Pediatric emergency medicine trisk 3341 3341
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FIGURE 109.2 Clinical photograph of a patient with an isolated flexor digitorum profundus
rupture of the long finger. Note the abnormal digital cascade and resting flexion posture of the
long finger in relationship to the adjacent unaffected digits. (Courtesy of Children’s
Orthopaedic Surgery Foundation.)
Amputations of the fingertip are not uncommon and can result in permanent
deformity. The current recommendation is to transport the amputated part in
saline-moistened gauze in a sealed bag that is kept cool in an ice–water mixture.
The amputated part should not be in direct contact with the ice water.
Reimplantation has been recommended in most cases involving children,
provided the distal piece is available and the tissues are not damaged beyond
repair. Even if the distal fragment does not remain viable, it serves a protective
function and facilitates growth of the tissue beneath it ( Fig. 109.3 ).
Reimplantation may not be an option if the avulsed tip is too small, macerated, or
grossly contaminated. In such cases, if sufficient skin is present, it can be closed
over the stump with sutures while taking care to protect the nail bed. Small
avulsions are best cared for with local wound care and petroleum-based dressing
until granulation and healing occur. If closure is not an option due to bone
exposure or missing tissue, hand specialist consultation is indicated to determine
if alternative surgical repair techniques may be beneficial. If emergent surgical
treatment is not an option, these patients may be treated with local wound care
and petroleum-based dressing until they can be seen by a hand specialist as
outpatients.
