Fingertip avulsion: Difference between revisions

Revision as of 18:56, 25 February 2018

Consult hand surgeon for all patients with Amputation proximal to the lunula (crescent-shaped whitish area)

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

The perionychium includes the nail bed and the paronychium.
The paronychium is the lateral nail fold (soft tissue lateral to the nail bed).
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.

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]

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]

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

Authors:

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 ==Background==
-[[File:Human nail anatomy.jpg|thumb|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===
+{{Fingertip 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==