Fingertip avulsion: Difference between revisions
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==Management== | ==Management== | ||
===No exposed bone or nail bed involvement=== | ===No exposed bone or nail bed involvement=== | ||
* | *Zone I injuries - tx conservatively with serial dressing changes alone | ||
**Cover wound with | **Cover wound with non-adherent dressing | ||
**Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then rapply nonadherent dressing | **Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then rapply nonadherent dressing | ||
**F/u in 2d | **F/u with PCP in 2d | ||
**Most will have epithelialization in approx 1 month<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | |||
===Exposed Bone=== | ===Exposed Bone=== | ||
*Rongeur bone if bony protuberance | *Zone II injuries | ||
** | **Consider hand surg consult | ||
**Rongeur bone if bony protuberance | |||
**Wound closure with flap | |||
**F/u with hand surgery in 3-5d | |||
**Healing time 3-6wks | |||
*Zone II injuries | |||
**Consult hand surg if available | |||
**May require distal phalanx amp | |||
**Consider treating like Zone II | |||
**Healing time 3-6wks<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | |||
==Source== | ==Source== | ||
Revision as of 20:56, 5 January 2015
Background
- 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.
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 - tx conservatively with serial dressing changes alone
- Cover wound with non-adherent dressing
- Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then rapply nonadherent dressing
- F/u with PCP in 2d
- Most will have epithelialization in approx 1 month[1]
Exposed Bone
- Zone II injuries
- Consider hand surg consult
- Rongeur bone if bony protuberance
- Wound closure with flap
- F/u with hand surgery in 3-5d
- Healing time 3-6wks
- Zone II injuries
- Consult hand surg if available
- May require distal phalanx amp
- Consider treating like Zone II
- Healing time 3-6wks[2]
Source
- Tintinalli