28 West Virginia Medical Journal www.wvsma.org

Case Report |

Susan Kurian

Meghan Davis

Alyssa FaziWest Virginia University School of Medicine, Morgantown, WV

W. Thomas McClellan MD, FACSPlastic and Reconstructive Surgery, West Virginia University, Morgantown, WV

Corresponding Author: W. Thomas McClellan M.D., F.A.C.S., 1085 Van Voorhis Rd Suite 350, Morgantown, WV 26505. Email: sukurian@mix.wvu.edu

AbstractAn active, right hand dominant

86-year-old male presented with transverse amputation of the right ring finger just distal to the DIP joint. Conservative management was recommended in order to preserve digit length, mobility, and the DIP joint. The IV3000 semipermeable dressing was utilized as the primary treatment. The clear adhesive dressing has a high moisture vapor transmission rate that facilitates creation of a suitable wound microenvironment.1 The digit showed significant epithelialization and mobility at two weeks post-injury and was healed with full range of motion at both the DIP and PIP joints by week six. There were no complications from use of the IV3000 dressing, and both healing time and pain during dressing change are improved over alternative dressings like gauze.

IntroductionThe IV3000 sandwich technique

for fingertip injury is a non-surgical alternative to the standard skin grafts or flaps used by hand surgeons for distal fingertip injuries. The clear IV3000 adhesive patch was designed to reduce rates of infection during central and peripheral venous catheterization. It features a moisture vapor transmission rate (MVTR) that is six times that of other dressings when placed over a wet surface and better than all dressings except gauze when placed over a dry surface.1 The IV3000 presumably aids healing by creating a suitable wound microenvironment with reduced moisture accumulation on the injury site and the surrounding normal skin. Other factors such as the levels of GAGs, proteoglycans, and growth factors, wound temperature, and the antibacterial properties of the dressing may also be involved.2 Since healing depends upon avoiding wound disruption during dressing changes, the minimally adherent grid pattern of the IV3000 dressing is also implicated in the reduction of pain during dressing removal and faster re-epithelialization of the injury. Healing of an amputated fingertip by secondary intention using

similar semi-permeable dressings has not been well studied, and skin grafts remain the standard of care. However, patients for whom surgery is unsuitable may benefit from use of the IV3000 treatment.

Case PresentationAn 86-year-old male presented

with a transverse avulsion amputation of his right ring finger at the distal phalanx. The injury was sustained when his hand was caught in a lawnmower. The amputation occurred just distal to the insertion site of the flexor digitorum profundus and showed some protruding bone (Figure 1). The wound was hemostatic upon presentation, and the patient had good range of motion. The history is significant for Parkinson’s disease, hyperlipidemia, cardiovascular disease, and atrial fibrillation. Surgery was deferred due to the lack of available skin, which would likely require removal of the DIP joint in order to recruit the required tissue. The decision to utilize the IV3000 dressing was supported by the patient as he wished to return to work the next day. Washout, minimal debridement of the skin edges, and shortening of the protruding distal phalanx was performed under local anesthesia, and the IV3000 dressing was applied. After two weeks using the dressing protocol, significant epithelialization had occurred and the patient had excellent range of motion with no signs of infection (Figure 2). The wound was well healed in six weeks, with full range of motion including the distal interphalangeal joint (Figure 3). The patient continued

IV 3000 Dressing for Fingertip Injury: Managementand Discussion

Figure 1. A. Volar view of wound on day of injury. B. Direct view of wound on day of injury.

A B

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to work in his shop and yard throughout the treatment period.

DiscussionConservative management for

fingertip injuries using the IV3000 dressing has previously been described by our team. These cases have demonstrated that secondary intention healing via the dressing had good cosmetic and functional outcomes, as well a several key advantages over other treatment options. This dressing has been the preferred treatment for fingertip injuries in our clinic for two years, replacing the need for surgical treatment. Patients are able to change the dressings at home every three to four days without the inconvenience of multiple office visits. The protocol is also suitable for patients who will not

tolerate immobilization after surgery and elderly patients wishing to preserve joint motion. Importantly, the treatment may also be used in rural locations where surgeons are not immediately available, since surgical options can still be pursued if IV3000 treatment fails.

This new case demonstrates use of the IV3000 dressing with the goal of preserving the patient’s DIP joint, in addition to the advantages described previously. Surgical treatment of this patient would have required additional dissection of the injury site and possibly the absolute loss of the joint. Surgery is required in patients with wound contamination, tendon laceration, joint exposure, or major protrusion of bone, none of which were a concern in this case. Alternative non-surgical options like gauze dressings have a longer healing

time,3 while Tegaderm and similar clear synthetics have lower MVTR values than IV3000,1 leading to complications like maceration. The IV3000 dressing is unique among surgical and non-surgical treatments in allowing full flexion of the PIP and DIP joints, preventing the stiffness associated with traditional treatment.

Application of the dressing is very simple. Two IV3000 patches are

Figure 2. A. Volar view of injury at 2 weeks using IV3000 protocol. B. Direct view of injury at 2 weeks using IV3000 protocol.

Figure 3. A. Volar view of finger after 6 weeks using IV3000 protocol. B. Direct view of finger after 6 weeks using IV3000 protocol.

Figure 4. Application of the IV3000 dressing. First, the digit is sandwiched between two IV3000 patches, then the edges are folded and secured with an adhesive bandage. Full flexion of the digit is preserved.

A A

B B

30 West Virginia Medical Journal www.wvsma.org

Case Report |

used to sandwich the digit distal to the PIP joint, then the free edges are adhered to each other, folded to the dorsum, and secured with an adhesive bandage (Fig 4). This equipment is readily available to ED physicians for the initial dressing, and patients can be discharged with simple analgesia. Importantly, the adhesive does not traumatize the wound bed with each dressing change. Epithelialization can occur without interruption, and pain during the change is minimized. There have been no adverse outcomes

in patients utilizing this dressing in our experience. Some patients may develop excessive granulation tissue. However, simple silver nitrate sticks have been effective in managing this in clinic, and the overall result is highly favorable.

ConclusionThe IV3000 fingertip dressing,

when used in suitable cases, has excellent cosmetic and functional results. The dressing creates a healthy wound microenvironment, minimizes trauma, and preserves

joint mobility. Despite evidence of good outcomes, management of fingertip injuries using high MVTR dressings like the IV3000 patch has not been well studied or utilized with patients.

References1. Lin YS, Chen J, Li Q, Pan KP. Moisture vapor

transmission rates of various transparent dressings at different temperatures and humidities. Chin Med J. 2009;122(8):927-930.

2. Irion G, editor. Comprehensive wound management. 2nd ed. Thorofare, NJ: Slack Incorporated; 2009.

3. Williamson DM, Sherman KP, Shakespeare DT. The use of semipermeable dressings in fingertip injuries. J Hand Surg Br. 1987;12(1):125-126.