MANUAL MINORS
A finger fat pad amputation refers to the partial or complete loss of the fatty tissues located at the fingertip, a critical area for protecting bone and tendon structures. This type of injury can occur due to acute trauma, such as an accident involving cutting tools or severe crushing.
Diagnosis
Diagnosis is made through a detailed clinical evaluation, observing the extent of tissue loss, the condition of blood vessels and nerves, and whether there is bone exposure. X-rays may be necessary to rule out associated fractures. The sensitivity and mobility of the finger should also be assessed to determine if other structures, such as tendons or nerves, are compromised.
Differential Diagnosis
Condition | Characteristics |
|---|---|
Crush injury without amputation | Tissue damage without complete loss of the fat pad. |
Puncture wound | Does not involve amputation but may cause deep tissue damage. |
Open finger fracture | Fracture with bone exposure without significant soft tissue loss. |
Severe abrasion injury | Superficial skin wear, but without complete fat pad amputation. |
Emergency Management
In the emergency department, it is vital to control bleeding by applying direct pressure and elevating the affected finger. The wound should be thoroughly irrigated with sterile saline solution to prevent infection and remove foreign bodies.
It is important to protect exposed structures with sterile dressings and keep the hand immobilised. Administration of analgesics and antibiotic prophylaxis should be considered, along with ensuring that tetanus vaccination is up to date.
Definitive Treatment
Definitive treatment will depend on the extent of the amputation. In minor cases, primary closure with sutures may be performed. However, for more severe amputations, coverage with skin grafts or local flaps may be required. If there is significant loss of structures such as tendons or bone, surgical reconstruction is considered. In cases where reimplantation is not feasible, rehabilitation with physiotherapy is essential to optimise finger function.
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