ORIGINAL CONTRIBUTION amputation, fingertip, open treatment; fingertip, amputation, open treatment Open Treatment of Fingertip Amputations Twenty-five patients with fingertip injuries at or distal to the distal inter- phalangeal joint were treated with a thorough cleansing of the wound with application of bacitracin and a sterile dressing. Warm soaks were begun 48 hours after injury. Crush injury was the most common type of trauma, fol- lowed by cutting injuries. Bone involvement was present in six cases. The average healing time was 29 days. At the time of complete healing, sen- sation was normal in 22 patients (88%). Systemic antibiotics were not ad- ministered routinely. No patient developed a wound infection. Our study documents that fingertip amputations can be successfully treated by non- operative methods that result in preservation of finger length and contour, retention of sensation, and healing without infection. [Lamon RP, Cicero JJ, Frascone RJ, Hass WF: Open treatment of fingertip amputations. Ann Emerg Med I2:358-360, June 1983.] INTRODUCTION Fingertip injuries that result in the loss of skin, subcutaneous tissue, fin- gemail, or bone can be treated by a variety of techniques, t3 Surgical proce- dures include local and distant tissue transfer flaps and flee skin grafts, a-6 Tissue transfer flap or skin graft procedures require a donor site and thus increase the complexity of the repair procedure. The open treatment of fin- gertip injuries has been advocated as an alternative to reconstructive proce- dares based on the rationale that open treatment affords a simpler approach and yields results which are as good as other forms of therapy. 4 We describe the results, limitations, and complications of open treatment of fingertip in- juries in 25 patients. R. P. Lamon, MD J. J. Cicero, MD R. J. Frascone, MD W. E Hass, MD St Paul, Minnesota From the Department of Emergency Medicine, St PauI-Ramsey Medical Center, St Paul, Minnesota. This study was supported by the St PauI-Ramsey Hospital Medical Education and Research Foundation. Address for reprints: Richard R Lamon, MD, St PauI-Ramsey Medical Center, 640 Jackson Street, St Paul, Minnesota 55101. METHODS Open treatment of fingertip amputations was carried out in 25 patients. The patients were included in the study if the amputation occurred at or distal to the distal half of the fingernail. Treatment consisted of an initial examination of the extent of injury, in- cluding the neurovascular and range of motion status of the finger. Digital block anesthesia was administered with 1% lidocaine. The finger was cleansed with povidone iodine solution, and the wound itself was irrigated with saline solution. If severe bleeding were present, hemostasis was secured with one or two sutures of fine, absorbable material. Hemostasis was achieved by means of a mild pressure dressing and elevation of the extremity when bleeding was mild to moderate. The open wound was covered with bacitracin ointment and dressed with a tubular gauze bandage. A four-pronged plastic splint was placed over the gauze dressing for immobilization and protection. Tetanus toxoid was admin- istered if the patient had not been immunized within the past five years. Systemic antibiotics were not prescribed routinely, but five patients were given a five-day course of 500 mg penicillin V four times a day, or an oral cephalosporin when a high degree of suspicion of deeper contamination was present. Debridement was often not necessary, but seven patients underwent debridement of fingemail, bone or devitalized tissue. Frequently, the patients were able to return to work 24 hours later. 12:6 June 1983 Annals of Emergency Medicine 358/33