Improving care for digit wounds

For healthcare practitioners working in both primary care and acute care settings, managing injuries to digits is a daily occurrence. It has been estimated that nearly 4% of visits to emergency department visits in the US are as a result of injury to a finger. Around 75% of these injuries will involve soft tissue injury requiring haemostasis, and a significant number will involve injury to a deep structure. Such injuries have a high rate of complications, and are a common source of litigation in the US for health care providers practicing in the acute care setting. Around 24% of all emergency department claims result from wound related complications – most commonly from failure to diagnose an injury to an underlying tendon, nerve, bone or joint capsule; or as a result of a missed foreign body in the wound.

It is vital for the clinician to perform a safe, thorough examination of the wound to enable accurate diagnosis and treatment of finger injuries. While healthcare providers have devised a variety of different approaches to evaluate and manage these injuries, experts agree that it is critical to evaluate all wounds in a bloodless field, to minimise the risk of complications. Failure to do so will lead to a higher rate of missed deep tissue injuries, missed foreign bodies and a higher rate of infection.

While traditional digital tourniquets provide the necessary haemostasis to achieve a bloodless field, there are well-documented complications associated with their use. These include neurovascular injury due to excessive pressure, and digital necrosis resulting from a forgotten tourniquet.