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Fingertip Slicing Injuries
Fingertips are commonly sliced by kitchen knives, mandolins and slicing machines. There are surgical and non-surgical ways to treat these injuries, and the non-surgical approach is often the better choice.
What are fingertip slicing injuries?
A fingertip slicing injury happens when a sharp blade, such as a kitchen knife, a mandolin or a commercial slicing machine, shaves off some or all of the skin and soft tissue at the end of a finger or thumb. There are two main ways to treat these injuries, surgical and non-surgical, and the right choice depends mainly on the size of the area affected.
At a glance
What is it?
A cut that shaves off some or all of the skin and soft tissue at the fingertip
Common symptoms
Bleeding and pain at the fingertip, and an area of missing skin or soft tissue
Who it affects
Anyone using a knife, mandolin or slicing machine in the kitchen or at work
Is it serious?
Not dangerous, but the wound needs the right care to heal well
Treatment options
Dressings until healed, or a skin graft for larger areas
First step
An assessment of the size and depth of the wound to plan the best treatment
Causes and risk factors
- Kitchen knives
- Mandolin slicers
- Commercial or home slicing machines
- Any sharp blade used close to the fingertips
Symptoms and how fingertip injuries present
The main features are bleeding from the fingertip and an area of missing skin, which may expose the soft tissue underneath. Bleeding can look dramatic because fingertips have a rich blood supply, even when the wound itself is not deep. If the slice is very deep it can expose bone, and this needs specialist review.
How are fingertip injuries diagnosed?
Assessment is based on examining the wound to work out its size and depth, and whether bone is exposed. An x-ray may be taken to assess the injury. Expert assessment guides which treatment, surgical or non-surgical, is likely to give the best result.
Treatment options
There are two main options for treating a sliced fingertip.
Surgical option (skin graft). A skin graft is placed over the sliced fingertip. This covers the area but requires an admission to hospital, anaesthetic, second wound to harvest the graft, usually from the wrist or forearm, immobilisation in a plaster for one week, ongoing dressings usually for a further week… and the skin that ends up on the fingertip is not normal finger skin.
Non-surgical option (dressings).
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.
Using the right type of non-stick dressing matters, since the wrong dressing can stick to the wound and be painful to remove.
Managing a slicing injury: First aid and dressings
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 after initial first aid
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.
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 |
Frequently Asked Questions
What are fingertip slicing injuries?
An injury where a sharp blade, such as a kitchen knife, mandolin or slicing machine, shaves off some or all of the skin and soft tissue at the end of a finger or thumb.
What causes it?
Kitchen knives, mandolin slicers, commercial or home slicing machines, and any sharp blade used close to the fingertips.
What can I do myself?
Elevate the injured hand and apply firm pressure with a clean dressing to control bleeding, which can look dramatic even from a shallow wound. Once bleeding is controlled, a non-stick dressing can be applied and changed regularly; Melbourne Hand Surgery stocks a slicing injury dressing pack available from Reception. If bone is exposed, seek specialist review.
What can a hand therapist do?
Fingertip slicing injuries are managed through dressings or, for larger wounds, a skin graft, rather than hand therapy in the initial stages.
What can a hand surgeon do?
Assess the size and depth of the wound to determine the best treatment. Two main options exist: ongoing dressings until the wound heals naturally, or a surgical skin graft for larger areas. The non-surgical, dressings-based approach is often the better choice, even though it can take longer to heal, because it avoids a hospital admission, a second wound to harvest a graft, and results in the area healing with normal finger skin.
What can I expect from treatment?
Small wounds under 1cm typically heal with dressings alone in 2 to 4 weeks. Wounds of 1 to 2cm can be treated with dressings or a skin graft and take 4 to 6 weeks to heal. Larger wounds over 2cm are more often treated with a skin graft, unless dressings are preferred, and take longer than 6 weeks to heal with dressings.
What happens if it's left untreated?
An open fingertip wound needs appropriate dressing care to heal well and avoid infection. Using the wrong dressing, or leaving a deep wound with exposed bone unassessed, can lead to a poorer result, so prompt appropriate care matters.