Fingertip Amputations (Hand Specialist)

A patient would be referred to a hand specialist if he/she presented with any of the following:

  • Type II or higher partial amputation of the fingertip
  • Oblique fingertip partial amputation with bone exposure or fracture
  • A large soft-tissue defect >1 cm2
  • An unstable fracture of the terminal phalanx

Do not discard the amputated part until you have thoroughly examined the wound. It may be possible to use some of the skin from the amputated segment as a skin graft to cover the open wound.

Surgical options

Possible surgical options for a hand specialist include:

  • Bone shortening and primary skin closure
  • Tip reposition
  • Local skin flap
  • Regional skin flap
  • Distant skin flap
  • Skin graft
  • Toe pulp transfer
  • Replantation
  • Micro vascular flap

Patient preparation

To prepare a patient for transfer to a hand specialist unit carry out the following procedure:

  • Administer intravenous (IV) fluids if the patient needs fasting for a general anaesthetic and for patient hydration
  • Give IV antibiotics. A first-generation cephalosporin is appropriate
  • Control pain with IV morphine or a digital block
  • Get a radiograph of the digit and also of the amputated segment (if available)
  • Clean and dress the finger stump with non-adherent dressing, and wrap the stump lightly with sterile dressings and bandage
  • Elevate the affected hand in a sling
  • Tetanus prophylaxis
  • The patient is now ready for transfer

Care of the amputated part

In order to take care of the amputated part carry out the following procedure:

  • Remove any foreign material from the exposed soft tissues
  • Clean the amputated part with saline, and wrap it in saline moistened gauze (damp, not soaking wet)
  • Place the wrapped segment in a plastic bag
  • Place the bag into a container filled with ice mixed with saline. DO NOT place the amputated part directly on ice [2]
  • Ensure that the bag containing the amputated part is appropriately labelled i.e patient details and part