Most fingertip injuries can be treated in a procedure room, provided p
roper lighting and equipment are available, Sound judgment and knowled
ge of fingertip anatomy are essential, Determining the mechanism of in
jury is important, because it may indicate the degree of contamination
, amount of tissue loss, and best treatment. Superficial wounds may be
allowed to granulate and contract spontaneously, In children, even am
putation may heal by secondary intention, with the fingertip sutured b
ack in place as a biologic dressing, Split- and full-thickness skin gr
afts may be appropriate, but diminished sensibility limits their usefu
lness on volar surfaces, Local skin flaps are indicated when the wound
bed is unsuitable for grafting or when skin is needed to cover expose
d bone or tendon, Direct closure may be used in amputations of 2 to 3
mm, When the nail bed is lacerated, the nail plate must be removed and
the wound repaired. Any free segments of nail bed should be sutured i
n place as a free graft. In children, treatment should be conservative
, with emphasis on preservation of digital length.