What Structures Can Be Injured When the Fingertip is Injured?
Skin, nails, nail bed, bones, tendons, and the cushion area of the fingertips, called the pulp, may be included. The skin on the inner side of our fingertips has many more nerve endings than other areas of our body. These nerve endings provide the sensation we have in our fingertips. These specialized structures can be damaged in fingertip injuries. When this specialized skin is injured, it is often difficult to create a new one completely when repair is impossible.
How Does a Fingertip Injury Occur?
Fingertip injuries are one of the most common injuries in the hand. Our fingertips are vulnerable to injury in many of our activities. Our fingertip can be crushed by a door closing, a hammer or a heavy object falling on the finger. They can be cut by a blade or electric tool such as a saw, grinder, hedge trimmer, or snow blower.
How are Fingertip Injuries Assessed?
It is important in determining treatment to understand how the injury occurred and if the patient has any underlying medical issues (diabetes, family history of vascular disease). The examination reveals the extent of tissue damage. Sensation and circulation in the tip are evaluated. Movement of the tip is also checked because there may be injuries to tendons that bend or straighten the tip. An X-ray is taken to evaluate for a fracture.
How are Fingertip Injuries Treated?
Severe crushing and amputation injuries can remove a portion or all of the tissue from the fingertip. If only the skin is removed and the skin loss area is less than one square centimeter, these injuries are usually treated simply by making a dressing and allowing the tissue to heal. The patient is followed by changing the dressing every 2-3 days.
If there is a wound with a bone exposed at the end, the bone can be shortened and treated with dressings. For larger skin losses, skin transplant (graft) is required. Smaller grafts are obtained from the little finger side of the hand, while larger grafts can be taken from the front of the arm or the hip. The nail bed must be repaired if it is injured.
When more than skin is lost and the bone is exposed due to the injury, the area can be covered by transferring a piece of skin together with the soft tissue under the skin (flap) to fill the gap and repair the tissue loss caused by the injury.
Larger wounds resulting in significant loss of finger tip tissue can be closed with a skin and subcutaneous tissue flap taken from the adjacent finger. The flap is left attached at the site where the wing was lifted to allow blood flow when it is sutured to the finger wound. The site where the flap was taken is closed with a piece of skin. A few weeks later, the flap heals in its new place and a skin blood vessel forms where it was sutured. The flap, which has sufficient blood supply, is separated by cutting it from the place where it was separated.
Fractures of the finger tip are common. Small fractures of the end of the bone usually do not affect the strength of the bone. Fractures of the soft tissue, such as the nail bed, require placement and usually stabilization with wires. Fractures near the joint may require a cast or a temporary K wire to hold the bone fragments in place.
If the damage is very severe, repair is impossible and improvement is not expected with serial dressings, the end of the finger bone may need to be shortened to close the wound.
What Does the Patient Experience After a Finger Tip Injury?
Sensitivity in the finger tip is common and can last for months. Sometimes the sensation in the finger tip is limited. There may be some loss of contour and the quality and texture of the skin may be different from the very special skin that covers the finger tip. There may be some shape deformity in the site where a piece of skin (graft) or flap was taken. If a flap procedure had to be performed, there is a higher likelihood of encountering joint stiffness in the area where the flap was taken.
If there is more severe crushing at the nail bed, then there is a higher likelihood of scarring at the nail bed and then deformity of the nail.
Hand rehabilitation after surgery must be closely monitored by a specialist physical therapist.
