Robert S. Chang Wallace A. Carter
Management—GeneralPrinciples History, and „Examination
Sp.ec.i.fi.c., „Trea.tm.entStrategi.es Digital „„Tip„ „ Iniuries„ withSkinand „Pulp „Tissue „„L,os,s„„O,n,ly
Digital „Tip. „Injuries with„„E.X.pos.ed„ „Bone
Injuries „„Inyolvingn „th.e„„Ps„risn.yc„hiMm Subungual" Hematoma Nail Bed „„AvMlsioninjMiies
Fingertip injuries are those that occur distal to the insertion of the flexor and extensor tendons at the level of the lunula. This is among the most frequently injured parts of the hand and such injuries may involve the skin, pulp tissue, distal phalanx, and perionychium, made up of the nail, nail bed, and surrounding structures ( Fig. 39-1). Injuries may be classified as closed crush, simple lacerations, open crush with partial amputation, and complete amputation. 1 The approach to treatment depends on the number versus other factors, including the specific digit involved (thumb or index finger); patient's age, sex, handedness, and occupation; as well as the size and angle of the wound, presence or absence of exposed bone, mechanism of injury, concurrent medical problems, and anticipated future use of the hand. The goals are to maintain length and cosmetic appearance, have the fingertip approach normal sensation and function, and have as short and uncomplicated a healing period as possible. This chapter is organized to separate distal fingertip injuries with and without bone exposure from those directly involving the perionychium.
FIG. 39-1. Anatomy of the perionychium.[From Zook, EG: The perionychium, in Green, DP (ed): Operative Hand Surgery, 2d ed. New York: Churchill Livingstone, 1988, p 1332, with permission.]
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