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Use of Acellular Urinary Bladder Matrix for Treatment of Fingertip Injuries
Meghan C McCullough, MD1, Peggy J Ebner, MD2, Theodore Brown, BS1, Eva Williams, MD, MPH, MS2, Kylie Tanabe, PA-C3, Ryu Yoshida, MD4 and David A Kulber, MD, FACS5, (1)Cedars Sinai Medical Center, Los Angeles, CA, (2)University of Southern California, Los Angeles, CA, (3)Cedars Sinai, Los Angeles, CA, (4)Cedars-Sinai Medical Center, Los Angeles, CA, (5)Division of Plastic and Reconstructive Surgery, Cedars Sinai Medical Center, Los Angeles, CA

Background: Fingertip injuries are a common but potentially debilitating injury. Preservation of functional length with restoration of sensate, supple tissue is paramount for reconstruction. Current surgical options range from amputation to more complex reconstruction with local flaps. Depending on the defect, these options may sacrifice length or inadequately restore sensate tissue. Urinary bladder matrix as a soft tissue regenerative scaffold has been successfully used in wound healing contexts elsewhere in the body, but has not been studied in application to the distal fingers. We present our experience utilizing this product for soft tissue coverage for fingertip injuries.

Methods: A retrospective review was performed analyzing all patients treated with urinary bladder extracellular matrix scaffold for fingertip injuries at a single institution between 2020 and 2023. Patient demographics were recorded including age, gender, level of injury, mechanism of injury and prior treatments. Surgical outcomes, including time to wound healing as well as any postoperative complications, were analyzed.

Results: A total of 10 cases were identified. Mean age was 51.8 (31-76) . Mechanism of injury included traumatic amputation (n = 4), burn injury (n = 1), and ischemic necrosis (n = 5). Level of injury was at the level of the distal phalanx (n=4), middle phalanx (n=3). Mean follow up time was 12.8 months. All patients required surgical irrigation and debridement followed by application of the matrix. Distal injuries routinely healed without further surgery, while use of the matrix for more proximal degloving injuries required secondary skin grafting. In two cases, reapplication of the matrix in a second surgery was necessary. Superficial infection occurred in one patient and resolved with oral antibiotics. The product was successfully used after infection in two cases. Average time to wound healing was 12.8 weeks. In the three patients requiring skin grafting time to readiness for grafting was 3, 4, and 5 weeks. High patient satisfaction with the procedure was noted. No revision surgeries were needed.

Conclusion: Distal fingertip injuries represent a reconstructive challenge. Urinary bladder matrix is a viable off-the-shelf alternative to secondary intention healing for fingertip injuries and allows for vascular ingrowth and re-generation of the soft tissue envelope. Safety and efficacy of the approach was demonstrated in this initial evaluation. Further, larger studies are warranted to look at this promising application.

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