Adequate Visualization

A bloodless field provides the optimal setting for the performance of a digital repair. Several types of tourniquets have been described in the literature, including the pneumatic tourniquet placed around the upper arm, the digital tourniquet using a 1-in. Penrose drain, and a surgical glove. In the last of these techniques, the patient wears a glove that has a cut fingertip corresponding to the injured digit. As the glove is rolled from distal to proximal, a tight band acting as a tourniquet is created around the base of the digit.3 The disadvantage of this technique is that different glove sizes, the varying thickness of the glove material, and the varying number of rolls produced may generate a wide range of pressures, making this technique less desirable in the ED setting. In the ED, a simple yet safe means of achieving

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hemostasis is with the digital Penrose tourniquet. With a 1-in. Penrose drain, the finger is carefully wrapped from distal to proximal, thereby exsanguinating the digit. Ihe drain is then carefully removed from distal to proximal and placed around the base of the finger, secured with a hemostat, to serve as a "tourniquet." Excessively high pressures, which can cause neurovascular damage, may be avoided by limiting the stretch of the drain to no more than 50 percent of the original length. 4

A magnification loupe can be extremely useful in the surgical repair of an injured finger. However, not many EDs are equipped with this tool. If a repair cannot be achieved without a loupe, the hand or plastic surgery specialist must be consulted.

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