Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

Abstract

Background Fingertip injuries with volar pulp tissue defects present a significant challenge in management. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressings for these injuries. Methods A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol included wound debridement, application of artificial dermis (Pelnac^®), and a semi-occlusive dressing (IV3000^®). The outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. Results The mean treatment duration was 45.29 days (SD = 17.53). Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score = 2.58, SD = 0.67). The sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean = 0.45, SD = 0.67), and cosmetic satisfaction was high (mean = 4.09, SD = 0.94). The overall patient satisfaction was high (mean = 4.41, SD = 0.67), regardless of injury severity. Conclusions The conservative treatment protocol using artificial dermis and semi-occlusive dressings is a promising strategy for managing fingertip injuries with volar pulp defects. This approach minimizes surgical morbidity and achieves excellent functional and aesthetic outcomes.

Keywords: Pelnac®; artificial dermis; fingerprint; fingertip; reconstruction; regeneration; semi-occlusive; volar.

Figure 1

The flow diagram of this study.

Figure 2

Application of artificial dermis and semi-occlusive dressing for fingertip injury. (A) Preoperative view of a middle finger pulp injury; (B) intraoperative view showing the application of artificial dermis (Pelnac^®) to the defect, followed by a semi-occlusive dressing (IV3000^®).

Figure 3

Treatment progression and outcomes following artificial dermis application and semi-occlusive dressing for a fingertip injury. (A) Pre-operative view of the right index fingertip injury with distal phalanx and soft tissue defect; (B) immediate post-operative view after debridement and application of artificial dermis; (C) five weeks post-treatment, showing the regeneration of pulp tissue and early restoration of the fingerprint pattern under the semi-occlusive dressing; (D) seven weeks post-treatment, demonstrating complete wound healing with well-formed fingerprint ridges, restored sensation, minimal pain, and satisfactory cosmetic appearance.

Figure 4

Reconstruction of a thumb tip defect using artificial dermis application and semi-occlusive dressing, resulting in nail splitting. (A,B) Pre-operative pictures showing a soft tissue defect of the right thumb side wall with tendon and bone exposure; (C) appearance after artificial dermis grafting; (D) follow-up photograph 7 weeks after the treatment, demonstrating good healing of the defect site but with observable nail splitting.

Figure 5

Clinical progression of fingertip regeneration following treatment with artificial dermis and semi-occlusive dressing, demonstrating variability in outcomes. (A) Pre-operative view of severe injuries to the left ring and little fingers with complete soft tissue loss and exposed distal phalanges; (B) four weeks post-treatment, showing significant granulation tissue formation and coverage of the exposed bone; (C) seven weeks post-treatment, demonstrating slower progression of wound healing, with no exposed bone and partial restoration of the fingerprint ridges. However, trophic changes in the nail bed are evident due to the shortened distal phalanges; (D) ten weeks post-treatment, revealing complete wound healing with residual scarring on the ring finger and near-complete regeneration of the fingerprint on the little finger. Hook nail deformities are present in both fingers as a consequence of the shortened distal phalanges, which could not be lengthened by the treatment protocol.