Traumatic amputation of Finger

A three years old girl sustained injury after her left hand accidentally caught by the escalator. Picture shows complete amputation of the fifth finger and fingertip injury of the fourth finger. The radiology film shows open fracture of the distal phalanx and complete bone loss of distal and intermediate phalanx of the fifth finger.

Basically traumatic finger amputation may be divided into

1. Distal to DIP joint (Fingertip injury)

2. Proximal to DIP joint.

Objective to achieve in managing this injury

1. Reduce pain

2. Preserve sensation of fingertip

3. To help the wound heal with as little functional disability.

Simple concept

1. Amputation distal to DIP – Refashioning

2. Amputation proximal to DIP – Re implant the finger provided avaibality of equipment and skillful hand surgeon to perform hand microsurgery. Even so, patient should be warned of possibility of failed implantation and the finger will not fully functioning. In the absent of all these, re fashioning is the answer to help the wound heal.

Management of traumatic finger amputation.

1) Airway, breathing and circulation. Always remember that live first before the limb.

2) Adequate analgesia

3) Wound irrigation

4) compression bandage to stop bleeding

5) Immobilization of the injured part

6) Radiology investigation to look for the extent of injury

7) Further evaluation of the injury under digital ring block or in the operation theatre.

8) Wound debridement

9) Refashioning of the injury distal to DIP and nail bed injury.

Note: Study shows that if nail and surrounding nail margin intact, then no need to remove the nail.

10) Re implantation of finger proximal to DIP if possible

a. Clean wound

b. adequate tissue

c. availability of facility and skills for hand microsurgery

11) immobilization of the injured part either by using K-wire or simple splint depending on assesment to the patient.

12) Antibiotic

13) finger exercise.

14) KIV for skin graft if wound can not be closed.