Fingertip avulsion: Difference between revisions
No edit summary |
|||
Line 14: | Line 14: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Diagnosis | ==Diagnosis== | ||
===Fingertip Zones=== | ===Fingertip Zones=== | ||
*Zone I - Distal to tip of phalanx | *Zone I - Distal to tip of phalanx |
Revision as of 06:40, 1 June 2015
Background
- Consult hand surgeon for all patients with Amputation proximal to the lunula (crescent-shaped whitish area)
Anatomy
- The perinychium includes the nail, the nailbed, and the surrounding tissue.
- The paronychia is the lateral nail folds
- The hyponychium is the palmar surface skin distal to the nail.
- The lunula is that white semi-moon shaped proximal portion of the nail.
- The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
- The germinal portion is proximal to the matrix and is responsible for nail growth.
Clinical Features
Differential Diagnosis
Diagnosis
Fingertip Zones
- Zone I - Distal to tip of phalanx
- Zone II - Between tip of phalanx and lunule
- Zone III - Proximal to lunule
Management
No exposed bone or nail bed involvement
- Zone I injuries - treat conservatively with serial dressing changes alone
- Cover wound with non-adherent dressing
- Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing
- F/u with PCP in 2d
- Most will have epithelialization in approx 1 month[1]
Exposed Bone
- Zone II injuries
- Consider hand surg consult
- Rongeur bone if bony protuberance
- Wound closure with flap
- F/u with hand surgery in 3-5d
- Healing time 3-6wks
- Zone III injuries
- Consult hand surgery if available
- May require distal phalanx amputation
- Consider treating like Zone II
- Healing time 3-6wks[2]