Fingertip Amputations



Fingertip Amputations


Robert Ryu

Hisham M. Awan



INTRODUCTION



  • Fingertip injuries are the most common hand injuries presenting to emergency departments.


  • Fingertip injuries with soft tissue loss may be time-intensive and challenging to treat.


  • Goals of management include preserving finger length, restoring a sensate, durable tip, and preserving bony support for nail growth when possible.


  • Anatomy



    • Fingertip anatomy (Figure 53.1)



      • Eponychium—also known as the cuticle, soft tissue at distal margin of proximal nail fold


      • Paronychium—lateral margins of nail fold


      • Hyponychium—barrier to microorganisms where nail bed meets skin of fingertip


      • Lunula—crescent-shaped structure seen at junction between sterile and germinal matrices


      • Nail bed



        • Sterile matrix—lies directly beneath the nail plate where it adheres to the nail bed


        • Germinal matrix—just proximal to the sterile matrix, responsible for majority of nail growth


EVALUATION



  • History and physical examination



    • Determine mechanism of injury, including avulsion, crush, or laceration.


    • Assess zone of injury and characteristics of laceration and presence or absence of exposed bone, which will ultimately guide management (Figure 53.2).




    • Evaluate range of motion to determine flexor or extensor tendon involvement.






FIGURE 53.1 Sagittal section of fingertip anatomy. Reprinted with permission from Wolfson A, Cloutier R, Hendey G, et al. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.






FIGURE 53.2 A new classification system for digital amputations distal to flexor digitorum superficialis tendon. FDP, flexor digitorum profundus; FDS, flexor digitorum superficialis. From Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128:725, with permission.


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Fingertip Amputations
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