LAUSR

Traditional techniques for managing fingertip crush injuries with exposed deep structures often provide patients with suboptimal results. We present a method of fingertip amputation reconstruction using serial BTM application and full thickness skin grafting with good aesthetic and functional outcomes. We present a case of a 21-year-old female who sustained a severe crush injury from a fire door to her left ring fingertip. This resulted in total fingertip degloving distal to the distal interphalangeal joint with bone exposure. Following extensive deliberations with the patient, we decided to reconstruct the defect using layered Biodegradable Temporising Matrix (BTM) aiming to maintain the length and restore the glabrous pulp contour. The patient underwent two serial BTM applications to achieve the desired volume and length of the fingertip under local anaesthetic. Post BTM delamination and the fingertip underwent full thickness skin grafting. 1 month post-operatively the graft showed complete take and fingertip volume appeared restored. Overall, the fingertip has been reconstructed with no loss of length and with great aesthetic and functional outcome. Severe fingertip amputations can traditionally be managed with flap reconstruction. However, this often does not have the desired aesthetic or functional outcome due to ill-restored fingertip volume and length. Dermal matrices, such as BTM, provide an operatively simple yet effective fingertip reconstructive technique with maintenance of length and restoration of finger volume when layered. Whilst multiple operations may not be acceptable for all patients, for those willing to comply we believe BTM provides a superior result.