Affected Part In A Fingertip Injury
Injured
components may include skin, bone, nail, nailbed, tendon,
and the pulp, the padded area of the fingertip. The skin on
the palm side of our fingertips is specialized in that it
has many more nerve endings than most other parts of our body.
These
nerve endings enable the fine sensation we have in our fingertips,
and they can also be damaged. When this specialized skin is
injured, exact replacement may be difficult.
Occurence
Fingertip
injuries are one of the more common injuries in the hand.
The fingertips are exposed in many of our activities. They
can be crushed, such as by a closing door, a hammer, or a
heavy object dropped onto the finger. They can be cut with
a knife or power tool, such as a saw, sander, lawnmower, or
snowblower.
Evaluation
It is
important to know how the injury occurred, and about any medical
problems, as these can factor into deciding about treatment.
Examination
reveals the extent of tissue injury and its size. Sensation
and circulation of the tip are assessed. Mobility of the tip
is also checked, as injuries can occur to the tendons that
bend or straighten the fingertip. X-rays are often needed
to see if the bone has been injured.
Treatment
Severe
crush can completely remove some or all of the tissue at the
fingertip. If just skin is removed and the defect is less
than a centimeter in diameter, it is often possible to treat
these injuries with simple dressing changes. If there is a
little bit of bone exposed at the tip, it can sometimes be
trimmed back slightly and treated with dressings, too.
For larger
skin defects, skin grafting is occasionally recommended. Smaller
grafts can be obtained from the little finger side of the
hand. Larger grafts may be harvested from the forearm or groin.
If the nailbed is injured, it is repaired.
When patients
lose more than skin and have exposed bone, the injury may
need to be covered with a flap of skin that has some soft
tissue with it for padding. Small wounds on the tip of the
finger may be covered with a flap from the injured finger.
Larger wounds, such as those that result in substantial loss
of the pulp, require a flap that is elevated from an adjacent
finger or other source. The flap remains attached to its original
site so that it has blood supply while it is stitched to the
finger wound. A skin graft is used to cover the donor site
defect.
After
a few weeks the flap has sufficient blood supply coming from
the injured finger as it heals into its new location, and
can be divided from its origin and fully set into the wound.
Fractures
of the bone in the tip of the finger are common. Very small
fractures of the end or tuft of the bone usually do not affect
the strength of the bone.
Repair
of the soft tissue, such as the nail bed, usually re-aligns
and stabilizes these bone fragments. Fractures closer to the
joint may require a splint or even a temporary metal pin(s)
to hold the bone fragments in proper position. If the damage
is too severe, amputation of the fingertip may be necessary.
Expectations
Fingertip
sensitivity is common and may last for many months. Sometimes
the feeling in the fingertip is limited. The contour may have
some distortion, and the quality and texture of the skin may
be different than the very specialized skin that normally
covers the fingertip. There also may be some deformity at
the donor site of a graft or flap. Stiffness can be a concern,
especially if a flap is needed.
If there
is a nailbed injury that is sharp and can be repaired, a normal
nail is likely. If there is more severe crushing of the nail
bed, then there is a greater likelihood of nail bed scarring
and subsequent deformity of the nail.
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