Use of Dermal Substitute in Pediatric Traumatic Fingertip Amputation Tissue Loss

Background: Treatment of pediatric fingertip tissue loss has traditionally included local wound care requiring frequent dressing changes. An alternative treatment includes the application of a dermal substitute, which offers the potential for decreased pain, anxiety, physician office visits, and increased cost savings. We sought to assess the outcomes, function, and aesthetics of pediatric fingertip amputations covered with a dermal substitute in the emergency department setting. Methods: We conducted a retrospective case series of pediatric fingertip amputations treated with a dermal substitute through a phone survey and clinical photographs using validated outcome measures, including the Patient-Reported Outcomes Measurement Information System/Pediatric Outcomes Data Collection Instrument scores, the Vancouver Scar Scale, and the incidence of infection or repeated procedures. Results: Nine pediatric patients were included, with an average age of 5.3 years. No infections or revision procedures were reported at final follow-up. The average Patient-Reported Outcomes Measurement Information System T-score was 56.1 (range 49–57), and the average Pediatric Outcomes Data Collection Instrument score was 81.4 (range 69–106). The visual analog scale score for overall appearance was 7.1, with a satisfaction level of 8.6 and a pain level of 0.25. The average Vancouver Scar Scale score for the 8 patients who submitted photographs was 2.63. All patients reported using their hands with normal function. Conclusions: Pediatric patients with fingertip injuries treated with a dermal substitute reported favorable patient-reported outcomes in function, pain, and aesthetics, with no incidence of infection or repeated procedures. Given the decreased pain and anxiety relative to local wound care for secondary healing, in addition to time and cost savings from fewer clinic visits, acellular dermal substitute can be added to the arsenal for the acute management of pediatric fingertip amputations with soft tissue defects.