Lipo-Layering: A Serendipitous Step Toward a Nonengineered, Regenerative Solution for Severe Fingertip Injuries

SUMMARY: Reconstructing subtotal or total volar fingertip avulsions remains a complex challenge, particularly in the absence of replantation options. Traditional flap techniques may be contraindicated or associated with significant donor-site morbidity. The authors describe a simple, reproducible technique using autologous adipose tissue grafting combined with platelet-rich plasma-"lipo-layering"-for the treatment of severe pulp avulsion injuries with exposed bone, tendon, and joint. Initially conceived as a temporary biological dressing while awaiting definitive reconstruction, lipo-layering unexpectedly resulted in complete granulation and re-epithelialization without the need for further surgical intervention. Over a 15-month period, 6 patients with 7 injured digits underwent 1 or 2 sessions of lipo-layering. All grafts integrated successfully, with full coverage achieved in less than 6 weeks. No flap procedures or secondary grafts were required. Functional outcomes were favorable: full proximal interphalangeal and distal interphalangeal joint extension in all cases, near-complete distal interphalangeal flexion in 5 out of 7 digits, and minimal pain or cold intolerance. Sensory recovery ranged from 1 to 2 g monofilament threshold. These results suggest that lipo-layering offers a promising alternative to more invasive techniques for volar fingertip reconstruction, particularly in cases involving deep structural exposure. The technique appears to be associated with minimal morbidity and is compatible with standard wound care protocols, making it a viable addition to the armamentarium of reconstructive hand surgery.