Fingertip injuries, defined as those distal to the insertion of the flexor and extensor tendons, are the most common injuries of the hand. Although maintenance of length, preservation of the nail, and appearance are important, the primary goal of treatment is a painless fingertip with durable and sensate skin. Considerable hand dysfunction results when a painful fingertip causes the patient to exclude the digit from use. Treatment must be individualized on the basis of many patient-related factors and specific wound characteristics. Methods of treatment include healing by secondary intention, skin grafting, shortening of the bone and primary closure, and coverage with a local or regional flap. Composite reattachment should be considered for fingertip
amputations in young children. Although microsurgical replantation is not indicated in most cases, it may be justified for some injuries of the thumb, including those in children.