Management of partial fingertip amputation in adults: Operative and non operative treatment |
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| Affiliation: | 1. Department of Medicine, Mount Sinai Beth Israel, New York, NY 10003, United States;2. Department of Orthopaedic Surgery, Brown University, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 0290, United States;1. Department of Oral and Maxillofacial Surgery/Pathology & 3D Innovation Lab, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands;2. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hasanuddin, Makassar, Indonesia;3. Department of Oral and Maxillofacial Surgery, University of Oulu, Oulu University Hospital, Oulu, Finland;1. Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK;2. NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK;1. Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland;2. Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany;3. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany;4. AO Research Institute Davos, Davos, Switzerland;5. Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, CA, United States |
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| Abstract: | BackgroundHand and finger injuries account for approximately 4.8 million visits to emergency departments each year. These injuries can cause a great deal of distress for both patients and providers and are often initially encountered in urgent care clinics, community hospitals, and level one trauma centers. Tip amputation injuries vary widely in mechanism, ranging from sharp lacerations to crush injuries that present with varying degrees of contamination. The severity of damage to soft tissue, bone, arteries and nerves is dependent upon the mechanism and guides treatment decision-making. The management algorithm can oftentimes be complex, as a wide variety of providers, including orthopedists, general surgeons, plastic surgeons and emergency physicians, may care for these injuries, depending on location and local culture. We review the common mechanisms for tip amputation and the optimal treatment in adults, based on the severity of the injury, degree of wound contamination, and the facilities available to the provider.MethodsPubmed was searched using text words for articles related to management of fingertip injuries in adults. Bibliographies of matching articles were searched for additional relevant articles, which were then also reviewed. 107 articles were reviewed in total, and 61 were deemed relevant for inclusion. All clinical studies and reviews were included. Particular attention was paid to articles published within the past 15 years.ResultsIn the United States, up to 90% of fingertip amputations are treated with non-replant techniques. In comparison, the majority of amputations in Asian countries are replanted due to moral values and importance of body integrity. Tip amputation injuries can be managed with local debridement, complex reconstruction, or simply with irrigation and application of a sterile dressing.ConclusionIn the United States, most fingertip amputations in adults are treated with non-replant techniques. However, the precise management of a fingertip injury in adults depends on the degree of injury itself, and a number of operative and non-operative techniques may be successfully employed. |
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| Keywords: | Finger Amputation Replant Soft tissue coverage |
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