Fassler PR
Department of Orthopedics, University of Cincinnati College of Medicine.
J Am Acad Orthop Surg. 1996 Jan;4(1):84-92. doi: 10.5435/00124635-199603000-00003.
The primary goal of treatment of an injury to the fingertip is a painless fingertip with durable and sensate skin. Knowledge of fingertip anatomy and the available techniques of treatment is essential. For injuries with soft-tissue loss and no exposed bone, healing by secondary intention or skin grafting is the method of choice. When bone is exposed and sufficient nail matrix remains to provide a stable and adherent nail plate, coverage with a local advancement flap should be considered. If the angle of amputation does not permit local flap coverage, a regional flap (cross-finger or thenar) may be indicated. If the amputation is more proximal or if the patient is not a candidate for a regional flap because of advanced age, osteoarthritis, or other systemic condition, shortening with primary closure is preferred. Composite reattachment of the amputated tip may be successful in young children. The outcome of nail-bed injuries is most dependent on the severity of injury to the germinal matrix.
指尖损伤治疗的主要目标是获得无痛、皮肤耐用且有感觉的指尖。了解指尖解剖结构和可用的治疗技术至关重要。对于软组织缺损且无骨质外露的损伤，二期愈合或植皮是首选方法。当骨质外露且有足够的甲床剩余以提供稳定且附着的指甲板时，应考虑采用局部推进皮瓣覆盖。如果截肢角度不允许局部皮瓣覆盖，则可能需要采用区域皮瓣（邻指或大鱼际）。如果截肢位置更靠近近端，或者由于年龄较大、骨关节炎或其他全身状况，患者不适合采用区域皮瓣，则首选一期缝合缩短术。对于幼儿，离断指尖的复合再植可能会成功。甲床损伤的结果主要取决于生发基质损伤的严重程度。
