Dimitrova-Chakarova Polina, Prommersberger Karl-Josef, van Schoonhoven Jörg, Mühldorfer-Fodor Marion
Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Germany.
Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany.
Handchir Mikrochir Plast Chir. 2025 Feb;57(1):32-43. doi: 10.1055/a-2496-2706. Epub 2025 Jan 20.
Since their introduction by Mennen and Wiese in 1993, semi-occlusive film dressings (SOFD) have been increasingly used in various clinical contexts, including the treatment of Allen type IV fingertip injuries, fingertip necrosis, and cases involving embedded foreign material.This study aimed to investigate whether and, if so, how the outcomes of Allen type III and IV fingertip injuries and fingertip necrosis differ from those of Allen types I and II. In addition, it aimed to investigate if the presence of embedded foreign material under a film dressing increases the risk of complications.A total of 50 patients with 44 fingertip injuries and 13 fingertip necroses were treated with an SOFD in combination with surgical intervention. In 22 out of 50 patients, foreign material was present under the film dressings. During follow-up, cold sensitivity, pain at rest and during activity, the usage of the injured finger in daily life, patient satisfaction with the aesthetic outcome, sensitivity, sweat secretion, papillary ridges, nail deformity, and mobility were assessed. The fingertips were examined for nail growth abnormalities. The results of the Allen type I-IV fingertip injuries and fingertip necrosis were compared with each other and related to findings from the uninjured fingers of the opposite hand. Clinical outcomes showed that SOFD led to good fingertip regeneration at any amputation level and in cases of fingertip necrosis. However, nail deformities increased with shorter lengths of the distal phalanx. Patients with necrosis were less satisfied with the aesthetic outcome compared to those receiving primary treatment after amputation injury. The presence of foreign material under the film dressings did not influence the healing process, and no infections were observed.SOFDs demonstrate good outcomes in Allen type III and IV fingertip injuries as well as in fingertip necrosis, comparable to those of Allen type I and II. However, it is essential to inform patients about potential risks such as nail deformities and compromised aesthetic appearance. Surgical interventions involving foreign material under an SOFD do not affect the healing of fingertip injuries, thus allowing for an expanded range of indications for SOFDs.
自1993年门嫩和维泽引入半封闭薄膜敷料（SOFD）以来，其在各种临床环境中的使用越来越多，包括治疗艾伦IV型指尖损伤、指尖坏死以及涉及嵌入异物的病例。本研究旨在调查艾伦III型和IV型指尖损伤及指尖坏死的结果与艾伦I型和II型是否不同，若不同，具体差异如何。此外，研究还旨在调查薄膜敷料下存在嵌入异物是否会增加并发症风险。共有50例患者，其中44例指尖损伤和13例指尖坏死接受了SOFD联合手术干预治疗。50例患者中有22例薄膜敷料下存在异物。在随访期间，评估了冷敏感性、静息和活动时的疼痛、受伤手指在日常生活中的使用情况、患者对美学效果的满意度、敏感性、汗液分泌、乳头嵴、指甲畸形和活动度。检查指尖是否有指甲生长异常。将艾伦I - IV型指尖损伤和指尖坏死的结果相互比较，并与对侧未受伤手指的结果相关联。临床结果表明，SOFD在任何截肢水平和指尖坏死病例中均能实现良好的指尖再生。然而，远端指骨长度越短，指甲畸形越严重。与截肢损伤后接受初次治疗的患者相比，坏死患者对美学效果的满意度较低。薄膜敷料下存在异物并不影响愈合过程，且未观察到感染。SOFD在艾伦III型和IV型指尖损伤以及指尖坏死中显示出良好的效果，与艾伦I型和II型相当。然而，必须告知患者潜在风险，如指甲畸形和美学外观受损。涉及SOFD下异物的手术干预不会影响指尖损伤的愈合，因此扩大了SOFD的适应证范围。
