FIGURE 109.2 Clinical photograph of a patient with an isolated flexor digitorum profundus rupture of the long finger Note the abnormal digital cascade and resting flexion posture of the long finger in relationship to the adjacent unaffected digits (Courtesy of Children’s Orthopaedic Surgery Foundation.) Amputations of the fingertip are not uncommon and can result in permanent deformity The current recommendation is to transport the amputated part in saline-moistened gauze in a sealed bag that is kept cool in an ice–water mixture The amputated part should not be in direct contact with the ice water Reimplantation has been recommended in most cases involving children, provided the distal piece is available and the tissues are not damaged beyond repair Even if the distal fragment does not remain viable, it serves a protective function and facilitates growth of the tissue beneath it ( Fig 109.3 ) Reimplantation may not be an option if the avulsed tip is too small, macerated, or grossly contaminated In such cases, if sufficient skin is present, it can be closed over the stump with sutures while taking care to protect the nail bed Small avulsions are best cared for with local wound care and petroleum-based dressing until granulation and healing occur If closure is not an option due to bone exposure or missing tissue, hand specialist consultation is indicated to determine if alternative surgical repair techniques may be beneficial If emergent surgical treatment is not an option, these patients may be treated with local wound care and petroleum-based dressing until they can be seen by a hand specialist as outpatients