Not Just a Flesh Wound! Properly Assessing Fingertip Injuries ...

Author

Jesse Dashe MD
September 11, 2023

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, which summarizes key topics in hand surgery for providers on the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

Question:

What are fingertip injuries?

Answer: 

Injuries where the tip of a digit is injured where part of the distal phalanx can be cut. These injuries are classified by how much bone vs. soft tissue is involved.

Finger Tip Injury. Source: Orthobullets

Question:

What needs to be checked with these injuries?

Answer: 

  • Tetanus vaccination is up-to-date within last 5 years

  • Fingertip perfusion and viability

  • Presence of exposed bone or nailbed injury

    • If there is a significant amount of exposed bone, it can be rongeured back to be flush

Exposed bone and dysvascular digit.

Question:

How should fingertip amputations be treated initially?

Answer: 

  • Cleanse wound thoroughly

  • Cover with non-adherent dressing like xeroform (ONLY 1 LAYER THICK TO PREVENT MACERATION) + gauze

  • Start antibiotics for 1 week (usually Keflex 500mg QID)

  • The patient is to change dressings twice daily

  • Splint for comfort

  • Refer to hand surgeon —> see within 1 week

Xeroform - 1 layer thick. Source: Amazon

Question:

How do these patients do long term?

Answer: 

  • These often can be treated conservatively and will granulate in over time —> patients do VERY WELL!

  • Sometimes, various flaps can be performed for tissue coverage, or a revision amputation may be needed

  • Cold sensitivity for about 2 years

  • Nail may not grow or have odd growth patterns long term

Healing Finger Tip Wound

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,