Hydrogel and Finger Caps: A Novel Dressing Method for Composite Grafts of Fingertips

Lee, Sam Yong; Lee, Dong Gyu; Hwang, Jae Ha; Kim, Kwang Seog

Abstract

BACKGROUND
Composite grafting is a useful reconstruction method for amputated fingertips when the size of the defect is small and vessels for anastomosis are not available. However, the survival rate of a composite graft is highly variable and difficult to anticipate. The most important factor for optimal wound healing is a moist environment, while wound desiccation is one of the main obstacles in graft survival. In this article, we introduce a new dressing method for preventing graft desiccation and enhancing the survival rate of grafts.
METHODS
From February 2012 to February 2019, 18 patients with fingertip injuries distal to the distal interphalangeal joint with or without nail bed injury were enrolled. After the amputated part was reattached as a composite graft using 5-0 nylon, Duoderm Hydroactive Gel was applied on the graft, which was then covered with a "finger cap." Each finger cap was cut from a sterile latex glove. Including the degree of graft survival, any complications related to the graft were recorded.
RESULTS
Not a single case of infection was observed. From the total of 18 composite grafts, eight took well without necrosis. In 10 cases, though partial necroses were observed they were of insignificant sizes, and all healed by secondary intention without other additional surgical procedures.
CONCLUSION
Treating fingertip defects with a composite graft and dressing method using hydrogel with a finger cap can prevent wound desiccation, enhance survival rates, and reduce patient distress.