Abstract
Fingertip injuries are common and can be difficult to manage because of unique anatomical considerations. Optimal treatment minimizes residual pain while preserving the function, length, and sensation of the affected digit. Several types of fingertip injury, including sharp or crush injuries, partial or complete amputations, and those involving the nail plate or nail bed, can occur. Depending on the type of injury, location within the fingertip, degree of soft-tissue loss, and involvement of perionychium, the most effective management may be one of several options. Knowledge of local and regional anatomy is paramount in selecting and performing the procedure that provides the best outcome. To address the array of possible fingertip injuries, we demonstrate several treatment options including (1) local flap reconstruction, (2) regional flap reconstruction, (3) revision or completion amputation, (4) nail bed repair, (5) acellular dermal regeneration templating, and (6) replantation. Outcomes are generally favorable but can be affected by injury and patient characteristics. The most common complications include nail deformity, cold intolerance, and painful neuroma formation.
Published outcomes of this procedure can be found at: J Am Acad Orthop Surg. 2013 Dec;21(12):756-66.
Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A262).
References
- 1.Lee DH, Mignemi ME, Crosby SN. Fingertip injuries: an update on management. J Am Acad Orthop Surg. 2013. December;21(12):756-66. [DOI] [PubMed] [Google Scholar]
- 2.Strauss EJ, Weil WM, Jordan C, Paksima N. A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries. J Hand Surg Am. 2008. February;33(2):250-3. [DOI] [PubMed] [Google Scholar]
- 3.Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980. October;12(3):257-65. [DOI] [PubMed] [Google Scholar]
- 4.Han SK, Chung HS, Kim WK. The timing of neovascularization in fingertip replantation by external bleeding. Plast Reconstr Surg. 2002. September 15;110(4):1042-6. [DOI] [PubMed] [Google Scholar]
- 5.Ni F, Appleton SE, Chen B, Wang B. Aesthetic and functional reconstruction of fingertip and pulp defects with pivot flaps. J Hand Surg Am. 2012. September;37(9):1806-11. Epub 2012 Jul 2. [DOI] [PubMed] [Google Scholar]
- 6.van den Berg WB, Vergeer RA, van der Sluis CK, Ten Duis HJ, Werker PM. Comparison of three types of treatment modalities on the outcome of fingertip injuries. J Trauma Acute Care Surg. 2012. June;72(6):1681-7. [DOI] [PubMed] [Google Scholar]
- 7.Burchiel KJ, Johans TJ, Ochoa J. The surgical treatment of painful traumatic neuromas. J Neurosurg. 1993. May;78(5):714-9. [DOI] [PubMed] [Google Scholar]
- 8.Melone CP, Jr, Beasley RW, Carstens JH., Jr The thenar flap—an analysis of its use in 150 cases. J Hand Surg Am. 1982. May;7(3):291-7. [DOI] [PubMed] [Google Scholar]
- 9.DaCruz DJ, Slade RJ, Malone W. Fractures of the distal phalanges. J Hand Surg Br. 1988. August;13(3):350-2. [DOI] [PubMed] [Google Scholar]
- 10.Lee LP, Lau PY, Chan CW. A simple and efficient treatment for fingertip injuries. J Hand Surg Br. 1995. February;20(1):63-71. [DOI] [PubMed] [Google Scholar]
- 11.Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg Br. 1993. August;18(4):416-22. [DOI] [PubMed] [Google Scholar]
- 12.Weichman KE, Wilson SC, Samra F, Reavey P, Sharma S, Haddock NT. Treatment and outcomes of fingertip injuries at a large metropolitan public hospital. Plast Reconstr Surg. 2013. January;131(1):107-12. [DOI] [PubMed] [Google Scholar]
- 13.Wang K, Sears ED, Shauver MJ, Chung KC. A systematic review of outcomes of revision amputation treatment for fingertip amputations. Hand (N Y). 2013. June;8(2):139-45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Butler DP, Murugesan L, Ruston J, Woollard AC, Jemec B. The outcomes of digital tip amputation replacement as a composite graft in a paediatric population. J Hand Surg EurVol. Vol 2016. February;41(2):164-70. Epub 2015 Nov 5. [DOI] [PubMed] [Google Scholar]
- 15.Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Elsevier; 2011. [Google Scholar]