Downloaded 312 times
Uploaded bySushil Sharma
Finger tip injuries
Finger tip injuries are common, especially in working adults and children, and require prompt treatment to restore function, sensibility, and a viable length. Injuries are classified based on the structures involved and treatments include revision amputation, primary closure, skin grafting, or flap reconstruction depending on the severity and location of the injury. Various flap techniques like V-Y advancement flaps or cross finger flaps are used to reconstruct the pulp and cover bone depending on the zone and site of injury on the finger or thumb.
More Related Content
Similar to Finger tip injuries
Finger tip injuries
- 1.
- 2. Introduction • Fingertip injuryis any soft tissue, nail or bony injury distal to insertion of the long flexor and extensor tendon of a finger or thumb. • Acute fingertip and thumb injuries are common and require prompt and meticulous composite soft tissue repair in incomplete amputations.
- 3. Epidemiology • Can affectall ages but common in working class adults and children. • In adults – Laceration (Most common) – Crush & Avulsion injuries • In children – Most injuries arise at home and due to jamming/crushing by doors
- 4. Clinical Presentation • History –Mechanism: • Avulsion • Laceration • Crush – Hand dominance – Occupation & Hobbies – Time since injury – Tetanus immunization status
- 5. Clinical Presentation • PhysicalExamination – Inspection • Crush vs Sharp injury • Presence or absence of exposed bone • Red line sign • Ribbon sign • Nail or Nail bed involvement • Viability of tip • Presence of foreign body – Range of motion • Flexor and Extensor tendon involvement
- 6. Clinical Presentation • Imaging –AP & Lateral Radiograph to assess the bony involvement.
- 7. Allens Classification Type Feature TypeI Involving pulp only Type II Pulp & Nail bed Type III Distal phalanx fracture with pulp & nail bed Type IV Lanula, Distal phalanx fr, Pulp & Nail bed
- 8. Classification Zone Characterstics Zone IDistal to distal phalanx Nail bed & matrix preserved Zone II Distal to lunula of nail bed Distal phalanx exposed Zone III Nail matrix involved Loss of entire nail bed Reference : Treatment of fingertip and nail bed injury Rosenthal EA Orthop Clin North Am 1983 Oct; 14(4):675-97
- 9. Classification - PNB •Evan & Bernadis (2000) • Too complex for daily clinical use
- 10. Objective of Repair •To restore – Sensibility – Function – Survial – Adequate length
- 11. Principle of FingerAmputation 1. Volar Skin flap should be long enough to cover the volar surface and tip of osseous structure and join dorsal flap without tension 2. End of digital nerve dissected carefully and resected 6mm proximal to soft tissue flap to prevent painful neuroma 3. Flexor and extensor tendon should be drawn distally, divided and allowed to retract proximally. 4. When amputation through joint the osseous condyle should be contoured to avoid clubbing 5. Before wound closure tourniquet should be released and vessel cauterized.
- 12. Management • Non Operative –Healing by secondary intention (<1 cm skin loss with no bone & exposed tendon) Ref : Indian J Orthop. 2007 Apr-Jun;41(2) 163-168 • Operative – Primary closure (Revision amputation) – Full thickness skin grafting – Flap Reconstruction
- 13. Healing by SecondaryIntention • Initial treatment with irrigation and soft dressing • After 7-10 days, soak in water peroxide solution daily followed by application of soft dressing and fingertip protector • Complete healing : 3-5 weeks
- 14. Revision Amputation • Removeremaining nail matrix to prevent irritant nail remnant • If flexor or extensor tendon insertion cannot be preserved, disarticulate DIP joint • Cut digital nerve & remaining tendon as proximal as possible • Palmar skin brought over bone and sutured to dorsal skin
- 15. Flap Reconstruction Techniques SiteTechnique 1. Finger Tip Straight/Dorsal Oblique Laceration •V-Y advancement flap •Digital island artery Volar Oblique Laceration •Cross finger flap (age>30 yrs) •Thenar flap (age<30 yrs) 2. Volar Proximal Finger Cross finger (Age>30 yrs) Axial flag flap from long finger 3. Dorsal Proximal Finger & MCP Reverse Cross Finger Axial flap from long finger 4. Volar Thumb Moberg Advancement Volar Flap (<2cm) FDMA (if >2cm) Neurovascular Island Flap (upto 4 cm) 5. Dorsal Thumb FDMA 6. First Web Space Z plasty with 60 degree flaps Posterior Interosseous Fasciocutaneuos flap 7. Dorsal Hand Groin Flap
- 17. Cap Technique Indication •Good qualityskin with sterile matrix Procedure •Composite tissue reattached
- 18. Kutler V-Y AdvancementFlap Indication • Pulp compromised • Lateral hyponychial skin uninjured
- 19. Atasoy V-Y AdvancementFlap Indication • Transverse/Dorsal oblique cut
- 20. Reverse Digital ArteryIsland Flap Indication • To cover dorsal & volar defect distally
- 21. Adipofascial Turnover Flap Indication •To cover distal dorsal defect 3 cm in length
- 22. Dorsal Pedicle Flap Indication •Amputation proximal to the nail bed • preserving length is essential • Attaching to other finger is undesirable
- 23.
- 24. Thenar Flap Indication • Middle& Ring Finger Coverage
- 26.
- 27.
- 28.