Fingertip injuries can be treated successfully without surgery

Sep 24 2012

By medwireNews Reporters

Most fingertip injuries can be treated without surgery, research from a large New York City public hospital suggests.

In this single-center series, two out of three fingertip injuries were treated without surgery. Despite this, patients who received conservative treatment had a return of normal sensation and fine-motor skills, as well as an earlier return to work than those who underwent surgery.

In assessing the management of fingertip injuries from their center, Nicholas Haddock (University of Pennsylvania Hospital, Philadelphia, USA) and colleagues state "it is clear that a large number of these injuries can be treated by conservative management."

Still, the group concedes that suboptimal outcomes resulting from patient socioeconomic limitations, poor compliance, and poor follow up remain a problem.

As published in Plastic and Reconstructive Surgery, the researchers reviewed records for patients with fingertip injuries presenting to Bellevue Hospital over a 6-month period in 2011.

One hundred fingertip injuries from 83 patients were included in the analysis. The most common mechanism of injury was crush (45%), followed by laceration (32%) and avulsion (23%). Most patients were employed as manual laborers, within the food industry or other service industries.

The vast majority of patients had one finger injured, while 7.2% had two fingers injured, and 4.8% had three fingers injured. The average size of the soft-tissue defect was 1.87 cm².

Of those treated, 64% healed without surgery while 18% underwent surgery. An additional 18% of patients were lost to follow up.

The surgical procedures used for the management of the soft tissue injury included removing the nail plate, full thickness skin graft, cross-finger flap, complete amputation, atasoy flap, thenar flap, and first dorsal metacarpal artery flap.

The treatment algorithm used by the hospital was not based on a defect size cutoff, but rather the type of injury, the necessity of returning to work, and the poor reliability of the patients to return for follow-up.

After treatment, sensation was intact in 65 digits and impaired in eight patients - 27 digits/patients were lost to follow up. Of the eight patients who lost sensation, four were managed with local wound care, three were treated with nail plate removal, and one treated with a cross-finger flap.

The time required before returning to work was 2.26 weeks for all patients. For those undergoing surgery, the time before returning to work was 4.33 weeks versus 2.98 weeks for patients treated without surgery.

Patients requiring surgery were significantly more likely to have a larger soft tissue defect than nonsurgical patients.

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