Orthopedic Clinic, Takita Hospital, Yamato-Kohriyama-Shi, Nara, Japan.
Nara Hand Surgery Institute, Takita Hospital, Nara, Japan.
J Plast Surg Hand Surg. 2023 Sep 27;58:115-118. doi: 10.2340/jphs.v58.18351.
Replantation is widely regarded as the first choice of treatment for finger amputations. However, if the fingertip of a traumatic finger amputation is missing after an injury, the following procedures are often performed to reconstruct this portion: flap surgery, stump surgery, or conservative treatment, including occlusive dressings. To our knowledge, no existing English literature reports using negative-pressure wound therapy (NPWT) to treat traumatic finger amputations. We postulated that NPWT may be applied as a conservative treatment for traumatic finger amputations, promoting the growth of granulation tissue and achieving early epithelialization of the fingertips. Among the case series of five patients, we included six injured fingers comprising two index, two middle, and two ring fingers. The fingertip of each traumatic finger amputation was either missing or highly crushed, making replantation impossible. To preserve finger length with conservative treatment, we adapted an NPWT device for finger amputations. It took an average of 22.7 days for the fingertips to epithelialize. Immediately after epithelialization, there was a slight decrease in sensory perception; however, all patients showed good recovery of sensory perception after 3 months. Range of motion remained unrestricted, with no reduction in grip strength. Patients were highly satisfied with their fingertip appearance. The regenerated nail exhibited slight deformation and shortening. No complications were observed. Our novel study regarding this new conservative treatment and its outcomes revealed that healing was achieved in a relatively short period; therefore, NPWT may serve as a new conservative treatment option in the future.
再植被广泛认为是手指离断伤的首选治疗方法。然而，如果创伤性手指离断伤的指尖缺失，通常会采用以下方法进行重建：皮瓣手术、残端修整术或保守治疗，包括闭塞敷料。据我们所知，目前尚无英文文献报道使用负压伤口治疗（NPWT）治疗创伤性手指离断伤。我们推测 NPWT 可作为一种保守治疗方法用于创伤性手指离断伤，促进肉芽组织生长，并实现指尖的早期上皮化。在五例患者的病例系列中，我们纳入了 6 根受伤手指，包括 2 根食指、2 根中指和 2 根环指。每个创伤性手指离断伤的指尖要么缺失，要么严重压碎，无法再植。为了通过保守治疗保留手指长度，我们为手指离断伤适配了 NPWT 设备。指尖平均需要 22.7 天才能上皮化。上皮化后立即出现感觉感知轻微下降，但所有患者在 3 个月后均表现出良好的感觉感知恢复。关节活动度不受限制，握力无下降。患者对指尖外观非常满意。再生指甲稍有变形和缩短。未观察到并发症。我们关于这种新的保守治疗及其结果的新研究表明，愈合在相对较短的时间内实现；因此，NPWT 可能成为未来的一种新的保守治疗选择。
