[Injuries of the terminal phalanx and nail]

In children the treatment of pulp injuries should amed at conservation. In amputations, replantation should always be tried owing to the high possibility of success and subsequent of functional recovery. In non-specialized workers the simplest and shortest operative procedure (natural healing or skin graft) should be preferred to ensure the quickest possible return to work. In specialized manual workers such as musicians and typists, the return of the sense of touch along with a functional distal joint is essential. In these cases all necessary reconstructive procedures are indicated. In women the cosmetic appearance is most important and requires precise nail reconstruction. Special considerations apply to certain digits: 1. The thumb should be kept as long as possible, without bone sacrifice, requiring plastic procedures to ensure good skin cover. When possible these should employ local flaps which may restore sensation, especially significant on the ulnar side of the pulp. If these local flaps are not possible, sensitive flaps (KUHN/HOLEVICH type) or sensory island flaps (MOBERG, LITTLER or HILGENFELDT type) may be used. 2. In the little finger conversation is almost as important as this digit is mobile, autonomous and represents the usual contact of the ulnar side of the hand. 3. In the index finger, employed manity for fine actions, DIP mobility is important for good pick up ability. Local flaps are preferred. If impossible sensitive flaps should be used on the radical aspect of the pulp, to avoid functional substitution of the middle finger for the index.