This patient stated "I think I cut off my finger.”
Unfortunately, fingertip injuries are exceedingly common in the emergency department (ED). Fingertip amputation is defined by an injury that occurs distal to the tendon insertions on the distal phalanx. Most will involve some kind of repair in the ED, and many will also require definitive operative care by a hand surgeon. Goals of care include pain reduction, preservation of sensation, and bony support for nail growth. While some hand surgeons will attempt re-implantation of an amputated fingertip, success rates remain exceedingly low. However, patients should be reassured that they will likely maintain most functionality of their hand. Injuries involving minor tissue loss (usually less than 1 cm squared) without exposed bone may be allowed to heal by secondary intention. Options for more significant injuries include revision amputation (rongeuring of bone) with primary closure, skin grafting, and flap reconstruction. Most of these injuries will require a digital nerve block for pain control and repair. I’m general, it is possible to restore the function and survival of a replanted part, with the general operative sequence being the vascular shunt first to minimize ischemia time, bone fixation with or without shortening if needed, extensor tendon repair, artery repair, venous anastomoses, flexor tendon repair, and nerve repair. This patient’s fingertip was amputated proximal to the nail bed so the bone was further debrided and the wound was closed with sutures. Fingertip injuries are traumatic events for patients but when properly managed in the emergency department, patients can enjoy a return of nearly full function of their hand.