by Dr. Brian A. Pinsky
Q: What are some common causes of fingertip injuries?
A: Fingertip injuries can be caused by a variety of situations ranging from a knife accident to the dropping of a heavy object. Seasonal activities such as lawnmowers, snowblowers, and fireworks are common causes of fingertip injuries and amputations.
Q: Where can I get my injury evaluated?
A: Fingertip injury evaluations can be performed in either an emergency room or private office setting. During this initial evaluation it is important that a thorough patient history is taken. This should include the mechanism of injury, medical history, medications, handedness, and patient occupation. Fingertips have remarkable healing potential, and many injuries can be treated without major surgery. Proper wound care, time, and patience often all help to facilitate the best outcomes.
Q: How should fingertip injuries be treated?
A: Fingertip injuries should be treated immediately with basic first aid practices including washing the area thoroughly with clean water or saline. Soap can be used if there is any dirt or gravel contamination of the wound. Dry sterile dressings should be placed, and any bleeding controlled with elevation and direct pressure from the opposite hand.
Q: What do I do if there is a finger amputation?
A: If there is a complete amputation, the amputated digit should be collected as soon as possible. The amputated piece can be gently cleaned with water or saline. It should be wrapped in a moistened gauze and placed in a sealed, water-tight plastic bag, such as a zip-loc or similar container. The finger should then be placed in the plastic bag on ice. It’s important to avoid contact between the ice and amputated digit, as it can cause further tissue damage. Then proceed to the nearest local trauma center for evaluation. Not all amputated fingers can be replanted, and it’s important to have the injury evaluated by a trained hand surgeon as soon as possible.
Q: Do I need to see a doctor if there is an injury to the nail bed?
A: Injuries involving the nail bed can be left to heal if the nail plate remains mostly adherent. Blood collections under the fingernail should be evacuated either directly or by placing holes in the nail with an 18-gauge needle or battery-powered cautery. Nail bed lacerations can be left to heal if the nail plate remains adherent. If the nail is partially avulsed, it can be removed completely, and the laceration repaired with a fine absorbable suture. The nail can then be temporarily sutured under the nail fold as a stent to protect the repair.
Q: What type of injury would require surgery and how?
A: Larger or more complex wounds that involve exposed tendons or larger portions of exposed bone may require reconstructive flap surgery. This involves transferring skin and soft tissue with its own independent blood supply to reconstruct the wound. Tissue is most commonly transferred from the proximal portion of the same finger or an adjacent non-injured finger. Complete amputations involving larger portions of the fingertip and nail bed can be replanted successfully using specialized microsurgical techniques. There is a higher rate of survival with sharp injuries that have a smaller zone of injury to the vessels and nerves. In young children, tissue can often be replaced directly as a composite tissue graft with good results.
In the case of any fingertip injury, it is important to undergo a timely evaluation by a hand surgeon or credible medical professional. When diligent wound care is adhered to, most patients with fingertip injuries have excellent outcomes and require minimal medical intervention. While tenderness and hypersensitivity are initially common, they do typically resolve over time. The Institute for Hand Surgery at New York Plastic Surgical Group is focused on providing comprehensive care for conditions of the hand, upper extremity, and peripheral nervous system. Head to newyorkhandandnerve.com for more information.