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Securing fingertip dressings: The new ‘cinch pink’ technique
Journal of Plastic, Reconstructive & Aesthetic Surgery (2012) 65, e167ee168
CORRESPONDENCE AND COMMUNICATION Securing fingertip dressings: The new ‘cinch pink’ technique Fingertip injuries are the most common type of injury faced by the hand surgeon.1 These include simple lacerations, nail bed injuries, crush injuries and tip amputations. Achieving a satisfactory dressing for these injuries is often difficult: The objectives are to apply an adequate dressing without compromising movement or the vascularity of the digit, whilst being robust enough to withstand the activities of daily living. Traditionally, the finger dressing usually consists of covering the whole finger with a non-adherent dressing, gauze, tubular finger gauze (or ‘finger bob’), secured with Elastoplast’ª or ‘inch pink’ tape at the base extending to the palm and/or the hand dorsum. We have found a number of drawbacks of using this method of securing the dressing: the tape is awkward to apply, often requiring more than one piece of tape with small cuts to allow the tape to mould around the base of the fingers, and requiring an assistant to hold the fingers separate during application. Including the whole digit in the dressing and extending the tape proximally into the palm can be uncomfortable and restricts movement of the uninjured proximal joints. Sweating in the glabrous skin of the palm causes the dressing rapidly to lose its adherence, roll up and become loose and dirty. Consequently we have modified the method of securing the dressing with ‘inch pink’ tape for fingertip injuries to a ‘cinch pink’ technique which is simpler and more rapid to apply. The proximal end of the tubular finger gauze is deliberately kept on the digit, ideally distal to the proximal interphalangeal joint. A single piece of ‘cinch pink’ tape is applied circumferentially without any tension so that it becomes adherent to itself. We carried out a randomized study with internal controls to compare the new method with the previous technique for securing the tubular finger gauze. Ten individuals (none of whom were patients) were recruited voluntarily to wear the dressing. Each volunteer had the dressings randomized to the middle finger of both dominant and non-dominant hands (chosen with a coin toss, heads for modified dressing on dominant middle finger, tails for modified dressing on non-dominant middle finger, with the traditional dressing
on the other hand in all cases) and photos were taken. Volunteers were simply advised to avoid getting the dressing wet but were given no other limitations in the use of their hands. Each volunteer was reviewed at 3 days and photos taken again of the dressings prior to their removal. The modified ‘cinch pink’ dressing was intact in all 10 cases, though two volunteers had slightly frayed edges to the tape (Figure 1). All volunteers reported that it was more comfortable than the traditional dressing and more manageable with minimal hindrance to their daily activities.
Figure 1
Cinch pink dressing 3 days after wear.
1748-6815/$ - see front matter ª 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2011.12.017
e168
Correspondence and communication to itself. As a precaution we advise this dressing should be used with injuries involving the tip of the finger only. This dressing would be contraindicated in infected or crushed digits, as a result of the risk of swelling, and in those with vascular compromise. The senior author has used the ‘cinch pink’ dressing in hundreds of cases, without any associated complications. This small study, which fits with our experience, has demonstrated that the new ‘cinch pink’ dressing remains intact longer, is more comfortable, is easier to manage for patients than the traditional method for securing the tubular finger gauze. Further, it facilitates mobilization of the proximal interphalangeal and metacarpophalangeal joints and negates the need for multiple dressing reapplications.
Conflict of interest Not required.
Funding Not required.
References Figure 2 dressing.
Roll-up of dressing in palm with traditional
With the traditional dressing, however, 3 volunteers had had to re-tape the dressing as the tape was riding up the finger due to poor adherence resulting from sweating in the palm. Interestingly all 3 volunteers spontaneously did this in a way that emulated the new ‘cinch pink’ dressing with a single circumferential tape. All 10 volunteers reported that the traditional dressing was ‘in the way’. Two volunteers reported that they were more prone to interfere with the tape edges in the traditional dressing as it peeled off the palm easily resulting in loose dressing on day 3 (Figure 2). We appreciate that with any circumferential dressing it is paramount not to compromise the vascularity of the digit by forming a tourniquet.2e4 To this end during the application of the modified ‘cinch tape’ dressing the surgeon should not apply any tension and simply allow it to adhere
1. Chang J, Vernadakis AJ, McClellen WT. Fingertip injuries. Clin Occup Environ Med 2006;5(2):413e22. ix. 2. Hart RG, Wolff TW, O’Neill WL. Preventing tourniquet effect when dressing finger wounds in children. Am J Emerg Med 2004; 22:594e5. 3. Fattah A. Dressed to kill: pressure necrosis secondary to finger dressing. J Plast Reconstr Aesthet Surg 2006;59:105e6. 4. Balfour GW. Hazards of tubular gauze finger dressings. Am J Emerg Med 2010;28:839e41.
