerative outcomes.
- Incorporating objective sensory assessments, such as the two-point discrimination test, alongside subjective evaluations to provide a more comprehensive understanding of sensory recovery
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Total (N = 31) | Bone Exposure | No Bone Exposure | Tendon Exposure | No Tendon Exposure |
---|---|---|---|---|---|
Gender | |||||
Male | 25 (80.6%) | 17 | 8 | 8 | 17 |
Female | 6 (19.4%) | 5 | 1 | 2 | 4 |
Age (years) | |||||
Mean ± SD | 43.29 ± 15.00 | 43.11 ± 17.22 | 43.36 ± 14.44 | 40.50 ± 14.73 | 44.61 ± 15.30 |
Affected Fingers | |||||
Thumb | 3 (9.7%) | 2 | 1 | 3 | 0 |
Index | 13 (41.9%) | 8 | 5 | 8 | 4 |
Middle | 6 (19.4%) | 4 | 2 | 4 | 2 |
Ring | 8 (25.8%) | 6 | 2 | 4 | 4 |
Little | 5 (16.1%) | 3 | 2 | 3 | 2 |
Complication | No. of Patients (%) | Management |
---|---|---|
Hook nail deformity | 6 (19.35%) | Observation and patient education |
Scar contracture | 1 (3.22%) | Steroid injection and silicone gel ointment |
Onychomycosis | 1 (3.22%) | Antifungal medication |
Nail splitting | 1 (3.22%) | Observation and patient education |
Outcome Measure | Bone Exposure | Tendon Exposure | Combined Exposure |
---|---|---|---|
Treatment duration (days) | 44.11 ± 10.48 (without) vs. 45.77 ± 19.91 (with) (p = 0.131) | 41.71 ± 15.67 (without) vs. 52.80 ± 19.65 (with) (p = 0.512) | 43.63 ± 11.09 (neither) vs. 53.33 ± 20.76 (both) (p = 0.143) |
Fingerprint regeneration score † | 2.44 ± 0.88 (without) vs. 2.63 ± 0.58 (with) (p = 0.781) | 2.57 ± 0.67 (without) vs. 2.60 ± 0.69 (with) (p = 0.917) | 2.37 ± 0.91 (neither) vs. 2.55 ± 0.72 (both) (p = 0.815) |
Hypoesthesia score § | 0.22 ± 0.66 (without) vs. 0.04 ± 0.21 (with) (p = 0.426) | 0.09 ± 0.43 (without) vs. 0.10 ± 0.31 (with) (p = 0.968) | 0.25 ± 0.70 (neither) vs. 0.11 ± 0.33 (both) (p = 0.963) |
Hyperesthesia score § | 0.11 ± 0.33 (without) vs. 0.31 ± 0.64 (with) (p = 0.382) | 0.28 ± 0.64 (without) vs. 0.20 ± 0.42 (with) (p = 0.702) | 0.12 ± 0.35 (neither) vs. 0.22 ± 0.44 (both) (p = 0.743) |
Pain score (VAS) § | 0.44 ± 0.52 (without) vs. 0.45 ± 0.73 (with) (p = 0.781) | 0.38 ± 0.58 (without) vs. 0.60 ± 0.84 (with) (p = 0.633) | 0.37 ± 0.51 (neither) vs. 0.55 ± 0.88 (both) (p = 0.743) |
Cosmetic satisfaction score ¶ | 4.22 ± 0.97 (without) vs. 4.04 ± 0.95 (with) (p = 0.654) | 4.14 ± 0.91 (without) vs. 4.00 ± 1.05 (with) (p = 0.787) | 4.12 ± 0.99 (neither) vs. 3.88 ± 1.05 (both) (p = 0.673) |
Overall satisfaction score ¶ | 4.66 ± 0.70 (without) vs. 4.31 ± 0.64 (with) (p = 0.174) | 4.47 ± 0.67 (without) vs. 4.30 ± 0.67 (with) (p = 0.492) | 4.62 ± 0.74 (neither) vs. 4.22 ± 0.66 (both) (p = 0.236) |
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Kang, D. Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol. J. Clin. Med. 2024, 13, 3646. https://doi.org/10.3390/jcm13133646
Kang D. Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol. Journal of Clinical Medicine. 2024; 13(13):3646. https://doi.org/10.3390/jcm13133646
Chicago/Turabian StyleKang, Daihun. 2024. "Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol" Journal of Clinical Medicine 13, no. 13: 3646. https://doi.org/10.3390/jcm13133646
APA StyleKang, D. (2024). Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol. Journal of Clinical Medicine, 13(13), 3646. https://doi.org/10.3390/jcm13133646