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10.02 Superficial Finger Tip Avulsion


Presentation

The mechanisms of injury can be a knife, a meat slicer, a closing door, or a falling manhole cover, or spinning fan blades, or turning gears. Depending on the angle of the amputation, varying degrees of tissue loss will occur from the volar pad, or finger tip.

What to do:

What not to do:

Discussion:

The finger tip, being the most distal portion of the hand, is the most susceptible to injury, and thus the most often injured part. Treating small and medium-sized finger tip amputations without grafting is becoming increasingly popular. Allowing repair by wound contracture may leave the patient with as good a result and possibly better sensation, without the discomfort or minor disfigurement of taking a split thickness graft. On the other hand, covering the site with a graft may give the patient a more useful and less sensitive fingertip within a shorter period of time. Unlike the full- thickness graft, a thin split-thickness graft will allow wound contracture and thereby allow for skin with normal sensitivity to be drawn over the end of the finger. The full- thickness graft, on the other hand, will give an early, tough cover which is insensitive but has a more normal appearance. The technique followed should be determined by the nature of the wound as well as the special occupational and emotional needs of the patient. Explain these options to the patient, who can help decide your course of action.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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