[Treatment of fingertip defect injuries with a semiocclusive dressing according to Mennen and Wiese]

M Mühldorfer-Fodor, B Hohendorff, K-P Vorderwinkler, J van Schoonhoven, K-J Prommersberger
Operative Orthopädie und Traumatologie 2013, 25 (1): 104-14

OBJECTIVE: The goal of conservative treatment of fingertip defects is to restore a stable and bulky pulp with recovery of sensitivity and a good skin quality.

INDICATIONS: Traumatic defects of the fingertip with or without involvement of the fingernail and/or exposed distal phalanx.

CONTRAINDICATIONS: Fractures of the distal phalanx with dislocation or joint involvement, necessitating an osteosynthesis. Allergy to any component of the dressing material. DRESSING TECHNIQUE: Application of a semiocclusive film dressing (polyurethane, bacteria- and waterproof, water vapor permeable). If necessary, debridement of necrotic tissue can precede the first film application. Until complete epithelialization of the defect, the dressing needs to be changed not more than once a week. Thereby, the wound itself must be kept untouched. FURTHER MANAGEMENT: Patients must be encouraged to move all finger joints with the applied dressing. After healing, the new skin is initially protected during heavy loading and shear stress, e.g., by a leather finger glove.

RESULTS: Based on the method of Mennen and Wiese [3], 200 fingertip injuries (some having involvement of the fingernail or exposed distal phalanx) healed within 20-30 days. The pulp was bulky remodeled with good skin quality including the "fingerprint", as well as nearly normal sensitivity. Using this method, Quell et al. [5] reported on 42 fingertip injuries healed within 2-6 weeks. All fingers could be used without limitation; these were free of pain, with remodeled "fingerprint" and barely visible scars, regular perspiration and restored sensitivity (two-point discrimination 2-8 mm).

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