Following completion of the repair, these wounds should be dressed with a nonadherent dressing followed by splinting, especially when there is a fracture Even in the absence of a fracture, splinting protects the wound from reinjury As an alternative, a bulky dressing (often a mitten dressing for fingertip injuries) can be placed over the injured site Petroleum-laced mesh dressings are particularly effective at optimizing healing and minimizing discomfort and damage on removal Administration of prophylactic antibiotics continues to be controversial, but is not routinely indicated even with open fractures, although the risk of antibiotics is low Meticulous wound care is likely most beneficial at preventing infection Antibiotics should be considered for dirty wounds or those with significant devitalized tissue FIGURE 109.3 Images demonstrating the healing after reimplantation of a distal fingertip amputation Despite the appearance of the necrotic tissue (A ) early in follow-up, the long-term follow-up image (B ) shows substantial healing (Courtesy of Children’s Orthopaedic Surgery Foundation.) Subungual hematomas, the collection of blood between the nail and the nail bed, are common and generally occur with crushing injuries Small hematomas are generally cared for without intervention If the patient is having significant pain, draining the hematoma may provide relief Hematomas involving more than 50% of the nail bed surface are more likely to be associated with significant nail