Zareef Usman, Green Anna, Moore Caroline, Iyer Hari, Katt Brian, Shah Ajul
Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Hand Surg Glob Online. 2025 Jan 24;7(2):186-191. doi: 10.1016/j.jhsg.2024.11.014. eCollection 2025 Mar.
Traumatic fingertip amputations are one of the most encountered injuries in the emergency department requiring evaluation by a hand surgeon. Current management strategies vary widely. We describe the use of acellular urinary bladder matrix (UBM) in complex distal fingertip injuries involving bone, soft tissue, and nailbed.
A prospective cohort of 47 patients with proximal fingertip amputations (36 Allen zone III and 15 Allen zone IV) underwent UBM application with resultant fingertip regeneration. Patients received the first application in the operating room. Subsequent applications were reapplied weekly in the clinic setting until fibrinous granulation tissue was observed (average 2.5 total applications). Patients performed daily dressing changes until regeneration was achieved.
The average time to regeneration was 8.4 weeks. The mean length deficit compared to the contralateral fingertip was 3.6 mm for zone 3 and 4.8 mm for zone 4 injuries. The static 2-point discrimination of the injured fingertip was 1.2 mm less sensitive compared to the contralateral uninjured finger in zone 3 injuries and 1.1 mm in the zone 4 cohort. Overall patient satisfaction measured on a 10-point Likert scale was 9.5. Seven complications were observed: 5 hook nail deformities, one bony exostosis requiring surgical excision, and one case of pyogenic granuloma.
Application of UBM is a reliable way to promote composite regeneration of Allen III-IV fingertip injuries. Its use resulted in excellent patient satisfaction with minimal complications encountered. Urinary bladder matrix should be considered for use in the treatment of proximal fingertip amputations.
Therapeutic IV.
创伤性指尖离断是急诊科最常遇到的需要手外科医生评估的损伤之一。目前的治疗策略差异很大。我们描述了脱细胞膀胱基质（UBM）在涉及骨骼、软组织和甲床的复杂远端指尖损伤中的应用。
对47例近端指尖离断患者（36例Allen III区和15例Allen IV区）进行前瞻性队列研究，应用UBM后实现了指尖再生。患者在手术室接受首次应用。随后每周在门诊重新应用，直到观察到纤维蛋白肉芽组织（平均总共应用2.5次）。患者每天更换敷料，直到实现再生。
平均再生时间为8.4周。与对侧指尖相比，3区损伤的平均长度缺损为3.6mm，4区损伤为4.8mm。在3区损伤中，受伤指尖的静态两点辨别力比对侧未受伤手指低1.2mm，在4区队列中低1.1mm。以10分制Likert量表衡量的总体患者满意度为9.5。观察到7例并发症：5例钩甲畸形、1例需要手术切除的骨外生骨疣和1例化脓性肉芽肿。
应用UBM是促进Allen III-IV级指尖损伤复合再生的可靠方法。其应用使患者满意度极高，并发症极少。膀胱基质应用于近端指尖离断的治疗应予以考虑。
治疗性IV级。
