OrthoMinute_02
Fingers get crushed, smashed, and crammed in all sorts of places.
73 y/o male who has done woodworking for years had an unexpected kickback from the tablesaw resulting in dorsal left index and long finger lacerations involving the nailbed (sterile matrix).
76 y/o female who was visiting Las Vegas and in the chaos of getting in the elevator, she had her right small finger caught in the elevator door which avulsed the soft tissue pulp from the finger.
8 y/o female on vacation to California with family when she got her right index finger slammed in a door resulting in laceration of the nail and pulp.
What do these patients have in common? They were all managed without surgery! What the hand literature has shown over the years (and what I have come to learn in my experience as a Hand Surgery PA over the past 15 years) is that we do not need to operate on fingertip defects like we used to, but rather allow for the body to heal remarkably as it was designed to do!
Previous surgeries of flaps and grafts offered coverage of the soft tissue defect but would also result in finger stiffness, increased cost for surgery, appointments and therapy for rehab as well as lost wages due to the recovery.
Lalonde et al. described a wonderful review of wound care, what factors affect wound care, how to counsel patients on dressing wounds, and how the body is able to heal over exposed bone, cartilage, joints and tendon.
What if a nailbed repair is needed, NO NEED TO SUTURE! Use “Dermabond” (2-octylcyanoacrylate) instead!
Take a look at this OrthoMinute to refresh quickly on these fingertip injuries!
Want to dive deeper? Check out these published articles 👇
And as always, I am here to help! You have a hand/wrist question and would like to talk, you can reach me here.
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