Abstract
Objectives:
To evaluate the clinical effectiveness of small intestinal submucosa-extracellular matrix (SIS-ECM) in the conservative treatment of traumatic fingertip injuries without residual tissue.
Methods:
We conducted a retrospective analysis of 11 patients (12 fingers) treated with SIS-ECM between 2022 and 2024. No surgical reconstruction or skin grafting was performed. Wound size, exposed tissue, wound conditions, healing duration, scar quality, sensory recovery, and patient satisfaction were recorded. Scar formation was assessed using the Vancouver Scar Scale, and sensory outcomes were evaluated with the Semmes-Weinstein Monofilament Test (S-W test).
Results:
All wounds achieved complete epithelialization, with a mean healing time of 42.8 days (range, 26-71). Small defects (≤1.5 cm2) healed in an average of 34.3 days (about five weeks), while medium-sized defects (1.6-3.0 cm2) required slightly longer (39.2 days). In contrast, large defects (>3.0 cm2) showed markedly prolonged healing (60.0 days) and more pronounced scarring. Cases with bone exposure also demonstrated delayed healing and inferior scar quality. No cases required secondary surgical intervention, and overall patient satisfaction was high.
Conclusions:
SIS-ECM appears to be a safe, effective, and minimally invasive alternative to skin grafting or flap procedures for fingertip injuries up to approximately 3 cm2 or without bone exposure. However, larger defects or those with bone exposure may require careful consideration due to the risk of delayed wound closure and inferior cosmetic results. The findings should be interpreted with caution given the lack of a control group.
Keywords: fingertip injuries, small intestinal submucosa-extracellular matrix (SIS-ECM), conservative treatment, clinical outcomes
Introduction
Fingertip injuries are a common type of trauma in both children and adults1,2). The goals of treatment are to preserve as much digit length as possible, restore sensation, and achieve an acceptable aesthetic outcome1-3). Management options for traumatic fingertip injuries without residual tissue include conservative treatment, skin grafting, or reconstruction with local flaps, depending on the extent and nature of the injury1,3-5). In some cases, conservative treatment is chosen for social or economic reasons6). Historically, conservative approaches have included topical agents, wound dressings, and artificial dermis products. More recently, biological materials have become increasingly available7,8).
One such material is small intestinal submucosa-extracellular matrix (SIS-ECM), which functions as a biological scaffold to promote tissue repair. SIS-ECM has been used in a wide range of clinical applications, including wound, cardiac, and vascular reconstruction6-13). Although two previous reports documented excellent results with SIS-ECM for fingertip injuries in a total of six cases6,13), long-term clinical outcomes following treatment have not been systematically evaluated, particularly with respect to wound size, bone exposure, and wound condition. Therefore, in this study, we retrospectively investigated the clinical outcomes of SIS-ECM in a series of fingertip injuries for which conservative treatment was selected.
Methods
This retrospective cohort study was conducted to evaluate the clinical outcomes of SIS-ECM in fingertip injuries. This study was approved by the Institutional Review Board of our institution, and all patients provided written informed consent before participation. The study adhered to the principles of the Declaration of Helsinki.
Patients
Eleven patients (12 fingers) with traumatic fingertip injuries and no residual tissue were treated with SIS-ECM alone at our department between December 2022 and March 2024 and were included in this study. The cohort comprised of nine men and two women, with a mean age of 55.5 years (range, 33-73). Of the 12 injured digits, six were middle fingers, three were thumbs, two were little fingers, and one was an index finger. The injury mechanisms included six pinch injuries, three crush injuries, two avulsion injuries, and one laceration.
At the initial examination, wounds were categorized based on defect size, presence or absence of bone exposure, and wound condition (clean, contaminated, or infected). Wound size was calculated as the product of length and width. The demographic and clinical characteristics of the patients are summarized in Table 1.
Table 1.
Demographic and Clinical Characteristics of Patients with Fingertip Injuries Treated with SIS-ECM.
