IV 3000 Fingertip Wound Protocol

INTRODUCTION:

Distal fingertip trauma and pulp amputations have traditionally been treated by hand surgeons with surgical skin grafting or local flap coverage. The IV3000 (Smith and Nephew) is a transparent semi-permeable synthetic dressing that improves wound healing. Its Moisture Vapor Transmission Rate (MVTR) is six times higher than other permeable dressings.  This gradient creates the necessary wound micro-environment that facilitates re-epithelialization without maceration. This environment includes: appropriate moisture and temperature levels, macromolecules(GAGs, proteoglycans), growth factors(macrophage and platelet derived), and protection from external pathogens. The IV3000 is minimally adherent due to its grid adhesive spread. This results in reduced pain during dressing changes and less disruption of neo-collagen formed in the wound bed.

OVERVIEW:

– Assess fingertip injury for possible surgical indications:

Prominent or degloved bone at fingertip

Nail bed laceration

Tendon injury

Open DIP joint laceration

Other finger/hand injuries requiring surgery

– If no indication for surgery proceed with IV3000 therapy

 

IV 3000 (standard) INSTRUCTIONS FOR APPLICATION (See Video)

 

– Equipment required:

Dressing pack, scissors

IV 3000 (standard) dressings x2 (NOT TEGADERM)

Band-Aid

 

– STEP 1

Clean and dry the injured finger

Lay one IV 3000 on a flat surface with sticky side UP

Place the finger onto the dressing

– STEP 2

Place the other IV 3000 sticky side DOWN to “sandwich” the finger tip

Press the sides of the IV 3000 dressings together to seal the finger

– STEP 3

Fold the excess IV 3000 edges under the finger

Use Band-Aid to reinforce the finger tip (do not pull too tight on the tip)

 

FOLLOW-UP CARE

Patients with isolated finger tip injuries treated with IV 3000 can be discharged home from the Emergency Department with simple analgesia

 

The need for oral antibiotics and tetnus booster should be assessed on an individual case basis, considering the mechanism of injury and initial wound contamination

 

The IV 3000 can get wet in the shower then gently dried, but care should be taken not to displace the dressing. Seek a replacement dressing if required.

 

Change IV 3000 dressing every 3-4 days or as needed.

Wash finger in soap and water. Pat the wound dry and then reapply the IV 3000 sandwich and bandaid.

 

Allow protected use and encourage movement of the finger.

 

OTHER

 

Note that Tegaderm™ and other clear synthetic dressings are NOT an adequate substitute for IV 3000 for these injuries.  They are significantly less “semi-porous” with a lower MVTR which may cause maceration of the surrounding normal skin and complicate wound healing.

 

Soft tissue and cancellous phalangeal bone can granulate and heal with this technique. If exposed viable bone protrudes beyond the tissue plane it should be resected back to be level with that tissue.

The PIP joint should not be included in the IV3000 sandwich in order to encourage movement of the finger and prevent stiffness.

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