Maleeha Mughal Anita T. Mohan Olivier Alexandre Branford Donald Dewar Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK E-mail address: [email protected]
19 December 2011
CORRESPONDENCE AND COMMUNICATION Securing fingertip dressings: The new ‘cinch pink’ technique Fingertip injuries are the most common type of injury faced by the hand surgeon.1 These include simple lacerations, nail bed injuries, crush injuries and tip amputations. Achieving a satisfactory dressing for these injuries is often difficult: The objectives are to apply an adequate dressing without compromising movement or the vascularity of the digit, whilst being robust enough to withstand the activities of daily living. Traditionally, the finger dressing usually consists of covering the whole finger with a non-adherent dressing, gauze, tubular finger gauze (or ‘finger bob’), secured with Elastoplast’ª or ‘inch pink’ tape at the base extending to the palm and/or the hand dorsum. We have found a number of drawbacks of using this method of securing the dressing: the tape is awkward to apply, often requiring more than one piece of tape with small cuts to allow the tape to mould around the base of the fingers, and requiring an assistant to hold the fingers separate during application. Including the whole digit in the dressing and extending the tape proximally into the palm can be uncomfortable and restricts movement of the uninjured proximal joints. Sweating in the glabrous skin of the palm causes the dressing rapidly to lose its adherence, roll up and become loose and dirty. Consequently we have modified the method of securing the dressing with ‘inch pink’ tape for fingertip injuries to a ‘cinch pink’ technique which is simpler and more rapid to apply. The proximal end of the tubular finger gauze is deliberately kept on the digit, ideally distal to the proximal interphalangeal joint. A single piece of ‘cinch pink’ tape is applied circumferentially without any tension so that it becomes adherent to itself. We carried out a randomized study with internal controls to compare the new method with the previous technique for securing the tubular finger gauze. Ten individuals (none of whom were patients) were recruited voluntarily to wear the dressing. Each volunteer had the dressings randomized to the middle finger of both dominant and non-dominant hands (chosen with a coin toss, heads for modified dressing on dominant middle finger, tails for modified dressing on non-dominant middle finger, with the traditional dressing
on the other hand in all cases) and photos were taken. Volunteers were simply advised to avoid getting the dressing wet but were given no other limitations in the use of their hands. Each volunteer was reviewed at 3 days and photos taken again of the dressings prior to their removal. The modified ‘cinch pink’ dressing was intact in all 10 cases, though two volunteers had slightly frayed edges to the tape (Figure 1). All volunteers reported that it was more comfortable than the traditional dressing and more manageable with minimal hindrance to their daily activities.
Figure 1
Cinch pink dressing 3 days after wear.
1748-6815/$ - see front matter ª 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2011.12.017
e168
Correspondence and communication to itself. As a precaution we advise this dressing should be used with injuries involving the tip of the finger only. This dressing would be contraindicated in infected or crushed digits, as a result of the risk of swelling, and in those with vascular compromise. The senior author has used the ‘cinch pink’ dressing in hundreds of cases, without any associated complications. This small study, which fits with our experience, has demonstrated that the new ‘cinch pink’ dressing remains intact longer, is more comfortable, is easier to manage for patients than the traditional method for securing the tubular finger gauze. Further, it facilitates mobilization of the proximal interphalangeal and metacarpophalangeal joints and negates the need for multiple dressing reapplications.
Conflict of interest Not required.
Funding Not required.
References Figure 2 dressing.
Roll-up of dressing in palm with traditional
With the traditional dressing, however, 3 volunteers had had to re-tape the dressing as the tape was riding up the finger due to poor adherence resulting from sweating in the palm. Interestingly all 3 volunteers spontaneously did this in a way that emulated the new ‘cinch pink’ dressing with a single circumferential tape. All 10 volunteers reported that the traditional dressing was ‘in the way’. Two volunteers reported that they were more prone to interfere with the tape edges in the traditional dressing as it peeled off the palm easily resulting in loose dressing on day 3 (Figure 2). We appreciate that with any circumferential dressing it is paramount not to compromise the vascularity of the digit by forming a tourniquet.2e4 To this end during the application of the modified ‘cinch tape’ dressing the surgeon should not apply any tension and simply allow it to adhere
1. Chang J, Vernadakis AJ, McClellen WT. Fingertip injuries. Clin Occup Environ Med 2006;5(2):413e22. ix. 2. Hart RG, Wolff TW, O’Neill WL. Preventing tourniquet effect when dressing finger wounds in children. Am J Emerg Med 2004; 22:594e5. 3. Fattah A. Dressed to kill: pressure necrosis secondary to finger dressing. J Plast Reconstr Aesthet Surg 2006;59:105e6. 4. Balfour GW. Hazards of tubular gauze finger dressings. Am J Emerg Med 2010;28:839e41.
Maleeha Mughal Anita T. Mohan Olivier Alexandre Branford Donald Dewar Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK E-mail address: [email protected]
19 December 2011