This table summarizes age, sex, injured digit, mechanism of injury, wound size, exposed tissue, and wound condition in 11 patients (12 fingers) who received SIS-ECM treatment.
| No. | Age | Gender | Site | Cause of injury | Wound size (cm2) | Exposed tissue | Wound condition |
|---|---|---|---|---|---|---|---|
| 1 | 42 | Male | Middle | Pinch | 1.2 | Subcutaneous tissue | Clean |
| 2 | 33 | Male | Middle | Pinch | 1.2 | Nail bed/dermis | Clean |
| 3 | 48 | Male | Thumb | Pinch | 3 | Dermis | Exudative |
| 4 | 72 | Male | Middle | Pinch | 1 | Dermis | Clean |
| 5 | 72 | Male | Index | Pinch | 1.5 | Dermis | Clean |
| 6 | 62 | Male | Thumb | Pinch | 2.5 | Subcutaneous tissue | Clean |
| 7 | 69 | Male | Middle | Laceration | 2.7 | Bone | Clean |
| 8 | 39 | Male | Middle | Pinch | 2.2 | Bone | Contaminated |
| 9 | 48 | Female | Little | Avulsion | 3 | Subcutaneous tissue | Contaminated |
| 10 | 72 | Male | Index | Crush | 4 | Subcutaneous tissue | Clean |
| 11 | 54 | Female | Thumb | Crush | 6 | Subcutaneous tissue | Contaminated |
| 12 | 55 | Male | Middle | Crush | 7.5 | Bone | Infected |
SIS-ECM: small intestinal submucosa-extracellular matrix
Treatment
OASIS extracellular matrix (two-layer fenestrated type; Cook Biotech Inc., IN, USA), a commercially available SIS-ECM product, was used for the treatment of all 12 fingers. First, the wound was cleansed by both mechanical and chemical debridement. The SIS-ECM was then trimmed slightly larger than the wound and affixed to the site with Steri-StripⓇ tape (Figure 1a). A nonadherent dressing was placed on top and secured with tape (Figure 1b), followed by application of a topical agent―either gentamicin ointment or povidone-iodine gel―depending on wound condition (Figure 1c). Finally, the wound was covered with gauze and secured with either tape or elastic bandages. Dressing changes were performed every three to four days. All wound management procedures, including SIS-ECM application and follow-up dressing care, were consistently carried out by the authors. Additional applications of SIS-ECM were considered when epithelialization was minimal after approximately one week or when detachment due to infection or exudate was observed. The decision for reapplication was based on clinical evaluation during follow-up dressing changes.
Figure 1.
SIS-ECM application and wound coverage procedure. (a) After mechanical and chemical debridement, the SIS-ECM was trimmed slightly larger than the wound area and secured using Steri-Strip® tape. (b) A nonadherent dressing material was applied over the SIS-ECM and fixed with tape. (c) Topical agents—gentamicin ointment or povidone-iodine gel, depending on wound condition—were applied over the dressing.
Abbreviations: SIS-ECM, small intestinal submucosa-extracellular matrix
Evaluation
Efficacy was assessed 6 months post-treatment using both objective and subjective criteria. Objective criteria included initial wound size, presence or absence of bone exposure, initial wound condition, time from injury to SIS-ECM application, need for additional applications, duration to complete wound closure, scar quality, and sensory recovery. Subjective assessment was based on patient satisfaction. Scar quality was evaluated using the Vancouver Scar Scale (VSS), which considers four parameters: color, vascularity, thickness, and pliability14). Scoring was performed by a blinded observer on a 0-15 scale, with higher scores indicating more pronounced scarring. Sensory recovery was assessed using the Semmes-Weinstein monofilament test (S-W test). Patient satisfaction was measured on a four-point scale ranging from one (dissatisfied) to four (very satisfied).
To further analyze prognostic factors, clinical outcomes were compared according to defect size (small, medium, large), bone exposure (present vs. absent), and wound condition (clean vs. contaminated/infected/exudative). Statistical analysis was performed using the Student's t-test, with p-values less than 0.05 considered statistically significant.
Results
All 12 fingers achieved complete wound healing. The treatment outcomes for each case are summarized in Table 2. The mean wound size was 3.0 cm2 (range, 1.0-7.5), and the mean duration from injury to SIS-ECM application was 3.5 days (range, 0-18). The average number of additional applications was 2.2 (range, 1-8), and the mean time to complete wound closure was 42.8 days (range, 26-71). Scar quality was generally favorable, with a mean VSS score of 2.2 (range, 0-5), and sensory recovery was also favorable, with a mean S-W monofilament value of 3.12 (range, 1.65-4.17). The average follow-up period was 7.6 months (range, 6-2). At final follow-up, the mean patient satisfaction score was 3.0 (range, 1-4); 25% of patients were very satisfied, 58.3% were moderately satisfied, and 16.6% were somewhat satisfied or dissatisfied. Most patients reported high satisfaction with both cosmetic and functional outcomes and did not request further treatment.
