Wound Dressing and Postrepair Care

Once the fingertip injury is repaired, it should be dressed in nonadherent gauze, such as Adaptic (Johnson & Johnson Medical, Inc.) or an antibiotic-impregnated petrolatum gauze, such as Xeroform (Kendall Healthcare Products) and wrapped with sterile gauze dressings. If possible, it is desirable to observe capillary refill after the dressing has been placed. Ihe fingertip should always be wrapped loosely to allow for adequate circulation. A metal or plastic-cap splint should be incorporated into the last layer of dressing for protection and avoidance of painful stimulation. Ihe hand should be kept elevated. Ihese injuries tend to be very painful, so adequate analgesia with oxycodone or hydrocodone should be offered to all patients. A follow-up wound check by the hand or plastic surgeon is recommended after 2 days. Sutures are usually removed 2 weeks after the injury. Exercises to prevent joint stiffness are begun 10 to 14 days following soft-tissue injuries and after 3 weeks if a distal phalangeal fracture is involved.5

Broad-spectrum antibiotics are not routinely recommended. Ihey may be considered in wounds that are contaminated, for injuries that are more than 12 h old, in the presence of exposed bone, or in patients with concurrent medical problems that may affect wound healing (i.e., those with diabetes, renal, or peripheral vascular disease).5 Antibiotics should be chosen to cover suspected contaminants and pathogens: Staphylococcus aureus, streptococci, gram-negative bacilli, and/or anaerobes, depending on the circumstances. Antibiotics should be given early and by a route to achieve high blood and tissue levels, often intravenously.

Indications for admission to the hospital include injuries that require repair in the operating room, those that require a course of intravenous antibiotics, as well as social issues such as homelessness or the patient's inability to follow basic aftercare instructions.

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