V-Y Flap Versus Occlusive Dressing in Treating Fingertip Injuries With Exposed Bone

Assiut University

Status: Completed

Conditions: Injury Arm

Treatments: Procedure: Flaps Coverage; Procedure: Occlusive Dressing

Study type: Interventional

Funder types: Other

Identifiers

NCT03193983

AssiutUMAAFDD

Details and patient eligibility

About

Fingertip is a complex structure that is responsible for the fine function of the fingers and the whole hand. A fingertip injury is any soft tissue, nail or bony injury distal to the insertions of the long flexor and extensor tendons of a finger .Fingertip injury is a serious condition that if untreated properly could lead to significant functional disability and disuse of the injured finger. Up to date, defining the best treatment option for this injury remains controversial. Hand surgeons are divided between proponents of flap coverage and conservative treatment, driven by beliefs, training programs and financial aspects. After recently reviewing the literature for the current best evidence and fundamentals of conservative treatment, Krauss and Lalandei in their recent review of the literature, pointed out to the necessity for implementing controlled trials to compare both ways of treatment.

Full description

The purpose of this study is to determine the efficacy and the results of occlusive dressing in treating fingertip injuries in comparison to flaps with much concern to certain factors that are closely related to our locality including patient compliance for regular follow up , functional outcome , time to return to work and its socioeconomical impact and cosmetic results .

Surgical group will undergo surgical coverage of the fingertip defect by V-Y flap using the skin on the volar aspect of the same finger designed as V shaped then mobilized dorsally to cover the defect and stitches to be Y shaped. Stitches are removed after 2 weeks.

Conservative group will undergo minimal trimming of the bone end and an occlusive dressing that is changed on a weekly basis till complete healing of the defect that occurs after 6 weeks

Enrollment: 60 estimated patients

Sex: All

Ages: 12 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• a. Inclusion criteria:

  1. Age Adults 12 - 60 years
  2. Diagnosis of fingertip injury with exposed bone (Allen type 2, 3 or 4) in any finger.
  3. Informed consent obtained by the patient.

Exclusion criteria

• · Old or complicated fingertip injuries.

  • Non-exposed bone fingertip injury (Allen type1).
  • Patients with severe debilitating disease.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 2 patient groups

Flaps Coverage

Experimental group

Description:

Surgical group will undergo surgical coverage of the fingertip defect by V-Y flap using the skin on the volar aspect of the same finger designed as V shaped then mobilized dorsally to cover the defect and stitches to be Y shaped. Stitches are removed after 2 weeks.

Treatment:

Procedure: Flaps Coverage

Occlusive Dressing

Experimental group

Description:

Conservative group will undergo minimal trimming of the bone end and an occlusive dressing that is changed on a weekly basis till complete healing of the defect that occurs after 6 weeks.

Treatment:

Procedure: Occlusive Dressing