Lipo-Layering: A Serendipitous Step Toward a Non-Engineered, 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. We describe a simple, reproducible technique using autologous adipose tissue grafting combined with platelet-rich plasma (PRP) - a method we refer to as "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, six patients with seven injured digits underwent one or two sessions of lipo-layering. All grafts integrated successfully, with full coverage achieved in less than six weeks. No flap procedures or secondary grafts were required. Functional outcomes were favorable: full proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint extension in all cases, near-complete DIP flexion in five out of seven digits, and minimal pain or cold intolerance. Sensory recovery ranged from 1 to 2g 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.