Dermal Substitute as Bridge in Finger Reconstruction
Dermal Substitute as Bridge in Finger Reconstruction
Twelve (46.2%) patients required no additional coverage after initial application of ADS. Fourteen (53.8%) patients required subsequent coverage at a later stage, of which 11 (42.3% of total patients) were treated with a pinch FTSG, 1 (4.2% of total) with a STSG, and 1 (4.2% of total) with a FTSG and cross finger flap (CFF). One (4.2% of total) patient required removal of the infected graft and reapplication of ADS and a pinch FTSG. This patient eventually died due to underlying comorbidities. For the patients selected for ADS, CFFs were strongly considered and discussed as an option. Six (23.1%) patients would have otherwise been treated with CFFs, but as a result of ADS application, CFFs were avoided in 5 (83.3%) patients (1 patient required CFF on subsequent operation). Twenty of 26 patients (76.9%) had satisfactory tip sensation with satisfactory 2-point discrimination (this series represents complex heterogeneous soft tissue involvement, and thus, further analysis of this parameter is difficult at best). Five (19.2%) patients developed hypersensitivity, and 6 (23.0%) had poor tip sensation with poor 2-point discrimination.
Eight (30.8%) patients were lost to long-term follow up, 1 of which was due to death. Five (19.2%) developed postoperative infections, of which 4 were treated successfully with antibiotics. Three (11.5%) patients developed contractures that were successfully treated with contracture excision and application of pinch FTSG. Two (7.7%) xenografts (Integra) failed to take, 1 due to necrosis and 1 due to infection. One failed case was treated with antibiotics, ADS removal, partial amputation, and a local flap, while the other with removal, ADS reapplication, and a pinch FTSG. Twenty-three (88.5%) patients had satisfactory range of motion, while 3 (11.5%) did not.
Results
Twelve (46.2%) patients required no additional coverage after initial application of ADS. Fourteen (53.8%) patients required subsequent coverage at a later stage, of which 11 (42.3% of total patients) were treated with a pinch FTSG, 1 (4.2% of total) with a STSG, and 1 (4.2% of total) with a FTSG and cross finger flap (CFF). One (4.2% of total) patient required removal of the infected graft and reapplication of ADS and a pinch FTSG. This patient eventually died due to underlying comorbidities. For the patients selected for ADS, CFFs were strongly considered and discussed as an option. Six (23.1%) patients would have otherwise been treated with CFFs, but as a result of ADS application, CFFs were avoided in 5 (83.3%) patients (1 patient required CFF on subsequent operation). Twenty of 26 patients (76.9%) had satisfactory tip sensation with satisfactory 2-point discrimination (this series represents complex heterogeneous soft tissue involvement, and thus, further analysis of this parameter is difficult at best). Five (19.2%) patients developed hypersensitivity, and 6 (23.0%) had poor tip sensation with poor 2-point discrimination.
Eight (30.8%) patients were lost to long-term follow up, 1 of which was due to death. Five (19.2%) developed postoperative infections, of which 4 were treated successfully with antibiotics. Three (11.5%) patients developed contractures that were successfully treated with contracture excision and application of pinch FTSG. Two (7.7%) xenografts (Integra) failed to take, 1 due to necrosis and 1 due to infection. One failed case was treated with antibiotics, ADS removal, partial amputation, and a local flap, while the other with removal, ADS reapplication, and a pinch FTSG. Twenty-three (88.5%) patients had satisfactory range of motion, while 3 (11.5%) did not.
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