Derm
Fingertip Amputation
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Fingertip Amputation
, Finger Tip Amputation
See also
Finger Laceration
Limb Amputation
Classification
Zone I Fingertip Amputation
Preserved distal phalanx without bone exposure
Majority of nail bed and nail matrix intact
Zone II Fingertip Amputation
Amputation distal to lunula of nail bed
Bony exposure of distal phalanx
Zone III Fingertip Amputation
Loss of entire nail bed
Large portion of distal phalanx lost
Precautions
See
Finger Laceration
Set expectations at time of initial presentation
Affected finger may heal poorly and never return to original function
Reattached partial amputations may not survive, but serve as a biologic dressing
Delayed healing or scarring may occur
Distal
Sensation
may never return
Management
Gene
ral measures
Irrigate, clean and debride the wound well
Antibiotics are not needed in most cases
Consider antibiotics only if grossly contaminated,
Immunocompromised
state, diabetes, vascular disease
Arora and Menchine in Herbert (2015) EM:Rap 15(10): 12
Rubin (2015) Am J Emerg Med 33(5):645-7 +PMID: 25682579 [PubMed]
Complicated wounds (e.g. larger wounds >2 cm or those involving bone)
Wound
may be cleaned, dressed and evaluated by hand surgery within 24 hours
Management
Reimplantation
Discuss with hand surgery as to whether patient is a candidate
Finger tip reimplantation has a high success rate
Jazayeri (2013) Plast Reconstr Surg 132(5): 1207-17 [PubMed]
See
Limb Amputation
Care of the amputated part
Care of the amputation site
Management
Non-Reimplantation Techniques
Anesthesia
See
Digital Block
Zone I Fingertip Amputation
Wound
left open for
Healing by Secondary Intention
Meticulous wound care with close observation
Conservative
Debridement
of excessive granulation tissue
Topical Antibiotic
ointment for moist
Wound Healing
Consider skin adhesive technique to control distal fingertip bleeding
Apply finger
Tourniquet
(e.g. tourni-cot)
De-engorge the finger using a venipuncture
Tourniquet
(dries the distal tip)
Appy repeatedly from proximal to distal (expect to see dark blood from fingertip)
Apply several layers of
Tissue Adhesive
to the fingertip
Lin (2015) J Emerg Med 48(6):702-5 +PMID: 25886984 [PubMed]
Zone II Fingertip Amputation
Dorsal Plane Amputation (angled toward finger dorsum)
More nail bed avulsed than pulp
Consider repair with
V-Y Plasty
Transverse Plane Amputation (perpendicular to finger)
Equal
amounts of nail bed and pulp avulsed
Consider repair with
V-Y Plasty
Volar Plane Amputation (angled toward volar finger)
More pulp avulsed than nail bed
Do not use
V-Y Plasty
for this avulsion
Zone III Fingertip Amputation
Amputate distal phalanx
References
Hori (2015) Crit Dec Emerg Med 29(3): 2-7
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