Matriderm dermal substitute in the treatment of post traumatic hand’s fingertip tissue loss

Abstract

Introduction: Treatment of fingers tissue loss is particularly challenging as it often necessitates advanced reconstructive techniques such as flaps or grafts, with esthetic and functional results that are not always as good as hoped for, with long healing times. Recently, along with tissue engineering development, numerous types of dermal substitute have been commercialized, with promising possibilities of treatment in finger tissue loss. In the author's unit, Matriderm ® is the most commonly used dermal substitute. As described by the manufacturer, this scaffold is designed to be covered with a split-thickness skin graft. In using a two-step procedure, the authors realized that in most cases of fingertips injuries, at three weeks follow-up, the wound appeared in an advanced state of healing, which permitted to avoid grafting. Material And Methods: Between October 2017 and October 2018, 27 fingers have been included in this study. Patients have been divided in two groups: those treated with Matriderm ® alone (15 fingers) and those who had a skin graft three weeks after the first surgery (12 fingers). At the 6-month follow-up, authors evaluated the esthetic results with the Vancouver Scar Scale (VSS), the functional results with Quick Disability of the Arm, Shoulder and Hand (qDASH) score, and sensibility by the mean of two-point discrimination test (2-PD).Results: All outcomes were overlapping in patients treated with or without skin graft: mean VSS was 2.3, mean qDASH was 13.3, and mean 2-PD was 7.7 mm. Conclusions:The results obtained allow to consider Matriderm ® , used also without skin graft coverage, as a valid solution for treatment of fingertip tissue loss.

Assessment of Two Commonly used Dermal Regeneration Templates in a Swine Model without Skin Grafting

“…However, only minor wounds reepithelialize without the need for transplantation [37] as also shown by Fulchignoni et al They recently published a clinical study, comparing the use of the non-crosslinked biomatrix with or without grafting in the treatment of fingertip tissue loss [38]. So, in the current study, it would have been an interesting point to analyze wounds of increasing sizes.…”

Double-pivot proper digital artery perforator flap for fingertip reconstruction

“…Recently, the moist antiseptic dressings have received global use [ 20 , 21 ], some artificial dermal substitute could even circumvent the necessity of skin graft and yield satisfying aesthetic outcome [ 22 ]. However, the usage of these substitute on bone exposure is still controversial [ 23 ], while this exposure was present in most of the cases in present study; an option is nibbling the protruding bone, which yet creates a shortened finger length [ 24 ]. But we do agree that this less invasive approach is promising and deserving more appreciation in repairing finger pulp.…”

Repair of a finger pulp or fingertip defect using a palmar rotatory flap pedicled with the perforating branch of the proper palmar digital artery: a retrospective study

“…Conventional repair methods for finger pulp soft tissue defects include the V–Y flap, cross-finger flap, proximal finger flap [ 19 ], digital artery inverted flap, dorsal flap of the first web [ 10 ], partial second toe transfer [ 9 ], and covering the wound with biomaterials to repair it [ 20 ]. Various flaps require different adaptation conditions [ 21 ].…”

“…The central area of the skin graft may increase the possibility of skin necrosis owing to blood accumulation and the presence of uneven stress [ 23 , 24 ]. Using a proximal finger flap [ 20 ], a digital artery inverted flap or a dorsal flap of the first web [ 10 ] to repair the defect of the distal finger pulp and fingertip is tantamount to demolishing an expensive wall and constructing a cheaper wall to replace it; the gain is lost. This approach does not conform to the principles of flap economics.…”