Georgoulis Dimitris J, Melissaridou Dimitra, Zafeiris Ioannis, Papagelopoulos Panayiotis J, Savvidou Olga D
First Department of Orthopedics, Attikon University Hospital, Athens, GRC.
First Department of Orthopaedics, Attikon University Hospital, Athens, GRC.
Cureus. 2021 Aug 10;13(8):e17068. doi: 10.7759/cureus.17068. eCollection 2021 Aug.
There is ongoing controversy regarding the best treatment of fingertip amputations, conservative treatment with secondary healing or surgical intervention. Healing by secondary intention has been proven to offer satisfactory recovery and function. More extensive wounds are treated surgically. However, even in Allen III and IV amputations, there is a lack of evidence to support enhanced healing and function of fingertips after surgical treatment compared to conservative management. Regarding fingertip amputations after animal bites, thorough debridement is the preferred treatment due to various micro-organisms, while there is no consensus about the primary closure of the wound. Inclusion cri-teria are complete amputations even with bone involvement at all levels. Exclusion criteria are skeletonized distal phalangeal bone, not surrounded by soft tissues, joint involvement and exposed tendon. It offers complete regeneration of the fingertip without signs of infection, even in animal bites wounds. There are few reports in the literature regarding the semi-occlusive dressing for treating fingertip amputations-only one report uses this technique after an animal bite in a two-year-old girl. In this case report, an Allen III fingertip amputation caused by a dog bite in a 64-year-old female was managed successfully using the semi-occlusive dressing technique. At the final follow up three months after the injury, the aesthetic results were satisfactory. The fingertip with the nail complex was almost normal with no nail hook deformity. The pad skin regenerated with no signs of infection. The functional results were excellent, with no joint stiffness or disability. The sensibility was satisfactory with two-point discrimination of 4 mm, and there was no tenderness, cold intolerance, or neuroma. The patient was satisfied and able to participate in all daily activities. The semi-occlusive dressing technique is an alternative treatment option for Allen III fingertip amputations after animal bites. It promotes regenerative healing, and despite bacterial colonization, no infection has been reported.
关于指尖截肢的最佳治疗方法存在争议，是采用保守治疗进行二期愈合还是进行手术干预。二期愈合已被证明能带来令人满意的恢复和功能。更广泛的伤口则通过手术治疗。然而，即使在艾伦III型和IV型截肢中，与保守治疗相比，仍缺乏证据支持手术治疗后指尖的愈合和功能得到增强。对于动物咬伤后的指尖截肢，由于存在各种微生物，彻底清创是首选治疗方法，而对于伤口的一期缝合尚无共识。纳入标准是完全截肢，即使各层面均有骨质受累。排除标准是指骨远端骨骼化、未被软组织包围、关节受累和肌腱外露。即使在动物咬伤伤口中，它也能使指尖完全再生且无感染迹象。文献中关于用于治疗指尖截肢的半封闭敷料的报道很少——只有一篇报道在一名两岁女孩被动物咬伤后使用了这种技术。在本病例报告中，一名64岁女性因被狗咬伤导致艾伦III型指尖截肢，采用半封闭敷料技术成功治疗。在受伤后三个月的最后随访中，美学效果令人满意。带有指甲复合体的指尖几乎正常，无指甲钩畸形。垫状皮肤再生且无感染迹象。功能结果极佳，无关节僵硬或残疾。感觉功能令人满意，两点辨别觉为4毫米，无压痛、冷不耐受或神经瘤。患者满意且能够参与所有日常活动。半封闭敷料技术是动物咬伤后艾伦III型指尖截肢的一种替代治疗选择。它促进再生愈合，尽管有细菌定植，但尚未有感染的报道。
