Melbourne Hand Surgery

mandolinWhether it's due to Masterchef, MKR or just bad luck, fingertips around Melbourne are commonly affected by slicing injuries from knives, home mandolins and professional slicing machines. There are two main options for treating such injuries - surgical and non-surgical. We usually find that the non-surgical approach is best. Read on to find out why:

Surgical option for fingertip slicing injuries

The surgical approach for slicing injuries is to place a skin graft on the sliced fingertip. This covers the area, but it also requires

  • admission to hospital
  • an anaesthetic
  • harvesting of a skin graft from a second area, usually from the wrist or upper forearm
  • immobilisation in a plaster for one week
  • ongoing dressings, usually for a further week
  • a risk of infection and scarring at two sites
  • ... and the skin that ends up on the fingertip is not normal finger skin.

This is a reasonable option, especially for very large areas, but in many instances our patients opt for the non-surgical option.

Non-surgical option for slicing injuries

The non-surgical approach is to dress the area until it heals. Most wounds will heal within 2-4 weeks. The time that these take to heal depends on the size of the affected area. Benefits include:

  • the patient can do their own dressings at home, which is more convenient
  • the patient can wash their finger in the shower or sink at any time
  • there is a low risk of infection, even though the wound is "open", because it can be washed frequently
  • the patient can continue using their finger (within the limits of their discomfort)
  • the skin that grows back over the area is "finger" skin

Patients can also opt to wear a protective plastic splint over their finger (like a thimble, but longer) to protect the area from being knocked against hard surfaces if this is likely to happen during their daily activities.

Dressings

A potential risk of the non-surgical approach is having the wrong type of dressings. If the wrong type of dressing material is used then the dressing will stick to the wound and will be extremely painful to remove. The solution to this is not to use the wrong type of dressing - so not to put kaltostat or gauze on the wound, and not to place jelonet on the wound in such a way that it sticks to the finger or becomes embedded in the tissues.

When the injury is fresh it bleeds, which makes it difficult to apply a dressing. In this instance a finger tourniquet or gravity can be used to great effect.

Gravity is a great option to use at home; if there are two people then the person with the bleeding fingertip kneels on the ground and holds their bleeding finger elevated ("stick it up in the air"), while the other person attends to the finger, which will bleed less while it is held up in the air. If there is one person then you have to hold your bleeding finger elevated while using your other fingers to apply pressure to the bleeding point with a tissue, handkerchief or whatever absorbent material you have to hand. You may wish to sit down as you do this and rest your arm and forearm against a wall, because holding your hand in the air for 10 minutes will get tiring.

A finger tourniquet (or "digital tourniquet") can also be used to temporarily stop a finger from bleeding. By wrapping an elastic band or something similar around the base of a digit you can stop the blood going into the finger, which stops the bleeding. It's important to note two things:

1) you will need to take the tourniquet off at some point, or else your finger will die from a lack of blood supply
2) when you take the tourniquet off the finger will temporarily bleed even more than when you put the tourniquet on.
... so the tourniquet is a temporary measure, and you'll need to use gravity as well.

The following is a step by step approach to dressing a bleeding sliced fingertip in a hospital emergency department or primary care facility:

a) Prepare the materials you need: saline, a dressing pack, a tegaderm, gauze, a 1" or 2" bandage, elastoplast/tape and an elastic band (to use as a tourniquet)

b) place the tourniquet on the bleeding finger (unless the bleeding finger has ceased bleeding through the judicious use of gravity)

c) clean the wound gently with saline. Most slicing injuries are clean so they don't need vigorous rubbing. Vigorous rubbing will make the wound bleed more. If you need to rub vigorously it is appropriate to inject local anaesthetic to the finger first, because rubbing vigorously will also hurt quite a bit otherwise.

d) dry the skin around the wound, and the wound, by dabbing with gauze.

e) apply a tegaderm (a plastic adhesive transparent dressing) to the wound and the surrounding skin.

f) apply additional dressings (eg gauze and a bandage) over the tegaderm and secure with tape. You need to apply gauze and bandage at the time of the first dressing because the wound is likely to bleed sufficiently that a bit of blood oozes past the tegaderm.

g) have the patient place their hand up in the air.

h) remove the tourniquet and have the patient keep their hand up in the air, preferably simultaneously applying pressure to the wound, for 10 minutes. This will give time for the bleeding to settle. After that the hand can be placed in a sling. Cautiously observe for additional bleeding onto the dressing. If there is none, the patient can be sent home after being given advice about further dressings in the weeks ahead.

Ongoing dressings

Melbourne Hand Surgery stocks a "Masterchef" or "Slicing Injury" dressing pack that contains 10 tegaderms and a 10 metre roll of coban (the coban comes in blue, red, green and skin-coloured options to suit your preferences). Patients who have a slicing injury can purchase these packs from Reception or can contact our rooms to schedule an emergency consultation for assessment of their injury and advice on how it should be managed. If the slicing injury exposes bone then we strongly recommend specialist review.

slicing kit

How long will dressings be needed for?

The following table provides a guide on the likely duration of dressings for finger slicing wounds, based on the size of the wound:

Injury size Treatment recommended Healing time with dressings
<1cm Dressings 2-4 weeks
1-2cm Either dressings or skin graft 4-6 weeks
>2cm Skin graft, unless you prefer dressings >6 weeks
FRACS

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