Fingertip is the part which exposes to external factors and is used to make almost every functions of the hand. There are many nerve ends that collect sensory stimulus on the fingertip. The nail forms a protective layer against traumas coming from upside part of the fingertip. To restore functional and sensual data collection function of the fingertip is quite difficult. Fingertip is exposed to contusion injuries at most. Cutter, compression, crushing etc are the injuries that are frequent. Fingertip detaching is the most common part of the finger detaching. To learn the trauma type is important for determination of the treatment option. Circulation and sensual examination should be performed. Injuries under the nail may be ignored. Fingertip movements should be determined. Chordas that is adhered to the last knot of the finger, bends and lifts the finger, may be dissociated during the trauma. Radiological examination should always be performed. Bone fractures and small part fractures may be detected in unexpected situations.
Fingertip injuries are one of the most problematic areas after the treatment due to the most common injury region of the hand. Repair of nerve structures is important to restore the supportive structure of the fingertip consisting of bone and nail; to provide pulpa structure which has a certain softness and distension; as it is the farthest region that provides the sense, to protect against trauma in case of sense loss.
Bone end fracture is very common in fingertip injuries. Closed small bone end fractures may be treated by only bracing from the bottom. If nail fold damage is present with the fracture, bone fixation may be required. If fractures are very small, current fractured parts may be removed for not forming pain further. If fractures are body fractures that effect the stability, fixation with a wire is appropriate.
Nail fold injuries should be treated by thin absorbable sutures. Nail fold and nail root repair is required for a proper nail extension. If the nail is separated from its place, it is important to bring the separated nail with the patient. The separated nail is adapted to its place after the nail fold is cleaned to support, to facilitate the further medical dressings and to leave the nail extension way open.
If nail deficit is present and the defect is small, nail graft taken from the same finger; and if the defect is bigger, nail graft taken from the toe is adapted.
If there is a severed part, the part should be taken to the hospital in appropriate circumstances. By development of microsurgery techniques, to suture the severed part to its place became common. It is possible to keep original shape and size of the finger by suturing the severed parts. Recent studies showed that sensory recovery may be provided even nerve repair is not performed.
In case of severance of end skin part of the finger with small bone parts, if vascular structures are not detected, that part may be sutured as a graft on its place by diminishing. This is usually applied in cases where child patients compress their fingertips to the door and rupture. This method is very successful because of high recovery potential of child patients. The part may be cured directly or the part may not be fed from lower tissues and may blacken. Even in this situation, recovery of the fingertip by leaving the blackened tissue should be waited in child patients. Therefore, a recovery which is close to the original shape of the finger may be provided with tissues coming from the bottom.
If the bone is not open and only defect is present, thin skin graft taken from other parts of the body may be used. If skin defects that will leave the bone open, tissues taken from the same finger, other fingers, the palm etc. are adapted to the skin defect.
If severe contusion injury is present, stump may be performed with current stable tissues after cleaning the surrounding tissues.
Fingertip sense may return after months after the treatment. Sometimes limited sense gaining is present. Therefore, the patient should be careful while using his/her finger. Sometimes the finger may not be proper as desired or transmitted tissues may not be same as the original skin tissue. Deformities may occur in tissue transmitted regions. Finger movement limitations may develop after the surgery. Physiotherapy and exercise program, sense training application is important.