Fingertip avulsion

Revision as of 03:47, 16 December 2013 by Ostermayer (talk | contribs) (→‎Anatomy)

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.

Management

No exposed bone or nail bed involvement

  • Treat conservatively with serial dressing changes alone
    • Cover wound with nonadherent dressing
    • Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then rapply nonadherent dressing
    • F/u in 2d

Exposed Bone

  • Rongeur bone if bony protuberance is <0.5cm in length
    • Then let heal by secondary intention as described above

Source

  • Tintinalli
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