IV 3000 Fingertip Wound Protocol

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

– 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.

What is Plastic Surgery Reconstruction After MohS Surgery?

by W. Thomas McClellan MD FACS    McClellan Plastic Surgery

I often get stopped in the hospital, on the street, or even in StarBucks to look at moles. Patients want to know if a mole is dangerous and what they should do about it. Can I remove the mole? Should they see their dermatologist? What is the best option?

I will address the skin cancer as a whole in another blog post but wanted to talk specifics about Moh’s Surgery, reconstruction of the resultant defect, and the importance of a close knit team in order to get optimal results.

Moh’s surgery is essentially a “real time” evaluation of the complete surgical margin as the skin cancer is removed from the patient. The Moh’s physician is a specialized dermatologist who removes the skin cancer tissue and also acts as the pathologist reading the “slide” under a microscope. This method has a cure rate of about 97%. Moh’s excision of skin cancer is most commonly performed on structures that hold critical value and where excessive resection of tissue is detrimental. Examples of these locations include the eyelid, nose, ear, and cheek.

Here is a Wikipedia link to read a more in depth description of Moh’s Surgery Moh’s Surgery Wikipedia

So why and how does a plastic surgeon get involved in Moh’s resection of skin cancer? If the defect resulting from skin cancer excision is small or uncomplicated then the Moh’s surgeon might perform the closure. However many times the defect may be larger than expected, involve a critical structure, or be quite complex. Occasionally general anesthesia, a brief hospital stay, multiple surgeries might be required. This is where I, as the plastic surgeon, get involved with the patient.

The relationship between the Moh’s Team and the Plastic Surgery Team is critical. Getting the wound repaired expeditiously is better for the result and patient. In other areas of the country, outside Morgantown West Virginia, a patient may wait days or even weeks before the wound can be closed by a plastic surgeon. I try to see the patient as soon as possible and bend my schedule to get the wound closed in the best manner and shortest time frame for the patient.

I have worked extensively with Dr’s Hancox and Carlisle, Moh’s Surgeons at Mountain State Dermatology, for years. This symbiotic relationship allows patients to be seen before  the cancer removal near a critical structure. Meeting the patient prior to resection allows me to discuss surgical options, create the best individualized surgical plan, show the patient examples of their particular surgery and recovery process, and demonstrate potential results they might have following surgery.

In addition the relationship allows same day scheduling of resection and repair of the skin cancer. So the patient can have the resection of the skin cancer at the Moh’s office and then travel to the hospital for the complex repair under the comfort of anesthesia. A same day process affords the patient the best of both worlds in resection and repair. The combination of these services, at this high level, is not offered anywhere else in our region!

Please see a few of my publications and videos on skin cancer reconstruction following Moh’s Surgery.

Forehead Reconstruction A to T flap after Moh’s Surgery

Eyelid Reconstruction Paper after Moh’s Surgery

Limberg Flap Following Skin Caner Resection

Hughes Flap for near Total Lower Eyelid Loss after Moh’s

Bone flap for Lower Eyelid Loss after Moh’s

Welcome to Our New Blog

Hi everyone. Wanted to let you know we are starting a shared blog between our website mtpsa.com and tumblr. See Dr. McClellan’s Tumblr Blog

I get great questions about plastic surgery from my patients that visit and call everyday. I hope to enlighten other by answering these questions and providing good content and trusted information.

I hope you find the blog helpful and I will try and keep it updated regularly.

See you in the blogverse!

Dr. M