Abstract
Background: Fingertip injuries are very common due to workplace accidents with a wide spectrum ranging from a small laceration and nail bed injuries to traumatic amputation and severe crush. It is best to retain as much native tissue as possible when viable. Out of the various available reconstructive options, one needs to select an option which preserves the length of the digit and achieves a painless fingertip with durable and sensate skin cover.
Materials and Methods: This is a prospective study of 63 cases with fingertip injuries over a period of 3 years from Aug 2016- Jul 2019. Various reconstructive options were considered for the fingertip injuries depending upon the size, shape, site, status of surrounding skin and structures exposed. The total duration of treatment varied from two to six weeks and follow-up ranged from two months to one year.
Results: Eighty out of 90 (88.88%) fingertip injuries in 63 patients required healing by tertiary intention either in the form of skin graft in 24/90(26.66%) or a flap cover in 50/90(55.55%) to ensure preservation of finger length/ contour and retention of sensation, while revision amputation was done in 6/90 (6.67%). Four out of 90(4.44%) healed by secondary intention. Eight out of 63(12.69%) developed wound infections while wound dehiscence and marginal necrosis in flaps were found in 2/50(4%) and 4/50(8%) in a total of 50 fingertip injured treated with flaps. Only 4 patients (9.5%) had persistent cold intolerance.
Conclusions:Majority of the fingertip injuries are machine related. Public awareness and ensuring strict adherence to workplace safety regulations may prevent these to a great extent.The treatment needs to be individualized and tailored to geometry of the defect and needs of the patients.All possible techniques of reconstruction must be known to the operating surgeon to achieve optimal recovery.

Key words: Avulsed fingertip, fingertip injuries, fingertip lacerations, flaps, crush injury