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Fingertip injuries Fingertip amputation Nail bed injuries Closed injuries Psychosocial factors KEY POINTS Fingertip injuries are common and there is a wide spectrum of presentation. Restoration of a stable, pain-free, and normal looking fingertip is the main goal of treatment. Psychosocial factors are important considerations in the formulation of a treatment plan.

Painful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior interosseous nerve graft along with vascularized synovial and fat tissue based on a branch of the posterior interosseous artery to provide healthy soft tissue for nerve healing of neuroma in continuity about the hand and digits.

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Venous congestion in distal digital replantations is a common problem as suitable veins are not always available. We compared two methods of venous decongestion, external bleeding ( n = 15) and dermal pocketing ( n = 28) carried out when venous anastomosis was not possible. The findings of this small study suggest that neither method of venous decongestion is clearly better than the other. Level of evidence: IV