Whether at home, on the job, or at play, our fingers are frequently placed in harm's way, and accidents that damage the fingertips are quite common. The fingertips are vulnerable to cuts, tears and crushing injuries that can damage the skin, soft tissues, nail or bone. Because the fingertips are dense with nerve endings, fingertip injuries can be extremely painful.
Fingertip injuries are frequently caused by a finger being slammed in a door, cut by a knife, or caught in machinery. Injuries can range from minor cuts and scrapes to severe, traumatic injuries, including amputation of all or part of the finger.
Treatment for Scrapes and Cuts
Treatment options depend on the severity and type of injury. Superficial scrapes and cuts that damage the tip of the finger usually heal well with conservative treatment including wound care, bandages, and topical medications. Deeper cuts and lacerations may require stitches to close the wound.
Treatment for Crushing Injuries
Crushing injuries often result in rupture or tearing of the tissues at the fingertip. The nailbed may also be injured, causing dark blood to collect beneath the nail. This is called a subungual hematoma. If the nailbed is injured, the nail may need to be removed to repair the tissue underneath. If there is significant swelling from blood collecting, the blood may need to be drained by burning a small hole in the center of the nail. If the nail is missing, an artificial cover may be applied to the nailbed until the nail grows back. In severe cases that result in a significant loss of tissue with bone or tendon exposed, reconstructive surgery may be required to close the wound and cover the exposed structures.
Treatment for Amputations
For an amputation of the fingertip, the treatment depends on the location and angle of the amputation, the age of the patient, condition of amputated piece, and associated medical problems. All fingertip amputations should be evaluated by a hand surgeon. An amputation at the tip that does not involve bone can usually be treated conservatively with wound care and bandaging; occasionally it may require closure with local finger flaps or a skin graft. Amputations further back on the finger involve the bone and require surgery to cover the bone and close the wound. Often this is accomplished by shortening the bone and closing the wound with stitches, but in some cases a skin graft or flap may be needed. If the amputated part has been saved, the skin and soft tissue may sometimes be used as a skin graft to close the wound.
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