Fingertip laceration

From WikEM
(Redirected from Fingertip Laceration)
Jump to: navigation, search

Background

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.
  • Consult hand surgeon for all patients with Amputation proximal to the lunula (crescent-shaped whitish area)

Anatomy

  • The perinychium includes the nail, the nailbed, and the surrounding tissue.
  • The paronychia is the lateral nail folds
  • The hyponychium is the palmar surface skin distal to the nail.
  • The lunula is that white semi-moon shaped proximal portion of the nail.
  • The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
  • The germinal portion is proximal to the matrix and is responsible for nail growth.

Clinical Features

Differential Diagnosis

Hand and finger injuries

Evaluation

Fingertip Zones

  • Zone I - Distal to tip of phalanx
  • Zone II - Between tip of phalanx and lunule
  • Zone III - Proximal to lunule

Management

No exposed bone or nail bed involvement

  • Zone I injuries - treat conservatively with serial dressing changes alone
    • Cover wound with non-adherent dressing
    • Instruct patient to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing
    • Follow up with primary care provider in 2d
    • Most will have epithelialization in approximately 1 month[1]

Exposed Bone

  • Zone II injuries
    • Consider hand surgery consult
    • Rongeur bone if bony protuberance
    • Wound closure with flap
    • Follow up with hand surgery in 3-5d
    • Healing time 3-6wks
  • Zone III injuries
    • Consult hand surgery if available
    • May require distal phalanx amputation
    • Consider treating like Zone II
    • Healing time 3-6wks[1]

Disposition

References

  1. 1.0 1.1 Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.