Do hand surgeons treat amputated fingertips?

Management of Shaved Off Fingertips

Hand surgeons are the appropriate specialists to treat shaved off or amputated fingertips, as they have the expertise to manage these injuries with the goal of preserving function, sensation, and appearance. 1, 2

Initial Assessment and Treatment Considerations

• Fingertip injuries are among the most common hand injuries, resulting in approximately 4.8 million emergency department visits annually 1
• The goals of treatment include minimizing pain, optimizing healing time, preserving sensibility and length, preventing painful neuromas, avoiding nail deformity, minimizing time lost from work, and providing an acceptable cosmetic appearance 1
• The mechanism of injury (sharp laceration, crush, avulsion) significantly impacts treatment decisions as it indicates the degree of contamination and amount of tissue loss 2

Treatment Options Based on Injury Severity

Conservative Management

• For superficial wounds or minor amputations with minimal tissue loss:
  • Healing by secondary intention (allowing the wound to granulate and contract spontaneously) may be appropriate 2
  • In children, even amputated fingertips may heal with the severed portion sutured back as a biological dressing 2

Surgical Management

• For injuries with soft tissue loss but no exposed bone:
  • Secondary intention healing or skin grafting is typically recommended 3
• When bone is exposed but sufficient nail matrix remains:
  • Local advancement flap coverage should be considered 3
• When the amputation angle doesn't permit local flap coverage:
  • Regional flaps (cross-finger or thenar) may be indicated 3
• For more proximal amputations or in patients with contraindications to regional flaps:
  • Shortening with primary closure is preferred 3

Regional Differences in Treatment Approach

• In the United States, up to 90% of fingertip amputations are treated with non-replantation techniques 4
• In Asian countries, most amputations are replanted due to cultural values regarding body integrity 4

Considerations for Severe Hand Injuries

• The concept of an "acceptable hand" (one with three fingers of near-normal length, near-normal sensation, and a functioning thumb) should guide treatment decisions 5
• Preservation of vital structures such as joints, flexor tendons, and vessels during initial debridement is crucial 5

Common Pitfalls and Caveats

• Failure to properly assess the mechanism of injury may lead to inappropriate treatment selection 2
• Underestimating the importance of preserving digital length, especially in children, can result in suboptimal functional outcomes 2
• Neglecting to consider the patient's occupation and hand dominance when planning treatment may lead to poor functional results 1
• Not addressing nail bed injuries properly can result in permanent nail deformities 3

Hand surgeons have the specialized training to evaluate the extent of fingertip injuries and determine the most appropriate treatment approach to optimize functional and aesthetic outcomes.