Pediatric emergency medicine trisk 3342 3342
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Following completion of the repair, these wounds should be dressed with a
nonadherent dressing followed by splinting, especially when there is a fracture.
Even in the absence of a fracture, splinting protects the wound from reinjury. As
an alternative, a bulky dressing (often a mitten dressing for fingertip injuries) can
be placed over the injured site. Petroleum-laced mesh dressings are particularly
effective at optimizing healing and minimizing discomfort and damage on
removal. Administration of prophylactic antibiotics continues to be controversial,
but is not routinely indicated even with open fractures, although the risk of
antibiotics is low. Meticulous wound care is likely most beneficial at preventing
infection. Antibiotics should be considered for dirty wounds or those with
significant devitalized tissue.
FIGURE 109.3 Images demonstrating the healing after reimplantation of a distal fingertip
amputation. Despite the appearance of the necrotic tissue (A ) early in follow-up, the long-term
follow-up image (B ) shows substantial healing. (Courtesy of Children’s Orthopaedic Surgery
Foundation.)
Subungual hematomas, the collection of blood between the nail and the nail
bed, are common and generally occur with crushing injuries. Small hematomas
are generally cared for without intervention. If the patient is having significant
pain, draining the hematoma may provide relief. Hematomas involving more than
50% of the nail bed surface are more likely to be associated with significant nail
