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SOURCE TITLE: Right Ring Finger Tip Amputation with Partially Exposed Bone
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ARTICLE CONTENT:
Right Ring Finger Tip Amputation with Partially Exposed Bone
Juan Jose Lizardi
History:
This case details a 26 year old, right hand dominant, male who presents with partially avulsed right ring finger tip after crush injury. He is otherwise healthy. He presents with the amputated segment which he transported in a moistened gauze, placed in a bag, over a slurry of ice and water.
Findings:
Amputation injury involving the tip of the fourth digit with absence of the volar surface of the fourth distal phalangeal tuft.
Diagnosis:
Partial soft tissue amputation to the right ring finger
Differential Diagnoses:
Distal tuft fracture
Injury to extensors/flexors of the digits
Workup Required:
XR of the affected hand and digit
Physical examination
Plan:
1. Administer tetanus prophylaxis to prevent tetanus infection.
2. Initiate intravenous (IV) antibiotics (Ancef) while the patient is in the Emergency Department to prevent infection.
3. Prepare amputated piece by sharply excision the fat from the tissue as well as removing the nail plate.
4. Perform a digital block by administering 1% lidocaine without epinephrine to the volar, metacarpal head of right middle finger.
5. Thoroughly washout the wound with 1000cc of normal saline mixed with iodine.
6. Attach the amputated, and prepared, amputated using 4-0 chromic gut sutures with simple interrupted knots
Expertise Needed:
Hand Surgery background would be helpful, but could be managed by emergency medicine providers if necessary
Treatment:
Composite graft of amputated digit applied to wound. Local wound care and close follow up recommended
Follow Up:
Patient was seen at 3 months post injury with fully healed wound and nail plate nearly fully regenerated
References
Borrelli MR, Landin ML, Agha R, Greig A. Composite grafts for fingertip amputations: A systematic review protocol. Int J Surg Protoc. 2019 May 23;16:1-4. doi: 10.1016/j.isjp.2019.05.001. PMID: 31897441; PMCID: PMC6921220.
Landin, Madeleine L. BSc (Hons)a; Borrelli, Mimi R. MBBS, MSb; Sinha, Vikram BSc (Hons)a; Agha, Riaz BSc (Hons), MBBS, MSc (Oxon), DPhil (Oxon), MRCSEng, FRSA, FHEA, FRSPHc; Greig, Aina V.H. MA, PhD, FRCS (Plast)d. Composite grafts for fingertip amputations: a systematic review. IJS: Short Reports 6(1):p e17, January/March 2021. | DOI: 10.1097/SR9.0000000000000017
Peterson SL, Peterson EL, Wheatley MJ. Management of fingertip amputations. J Hand Surg Am. 2014 Oct;39(10):2093-101. doi: 10.1016/j.jhsa.2014.04.025. PMID: 25257490.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6921220/
https://journals.lww.com/ijsshortreports/fulltext/2021/01010/composite_grafts_for_fingertip_amputations__a.4.aspx
https://pubmed.ncbi.nlm.nih.gov/25257490/
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