Long-term Outcomes of Semi-Occlusive Film Dressing versus Homodigital Neurovascular Island Flap Reconstruction for Fingertip Amputations: A Retrospective Comparative Cohort Study

Abstract Introduction: Fingertip amputations are common hand injuries that may be managed surgically or conservatively. Semi-occlusive film dressing (SOFD) is an established non-operative treatment, but comparative long-term data are limited. This study evaluated long-term functional, sensory, and patient-reported outcomes after SOFD and compared them with a previously published historical cohort treated with homodigital neurovascular island flaps (HNIF). Materials and Methods: This retrospective comparative cohort study included adults with isolated fingertip defects distal to the distal interphalangeal joint. The SOFD cohort comprised 20 patients (25 fingers) with a mean follow-up of 74 ± 21 months. Outcomes were compared with a previously published historical HNIF cohort of 28 patients (29 fingers) with a mean follow-up of 105 ± 42 months. Assessments included range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, sensory testing, nail and scar outcomes, pain, patient satisfaction, and return to work. Results: Patients in the SOFD cohort were older at the time of injury than those in the HNIF cohort (52.5 ± 15.7 vs. 42.9 ± 15.5 years; p = 0.042), and follow-up was shorter (74 ± 21 vs. 105 ± 42 months; p = 0.020). Time to complete wound healing was shorter after SOFD (7.3 ± 3.2 vs. 14.6 ± 9.6 weeks; p < 0.001). Grip strength, DASH score, and overall patient satisfaction did not differ significantly between cohorts. Static two-point discrimination differed statistically between cohorts (3.85 ± 1.2 vs. 4.0 ± 1.1 mm; p = 0.015), whereas Semmes-Weinstein monofilament testing showed no significant difference (p = 0.752). No patient in the SOFD cohort required physiotherapy or reoperation, compared with 57.1% and 17.9%, respectively, in the historical HNIF cohort. Conclusions: In this retrospective comparison with a historical HNIF cohort, SOFD was associated with shorter healing time and similar long-term functional and patient-reported outcomes. The small absolute difference in two-point discrimination should be interpreted cautiously. These findings support SOFD as a less invasive treatment option for selected fingertip amputations, while the non-concurrent cohort design precludes causal conclusions.