A 30-year-old male presented to emergency department with a right 3rd digit distal amputation that happened 30 minutes prior to arrival while working on his car. The patient states that a sharp part of a car fell onto his finger, snapping a part off.

He brought the distal tip wrapped in a paper towel. Emergency department physician immediately placed it in an ice bath with a plastic bag separating the tissue from the ice.

The wound was thoroughly explored and cleaned with betadine and sterile water. Digital block and local anesthesia with 5 cc of 1% lidocaine was given. Tetanus booster and Unasyn IV were given.

After reviewing the X-ray at bedside, emergency department physician proceeded with repair of the tissue. The amputation had left the nail intact as you can see on the lateral X-ray.

The patient's own nail was used in a process to give the repair integrity. The emergency department physician started with an initial suture through the nail and then the tip to bring the tissue together under the nail. Then he worked around the wound with 4-0 Prolene sutures x 14 in total. Finger splint applied.

Patient noted return of sensation and there was redness returning to the tissue about an hour after the repair.

Patient was discharged with PO Keflex and a hand surgeon follow up.

X-ray images taken before (left) and after (right) the repair:

Here are the images of the finger after repair:

Pearls/Teaching Points

"Time is finger"

• The earlier a patient presents with an amputated finger, the higher the chances are for re-implantation
• The correct storage of the amputated fingertip increases the chances of salvaging it: place it on ice bed in a plastic bag separating tissue and ice

Do not take off and throw away a nail unnecessarily: it can be used during repair as a support of structural integrity of an amputated finger

Treat it as an open fracture: IV antibiotics in emergency department, finger splint, close follow up with a hand surgeon

 
Courtesy of Dr. Virat Patel
Drexel University Emergency Medicine Residency Alumnus
Class of 2019

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

 
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