Table 2.
Treatment Outcomes Following SIS-ECM Application for Fingertip Injuries.
The table includes wound size, time from injury to SIS-ECM application, number of additional applications, days to complete wound closure, VSS score, S-W Monofilament score, follow-up period, and patient satisfaction score for each case.
| No. | Wound size (cm2) | Duration until application | Additional application | Days of wound closure | VSS | S-W test | Patient satisfaction | |
|---|---|---|---|---|---|---|---|---|
| 1 | 1.2 | 2 | 1 | 36 | 1 | 2.83 | Green | 3 |
| 2 | 1.2 | 3 | 2 | 32 | 0 | 3.61 | Blue | 3 |
| 3 | 3 | 2 | 2 | 39 | 0 | 2.36 | Green | 3 |
| 4 | 1 | 0 | 1 | 38 | 1 | 3.61 | Blue | 4 |
| 5 | 1.5 | 0 | 1 | 31 | 1 | 3.61 | Blue | 4 |
| 6 | 2.5 | 3 | 1 | 26 | 2 | 1.65 | Green | 4 |
| 7 | 2.7 | 2 | 1 | 42 | 2 | 2.36 | Green | 3 |
| 8 | 2.2 | 6 | 1 | 46 | 4 | 4.17 | Purple | 3 |
| 9 | 3 | 4 | 1 | 43 | 2 | 3.61 | Blue | 1 |
| 10 | 4 | 1 | 5 | 51 | 4 | 3.61 | Blue | 2 |
| 11 | 6 | 1 | 8 | 71 | 4 | 2.36 | Green | 3 |
| 12 | 7.5 | 18 | 2 | 58 | 5 | 3.61 | Blue | 3 |
| Average | 3.0 | 3.5 | 2.2 | 42.8 | 2.2 | 3.12 | - | 3 |
S-W: Semmes–Weinstein; SIS-ECM: small intestinal submucosa-extracellular matrix; VSS: Vancouver Scar Scale
When outcomes were stratified by defect size, smaller defects (≤1.5 cm2) achieved faster wound closure and lower VSS scores compared with larger defects. In contrast, large defects (>3.0 cm2) required longer closure times and showed poorer scar quality and lower patient satisfaction. Detailed clinical outcomes according to defect size are presented in Supplementary Table 1.
Cases with bone exposure (n = 3; Cases 7, 8, and 12) tended to have longer wound closure times (48.7 vs. 40.8 days), higher VSS scores (3.7 vs. 1.7), and higher S-W monofilament values (3.38 vs. 3.03), compared with cases without bone exposure (n = 9). Patient satisfaction scores were comparable (3.0 vs. 3.0). However, none of these differences reached statistical significance (Supplementary Table 2).
A comparison based on wound condition showed that wounds classified as “clean” at presentation tended to heal faster than contaminated, infected, or exudative wounds (36.6 vs. 51.4 days, p = 0.06), with lower VSS scores (1.6 vs. 3.0, p = 0.21) and higher patient satisfaction (3.3 vs. 2.6, p = 0.20). However, these differences did not reach statistical significance (Supplementary Table 3).
Case presentation 1 (Case 5)
A 72-year-old man sustained a fingertip injury to his left index finger after it was pinched by a machine at work. The defect measured 1.5 cm2 and was superficial, extending into the dermis without involvement of bone or tendon (Figure 2a). SIS-ECM was applied on the day of injury (Figure 2b). One additional application was performed during the course of treatment, and complete wound closure was achieved 31 days after the initial SIS-ECM application. At 7 months after wound closure, the fingertip exhibited a well-contoured appearance with a plump finger pad and restoration of fingerprints (Figure 2c). The VSS score was one, the S-W monofilament test value was 3.61 (blue), and the patient reported high satisfaction with a score of four on the satisfaction scale.
Figure 2.
Case 5 was a 72-year-old man who injured his left index finger by a machine at work, resulting in a fingertip defect measuring 1.5 cm2 (a). SIS-ECM was applied to the defect on the day of injury (b). Seven months after wound closure, the wound was observed to have formation of a plump finger pad and fingerprints (c).
Case presentation 2 (Case 11)
A 54-year-old woman sustained a crush injury to her right thumb caused by a machine at work. The defect measured 6.0 cm2 and extended from the fingertip to beyond the interphalangeal joint (Figure 3a). SIS-ECM was applied to the wound on the day after the injury (Figure 3b). A total of eight additional applications were performed, and complete wound closure was achieved 71 days after the initial application. At 11 months after wound closure, the thumb showed noticeable deformity and scarring (Figure 3c and d). The VSS score was four, the S-W monofilament test value was 2.36 (green), and the patient reported moderate satisfaction with a score of three on the satisfaction scale.
