IV3000 Dressing for Fingertip Injury: Management and Discussion Susan Kurian, Meghan Davis, Alyssa Fazi

West Virginia University School of Medicine, Morgantown W.Va. W. Thomas McClellan M.D., F.A.C.S.

Plastic and Reconstructive Surgery, West Virginia University, Morgantown W.Va. Abstract: An 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. Introduction: The 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 likely 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 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.

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

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Case Presentation: An 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 to work in his shop and yard throughout the treatment period.

Figure 3. A. Volar view of injury at six weeks using IV3000 protocol. B. Direct view of injury at six weeks using IV3000 protocol.

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

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Discussion: Conservative management for fingertip injuries using the IV3000 dressing has previously been reported by our team. These cases demonstrated that secondary intention healing via the dressing had good cosmetic and functional outcomes. Patients were able to change the dressings at home every three to four days without the inconvenience of making multiple office visits. The protocol is well suited to patients who will not tolerate immobilization after surgery and elderly patients wishing to preserve joint motion. The treatment may also be used in rural locations where surgeons are not immediately available. One key advantage is that surgical options can still be pursued if IV3000 treatment fails. 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 also unique in allowing full flexion of the PIP and DIP joints, which prevents the stiffness associated with traditional treatments.

Application of the dressing is very simple. Two IV3000 patches are 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. 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 therefore occur without interruption, and pain during the change is minimized. In our experience, some patients develop excessive granulation tissue. However, simple silver nitrate sticks have been effective in managing this in clinic, and the overall result is highly favorable. Conclusion: The IV3000 dressing is not suited to all fingertip injuries, and surgery is still necessary in cases where there is contamination, tendon laceration, joint exposure, or major protrusion of bone. For other patients, conservative management with the IV3000 dressing is an option with excellent cosmetic and functional results. Despite evidence of good outcomes, management of fingertip injuries using similar techniques has not been well studied or described to patients.

References: 1. 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.