Fingertip avulsion

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

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 III injuries
  • Consult hand surg if available
  • May require distal phalanx amp
  • Consider treating like Zone II
  • Healing time 3-6wks

Source

• Tintinalli