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Composite Regeneration of Fingertip Injuries Using Acellular Bladder Matrix
Anna H Green, MD1, Usman Zareef, BA2, Caroline Moore, PA-C3, Corrin C Trerotola, BS3, Kristie Rossi, BS3, Brian M Katt, MD4 and Ajul Shah, MD3, (1)Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, (2)Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, (3)The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, NJ, (4)Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

Introduction
Fingertip injuries are one of the most common reasons for hand surgeon referral. Management strategies range from dressing changes to revision amputation to flap coverage. Complex injuries around the lunula or eponychial fold are often treated surgically, but come at the cost of donor site morbidity or a shortened finger. We present 10 cases of Allen Zone 3/4 injuries treated surgically using acellular bladder matrix that resulted in composite regeneration of the fingertip.
Materials & Methods
Ten patients met inclusion criteria of Allen 3/4 fingertip injury. Patients underwent irrigation and debridement with ACELL MicroMatrix® application within 10 days of their injury. Further MicroMatrix was applied if necessary during weekly follow-up. The number of applications, time to regeneration, static two-point discrimination, fingertip length (compared to contralateral), complications, and patient satisfaction were recorded.
Results
All patients demonstrated composite regeneration of the fingertip. The average time to regeneration was 8.7 ± 1.5 weeks, with a mean of 3.2 ± 0.63 total applications. The mean length deficit compared to the contralateral side was -3.25 ± 1.41 mm. Average two-point discrimination of the injured fingertip was 4.33 ± 1.36 mm, which was 0.71 ± 1.14 mm less sensitive compared to the contralateral side. Average satisfaction on a scale from 1 to 10 (10 = most satisfied) was 9.6 ± 0.76. There was 1 hook nail deformity and 1 bony exostosis requiring excision. Refer to figures 1-4 for the injury and 3-month follow up for 4 of the patients in the cohort.
Conclusions
Acellular bladder matrix is a simple and reliable method of reconstructing complex fingertip injuries, which offers potential for composite sensate and aesthetically pleasing regeneration without the downside associated with traditional methods of reconstruction.




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