Figure 3.
Case 11 was a 54-year-old woman who injured her right thumb by a machine at work, resulting in a large fingertip injury extending from the fingertip to the interphalangeal joint with a defect area of 6 cm2 (a). SIS-ECM was applied to the defect on the day of injury (b). After a further eight applications, the wound closed 71 days after the first application. Eleven months after wound closure, there was still significant deformity and scarring. The frontal and lateral views of the appearance of the wound are shown (c, d).
Abbreviations: SIS-ECM, small intestinal submucosa-extracellular matrix
Discussion
The fingertips are responsible for delicate movements that allow the gripping of small objects. Because they are constantly in use, their reconstruction requires consideration not only of functionality, but also of aesthetic appearance1-3). Various treatment methods have been described, including simple dressing, skin grafting, different types of skin flaps, and free tissue transfer1,3-5). However, these approaches often raise concerns about scarring and donor-site morbidity, including joint contracture due to immobilization15). Recently, new technological advances, such as artificial dermis and reconstructive methods without autologous transplantation, have been gaining momentum in treatment planning2). We applied SIS-ECM to various types of fingertip injuries and observed satisfactory results, based on the concept that SIS-ECM can minimize scar and pigment mismatch by inducing epithelialization from the adjacent skin. We retrospectively reviewed the clinical outcomes of 11 patients with 12 fingers treated exclusively with SIS-ECM.
SIS-ECM is a naturally occurring extracellular matrix derived from the submucosal layer of the porcine small intestine16). It is composed of collagen and other extracellular matrix components, including glycosaminoglycans, proteoglycans, fibronectin, and growth factors, such as basic fibroblast growth factor and transforming growth factor-β16). It functions as a scaffold to promote the migration, adhesion, and proliferation of epidermal keratinocytes and fibroblasts around the wound site, and it gradually develops into a dermal-like tissue9,17). This ability to promote cell proliferation differentiates SIS-ECM from other biological wound care products, including conventional artificial dermis, and may contribute to improved color and texture outcomes that resemble normal skin.
In addition to these biological properties, SIS-ECM offers several practical advantages. Application is simple, does not require suturing to the wound edge, and usually does not necessitate fixation, often eliminating the need for local anesthesia8). These features may help simplify the procedure and reduce patient burden compared with conventional artificial dermis6,18). Furthermore, with respect to availability and costs, SIS-ECM is widely accessible; however, medical material costs vary depending on country-specific reimbursement and procurement conditions. In view of these differences and the potential need for repeated applications, we refrained from making cost claims and did not conduct a formal cost-effectiveness analysis.
In cases of small defects (<1.5 cm2) without exposed bone, conservative treatment with topical medications can be effective, particularly with semi-occlusive dressings, which have shown favorable outcomes in prior studies19-21). However, extensive injuries, if not managed appropriately and in a timely manner, may lead to functional and cosmetic complications19). A previous study suggested that a local or free flap should be used for defects larger than 2.5 cm2 22). In the present study, the use of SIS-ECM resulted in successful healing of defects ranging from 1 to 7.5 cm2 without surgical treatment, with preserved range of motion in all cases and protective sensation maintained in 11 of 12 fingers.
Particularly, as in Case 5 (a pinch injury with a 1.5 cm2 defect), the fingertip appearance after healing was almost indistinguishable from normal, with restoration of a plump finger pad and fingerprints. In contrast, severe crush injuries such as Case 11 (6.0 cm2 defect) demonstrated delayed healing with marked scarring and deformity (Figure 3).
When outcomes were analyzed by defect size (Supplementary Table 1), larger defects (>3 cm2) tended to have longer wound closure times, higher VSS scores, and lower patient satisfaction compared with smaller defects. In our analysis, cases with bone exposure (n = 3) also showed delayed healing, inferior scar quality, worse sensory recovery, and lower satisfaction than those without bone exposure (Supplementary Table 2). Furthermore, wounds initially classified as clean tended to heal faster, with better scar quality and higher satisfaction than contaminated or infected wounds (Supplementary Table 3). These findings highlight the importance of careful case selection and appropriate initial wound management before SIS-ECM application.
