Finger tip and nail bed injuries

Damage to any of the anatomic structures of the finger tip can result in a change in use of the hand, even making some tasks impossible. Prevention is naturally most important; however, when an injury occurs, anatomic restoration should be the goal. Treatment should be the most direct and simple to reach the optimal structural and functional result. Caveats of treatment are: (1) save nails; (2) reapproximate nail matrix lacerations; (3) use wound contraction and epithelialization to advantage; (4) restore pulp when necessary with volar innervated flaps from the same finger; (5) reduce fracture angulation and displacement; (6) use skin grafts when subcutaneous tissue is sufficient; and (7) replace small noncrushed skin-pulp amputations and traumatic flaps.