Lehigh County Health & Medicine Spring 2021 - 23

S

figure 1
Important fingertip landmarks.

pring has sprung, and once
again cleanup time will
be on everyone's agenda
after a long winter. Leaves
somehow blown in from
your neighbor's yard have piled up, still moist
from the melting snow. Sticks and stones must
be cleared from sidewalks, stairs, and long
driveways. Low lying tree branches should be
carefully pruned. Not to mention all the chores
undone indoors. Hopefully, the snowblower
has at last been put away, but replaced by the
equally dangerous lawnmower when clogged.
Must a chainsaw be necessary, or instead just
a table saw? Pruners, clippers, hatchets, axes,
shovels, chisels, hammers, pliers, the list of toys
goes on. Will an overhaul to reclaim working
order be necessary for any?

So much to do. The days may be longer, but
so little time. Speed and efficiency becomes
the buzzword for their completion. A warning
then is apropos-beware of haste and shortcuts.
Accidents happen, and injuries will result.
Scrapped, stomped, sliced, shredded, or just
punctured, torn, or avulsed. Many may appear
inconsequential, and usually the fingertip suffers
most. After all, the human differs from the ape
in their prehensile capabilities, a fancy word
for being able to pinch a thumb to the other
fingers to enable fine grasp, dexterity, and hand
coordination. It is true that the fingertip injury
is probably the second most common surgical
diagnosis in the local emergency room-right
after burns.
Once seeking help, make sure your tetanus
status is up to date. Antibiotics will depend
on the mechanism and extent of injury, as
will the need for an x-ray to see if there are
any broken bones or dislocations. Even the
simplest fingertip injury can result in edema
or swelling of the whole hand. Consequently,
one of my idiosyncrasies is that since any ring
or ornament even on an uninjured finger once
swelling begins can compress that digit compromising blood flow, much like a tourniquet, so
should be removed ASAP even if need be cut
off! Function including joint movement and

Figure 2.
Partial thumb amputations solved by
a microsurgical toe transfer.

loss of sensation must then be assessed. After
that, local anesthesia to numb the nerves at the
base of the digit will make further evaluation
and repair of any wounds more feasible. Now
treatment of any soft tissue open wounds can
begin, while those involving tendon or bones
must be another story for another day.
On the palmar side of the fingertip, any
persistent bleeding from the pulp [Figure 1.]
can be expected to recur from even a superficial
laceration [cut] upon movement, so sutures
may be the best way to close the wound to
stop this. A little loss of skin [< ½ in.2] will
heal spontaneously. This may take a few weeks
as the wound must contract closed, thereby
pulling glabrous, tough, yet sensate tissue into
the defect-far better than a skin graft from
elsewhere that would only accomplish quicker

healing yet deficient in replacing like-with-like.
On the nailplate side, a subungual hematoma
[blood collecting under the nail] can be very
painful; and often resolved by puncturing the
nailplate to make drain holes. However, more
often than not, this is not just due to a cut in the
nailbed to which the nailplate attaches. Since the
nailbed is also intimately attached to the distal
phalanx [fingertip bone], this may be a sign that
that may have been broken with the sharp bone
pieces disrupting the nailbed. If the bleeding
is significant or if the nail itself has been split
or torn off, the nailplate should be removed
in toto to allow visualization of the nailbed in
its entirety. Only in this way can any nailbed
lacerations be repaired carefully in a smooth
Continued on page 22
SPRING 2021 | Lehigh County Health & Medicine 23



Lehigh County Health & Medicine Spring 2021

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Spring 2021

Lehigh County Health & Medicine Spring 2021 - 1
Lehigh County Health & Medicine Spring 2021 - 2
Lehigh County Health & Medicine Spring 2021 - 3
Lehigh County Health & Medicine Spring 2021 - 4
Lehigh County Health & Medicine Spring 2021 - 5
Lehigh County Health & Medicine Spring 2021 - 6
Lehigh County Health & Medicine Spring 2021 - 7
Lehigh County Health & Medicine Spring 2021 - 8
Lehigh County Health & Medicine Spring 2021 - 9
Lehigh County Health & Medicine Spring 2021 - 10
Lehigh County Health & Medicine Spring 2021 - 11
Lehigh County Health & Medicine Spring 2021 - 12
Lehigh County Health & Medicine Spring 2021 - 13
Lehigh County Health & Medicine Spring 2021 - 14
Lehigh County Health & Medicine Spring 2021 - 15
Lehigh County Health & Medicine Spring 2021 - 16
Lehigh County Health & Medicine Spring 2021 - 17
Lehigh County Health & Medicine Spring 2021 - 18
Lehigh County Health & Medicine Spring 2021 - 19
Lehigh County Health & Medicine Spring 2021 - 20
Lehigh County Health & Medicine Spring 2021 - 21
Lehigh County Health & Medicine Spring 2021 - 22
Lehigh County Health & Medicine Spring 2021 - 23
Lehigh County Health & Medicine Spring 2021 - 24
Lehigh County Health & Medicine Spring 2021 - 25
Lehigh County Health & Medicine Spring 2021 - 26
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Spring21
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMFall_Winter20
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LehighCountyHealthMedicineSummer2020
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Spring20
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Winter19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Fall19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Summer19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Spring19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Winter18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Fall18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSummer18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSpring18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMWinter2018
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMWinter18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/Fall2017
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSummer2017
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSpring2017
https://www.nxtbookmedia.com