Journal Article

Nail Regeneration of an Allen III Fingertip Amputation After a Dog Bite Using the Semi-occlusive Dressing Technique: A Case Report and Literature Review

Zafeiris, Ioannis, Georgoulis, Dimitris J, Savvidou, Olga D, Melissaridou, Dimitra, Papagelopoulos, Panayiotis J

2021

Overview

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.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.

• Publisher: Cureus
• Subject: Orthopedics / Plastic Surgery / Trauma