Fingertip Injuries and Amputations: A Review of the Literature

Abstract

The fingertip is defined as the part of the digit distal to the insertion of the extensor and flexor tendons on the distal phalanx. Devastating injuries to the hand occur every year that lead fingertip amputations in thousands of people. The highest incidence rates are usually seen in children less than five years old and in adults over the age of 65. There are various presentations of injury that may end up with post-traumatic fingertip amputation, including lacerations, avulsions, and crush injuries. The fingertip is vital for sensation, as it has a high concentration of sensory receptors, and hence the restoration of sensation is the most important focus of treatment. The three main goals of treatment are the restoration of sensation and durability in the tip and assuring proper bone support to allow for nail growth. Many complications can arise after fingertip amputation, including delayed wound healing, nail deformities with poor aesthetics, hypersensitivity, residual pain, cold intolerance, scar retraction, flexion contractures, chronic ulceration, infection, and flap loss. The objective of this study is to provide an overview of the anatomy of the fingertip, the presentation of fingertip injuries and their management, and complications that might arise after surgery.

Fingertip Amputation Injury of Allen Type III Managed Conservatively with Moist Wound Dressings

“…Although the healing time depends on the degree of injury, the average healing time in conservative management has been reported as 2–12 weeks [ 13 ]. Fingertip amputation with exposed bone takes the longest to heal [ 16 , 17 ]. In our case, it took 12 weeks for complete healing to occur, which may have been associated with the size of the defect and exposed bone.…”

“…Furthermore, the patient’s smoking history may have also affected the healing time [ 5 , 18 ]. Since conservative management requires a relatively long healing time, revision amputation may be favorable in patients who cannot tolerate an open wound for a long time and desire faster healing [ 5 , 16 , 17 ]. The average time to return to work is reported to be 1.5 months after revision amputation and 3.2–4.0 months after replantation [ 5 ].…”

“…A common challenge with sensation which is associated with conservative treatment is cold intolerance [ 5 , 13 , 16 ]; however, it gradually improves and resolves by 1 year [ 13 ]. Cold intolerance is also commonly reported after operative treatment, especially in revision amputation [ 5 , 16 ]. However, cold intolerance is assumed to be due to vascular insufficiency and peripheral nerve injury at the time of the fingertip injury, regardless of the treatment method [ 21 ].…”

“…Each treatment for fingertip amputation injuries has its advantages and disadvantages. While revision amputation provides faster healing, it does not restore the original finger length and is associated with frequent occurrences of cold intolerance [ 5 , 16 ]. Replantation can help restore the original finger; however, the amputation mechanism must be sharp, the amputated digit must be properly retrieved, and immediate replantation must be performed.…”

“…Although the healing time for conservative management of fingertip amputations may be longer, conservative management has several advantages over operative management: good aesthetic and functional results with almost normal sensitivity, no need for hospitalization and immobilization, and no postoperative complications. Thus, conservative management may be more effective than operative management overall [ 13 , 16 ]. When selecting the treatment strategy for fingertip amputation injury, it is recommended that doctors fully explain to the patient the advantages and disadvantages of both operative management and conservative management and consider the patient’s preference.…”