Based on these findings, SIS-ECM may support a modest expansion of the indications for conservative treatment beyond the conventional limit of 2.5 cm2, while potentially reducing donor-site morbidity and the need for immobilization associated with skin grafting and flaps. However, careful case selection remains essential, particularly for larger defects or those with unfavorable conditions (such as bone exposure or infection), where delayed wound closure and suboptimal cosmetic outcomes remain concerns.
The limitations of this study include the small sample size and the lack of randomization. The follow-up period for sensory evaluation was relatively short, averaging 7.6 months. Wound closure was defined as complete epithelialization observed after spontaneous detachment of the scab; this definition may have slightly overestimated the actual healing time. In addition, the study did not include a control group receiving standard conservative treatments such as semi-occlusive dressings, which have been shown to be effective for fingertip injuries. These limitations should be considered when interpreting the findings, particularly regarding the potential superiority of SIS-ECM. Future studies with a prospective, randomized controlled design are warranted to validate its clinical efficacy compared with conventional treatments. In addition, the study did not include a control group receiving standard conservative treatments such as semi-occlusive dressings, which have been shown to be effective for fingertip injuries. These limitations should be considered when interpreting the findings, particularly regarding the potential superiority of SIS-ECM. Future studies with a prospective, randomized controlled design are warranted to validate its clinical efficacy compared with conventional treatments.
Conclusions
SIS-ECM is a simple and comparatively low-cost option for fingertip injuries, particularly for clean wounds without bone exposure. It may allow a modest expansion of conservative treatment indications beyond the conventional 2.5 cm2 limit. However, large defects (≥3 cm2) or those with unfavorable wound conditions require careful case selection, as delayed healing and suboptimal cosmetic outcomes remain concerns. Given this study's limitations―including the small sample size, lack of a control group, and non-randomized design―these findings should be interpreted with caution. Further prospective, randomized controlled studies are needed to confirm the clinical efficacy of SIS-ECM.
Author Contributions: Y.S. co-wrote the first draft of the manuscript; S.I. was involved in protocol development; H.W. and M.I. researched the literature and conceived the study; A.N. was involved in ethical approval, patient recruitment, and data analysis; S.A. reviewed and edited the manuscript; All authors approved the final version of the manuscript.
Conflicts of Interest: There are no conflicts of interest.
Ethical Approval: This study was approved by the Wakayama Medical University Hospital Ethics Committee (Approval No. 4359).
Informed Consent: Written informed consent was obtained from all patients presented in this article.
Supplementary Material
Clinical outcomes according to defect size, defined as small (≤1.5 cm2), medium (1.6-3.0 cm2), and large (>3.0 cm2). Values are presented as mean ± SD. Larger defects tended to have delayed wound closure and worse scar quality.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.
Clinical outcomes by bone exposure. Clinical outcomes according to the presence or absence of bone exposure. Values are presented as mean ± SD. Cases with bone exposure tended to show delayed healing and poorer scar quality than those without exposure.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.
Clinical outcomes by wound condition (clean vs. non-clean). Clinical outcomes according to wound condition (clean vs. non-clean). Values are presented as mean ± SD. Clean wounds tended to heal faster and showed better scar quality and higher patient satisfaction.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.
Acknowledgments
The authors thank Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University, for proofreading and editing support.
Funding Statement
The authors received no financial support for the research, authorship, and/or publication of this article.
