Soft-Tissue Injuries of the Fingertip: Methods of Evaluation and Treatment. An Algorithmic Approach

Abstract

The fingertip is the most commonly injured part of the hand, and therefore fingertip injuries are among the most frequent injuries that plastic surgeons are asked to treat. Although microsurgical techniques have enabled replantation of even very distal tip amputations, it is relatively uncommon that a distal tip injury will be appropriate for replantation. In the event that replantation is not pursued, options for distal tip soft-tissue reconstruction must be considered. This review presents a straightforward method for evaluating fingertip injuries and provides an algorithm for fingertip reconstruction.

Digital Tip Amputations from the Perspective of the Nail

“…These seemingly mundane injuries represent a significant cost to society and to the affected individuals for treatment and from losses due to decreased production. Persistent cold intolerance [1, 8, 23–25], tenderness, and disfigurement [1, 8, 11] may have a major long-term impact on personal and professional activities [26]. In each case, the final outcome depends to some degree on the initial treatment, which may cause more disability than the injury itself.…”

“…Complete healing takes place within 4–6 weeks [3, 6, 9, 10, 12–19]; larger wounds with bone exposure [1, 8] require the longest time to heal. During the initial 1-2 weeks, the amputation stump undergoes little change except for the establishment of a granulation pad, which gradually covers the exposed bone.…”

Purse-string Suture as a Complementary Technique with Conventional Flaps in Repairing Fingertip Amputation

“…1 Fingertip is an extremely specialized end organ with a highly developed sense of touch and requires precise wound care for optimal results. So there are many models for this organ's reconstruction: the secondary wound healing, shortening with closure, skin grafting, primary closure, and flaps.…”

Reconstruction of the thumb tip using palmar neurovascular flaps

“…These range from healing by secondary intention and skin grafts [6] to simple palmar V-Y plasties [7] and bilateral V-Y plasties [8], various island flaps [9,10,11], and even free toe pulp transfer for very large defects [12]. Skin grafting on the defect is an easy method, but usually results in poor sensory function and, therefore, should only be considered if other options are not feasible.…”

“…Healing by secondary intention (e.g., under a semiocclusive dressing) is a very good method for small defects (≤ 1.5 cm 2 ) without exposure of bone or tendons. If successful, it results in a good pulp with complete return of sensory function [6].…”