Decellularized Matrix and Supplemental Fat Grafting Leads to Regeneration following Traumatic Fingertip Amputation

Decellularized scaffold materials are capable of regenerating missing tissues when utilized under appropriate conditions. Fat grafting also has reported advantages in revitalizing damaged tissue beds. This report details a case of traumatic fingertip amputation treated with a combination of decellularized materials in conjunction with fat grafting, resulting in a supple and functional reconstruction of the affected digit. After traumatic fingertip amputation, a patient was initially treated with decellularized porcine urinary bladder matrix powder. As a second stage, the healed tip scar tissue was reexcised, and a second application of powder was applied. As a third stage, the tip scar tissue was reexcised and a decellularized bilayer was sewn into the soft tissues of the debrided tip, resulting in an improved soft tissue envelope. As a final stage, the restored fingertip soft tissue envelope was fat grafted for additional bulk. Patient underwent treatment every other day with decellularized porcine urinary bladder matrix (powder and bilayer) and was able to reasonably regenerate the traumatic fingertip soft tissue envelope. This resulted in an envelope that was further enhanced with fat grafting. The resulting digit was sensate with maintained length, and possessed a more normal appearance than would be achieved by healing by secondary intention, or local flap or graft coverage. Decellularized materials can be utilized in conjunction with fat grafting to treat traumatic fingertip amputations in select patients. This combination approach is able to achieve a sensate fingertip and regain length lost in the affected digit. Additionally, we describe a novel technique that can be employed to maximize the amount of soft tissue regenerated by the decellularized products.