SP5.4 A review of conservative management of fingertip amputations

Aims

Fingertip amputations are a common presentation, with no definitive guideline, the decision between surgical and non-operative management of these injuries is controversial.

This review aims to identify evidence supporting the use of non-operative treatment methods for fingertip amputations. It is hoped that the evidence gathered will guide treatment decisions and identify areas for further work.

Methods

A search was conducted using Pubmed, Google Scholar and Sage journals. The search terms were ‘Fingertip semi-occlusive’ and ‘fingertip amputation dressing’.

Results

33 papers, published between 1972 and 2022 were reviewed, 1789 fingertip amputations treated non-operatively across the identified literature. There were overwhelmingly positive outcomes for fingertip amputations treated non-operatively; with healing time between 15 and 60 days, excellent two-point discrimination of between 2.5 and 6mm and low rates of infection and other complications. In the limited studies comparing non-operative to surgical treatment, better functional and aesthetic outcomes were found with non-operative management, another ceased recruitment to the surgical management arm due to the lack of benefit over non-operative management and a third found no benefit to surgery by experienced hand surgeons.

Conclusion

There is limited experimental data available in this area, and well conducted randomised control studies are needed. With that limitation in mind, the available literature provides evidence that management of fingertip amputations with dressings produces comparable, if not superior results to surgical management. Given the elimination of surgical morbidity, and ability to provide non-operative management in any location it Is recommended that this be offered as an excellent treatment modality.