References
- 1.Kawaiah A, Thakur M, Garg S, et al. Fingertip injuries and amputations: a review of the literature. Cureus. 2020;12(5):e8291. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Tos P, Crosio A, Adani R. Fingertip injuries and their reconstruction, focusing on nails. Hand Surg Rehabil. 2024;43S:101675. [DOI] [PubMed] [Google Scholar]
- 3.Lou X, Zhu H, Xue H, et al. One-stage wound healing of fingertip injuries induced by treatment of artificial dermis. Handchir Mikrochir Plast Chir. 2018;50(4):269-75. [DOI] [PubMed] [Google Scholar]
- 4.Ramirez EG, Hoyt KS. Management of hand injuries: part II. Adv Emerg Nurs J. 2016;38(4):266-78. [DOI] [PubMed] [Google Scholar]
- 5.Wang J, Huang Z, Cueva Jumbo JC, et al. Long-term follow-up of one-stage artificial dermis reconstruction surgery for fingertip defects with exposed phalanx. Hand Surg Rehabil. 2022;41(3):353-61. [DOI] [PubMed] [Google Scholar]
- 6.Kawanami K, Yoshimura S, Yano H. Clinical experience of OASISⓇ extracellular matrix for fingertip injury. Jpn J Surg Wound Care. 2021;12(2):59-62. [Google Scholar]
- 7.Salgado RM, Bravo L, García M, et al. Histomorphometric analysis of early epithelialization and dermal changes in mid-partial-thickness burn wounds in humans treated with porcine small intestinal submucosa and silver-containing hydrofiber. J Burn Care Res. 2014;35(5):e330-7. [DOI] [PubMed] [Google Scholar]
- 8.Nobuyma A, Ayabe S, Kang S, et al. The simultaneous application of OASIS and skin grafting in the treatment of tendon-exposed wound. Plast Reconstr Surg Glob Open. 2019;7(7):e2330. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Nihsen ES, Johnson CE, Hiles MC. Bioactivity of small intestinal submucosa and oxidized regenerated cellulose/collagen. Adv Skin Wound Care. 2008;21(10):479-86. [DOI] [PubMed] [Google Scholar]
- 10.Brown-Etris M, Milne CT, Hodde JP. An extracellular matrix graft (OasisⓇ wound matrix) for treating full-thickness pressure ulcers: a randomized clinical trial. J Tissue Viability. 2019;28(1):21-6. [DOI] [PubMed] [Google Scholar]
- 11.Madden NJ, Troutman DA, DeMarsico AJ. Use of a small intestine submucosa extracellular matrix patch in repeated carotid endarterectomy. J Am Osteopath Assoc. 2014;114(9):732-4. [DOI] [PubMed] [Google Scholar]
- 12.Quarti A, Nardone S, Colaneri M, et al. Preliminary experience in the use of an extracellular matrix to repair congenital heart diseases. Interact Cardiovasc Thorac Surg. 2011;13(6):569-72. [DOI] [PubMed] [Google Scholar]
- 13.Kobayashi H, Fukuzumi S, Sato T. Experience with OASIS extracellular matrix: characteristics of clinical application and prospects. Jpn J Plast Surg. 2023;66(8):947-53. [Google Scholar]
- 14.Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16(5):535-8. [DOI] [PubMed] [Google Scholar]
- 15.Krauss EM, Lalonde DH. Secondary healing of fingertip amputations: a review. Hand (N Y). 2014;9(3):282-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Hiles M, Hodde J. Tissue engineering a clinically useful extracellular matrix biomaterial. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(suppl 1):S39-43. [DOI] [PubMed] [Google Scholar]
- 17.Niezgoda JA, Van Gils CC, Frykberg RG, et al. Randomized clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers. Adv Skin Wound Care. 2005;18(5 Pt 1):258-66. [DOI] [PubMed] [Google Scholar]
- 18.Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg. 2008;122(3):105e-17e. [DOI] [PubMed] [Google Scholar]
- 19.Adani R, Tang JB, Elliot D. Soft and tissue repair of the hand and digital reconstruction. J Hand Surg Eur Vol. 2022;47(1):89-97. [DOI] [PubMed] [Google Scholar]
- 20.Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg Br. 1993;18(4):416-22. [DOI] [PubMed] [Google Scholar]
- 21.Germann G, Rudolf KD, Levin SL, et al. Fingertip and thumb tip wounds: changing algorithms for sensation, aesthetics, and function. J Hand Surg Am. 2017;42(4):274-84. [DOI] [PubMed] [Google Scholar]
- 22.Kobayashi H, Imai Y, Hirao T, et al. Histopathological analysis of decellularized porcine small intestinal submucosa after treatment of skin ulcer. Plast Reconstr Surg Glob Open. 2021;9(12):e3967. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Clinical outcomes according to defect size, defined as small (≤1.5 cm2), medium (1.6-3.0 cm2), and large (>3.0 cm2). Values are presented as mean ± SD. Larger defects tended to have delayed wound closure and worse scar quality.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.
Clinical outcomes by bone exposure. Clinical outcomes according to the presence or absence of bone exposure. Values are presented as mean ± SD. Cases with bone exposure tended to show delayed healing and poorer scar quality than those without exposure.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.
Clinical outcomes by wound condition (clean vs. non-clean). Clinical outcomes according to wound condition (clean vs. non-clean). Values are presented as mean ± SD. Clean wounds tended to heal faster and showed better scar quality and higher patient satisfaction.
S-W test: Semmes–Weinstein monofilament test; SD: standard deviation; VSS: Vancouver Scar Scale.