• Brian Wai Lin.
• Department of Emergency Medicine, Kaiser Permanente, San Francisco, California and Emergency Department, University of California San Francisco, San Francisco, California.
• J Emerg Med. 2015 Jun 1;48(6):702-5.

BackgroundDistal fingertip pad dermal avulsion injuries can be challenging for emergency physicians. A common occurrence with these injuries is difficult-to-control bleeding. The nature of these wounds is such that conventional primary closure to achieve hemostasis is not feasible. Often, direct pressure, even for prolonged periods, will not adequately control the bleeding. Currently recommended techniques are inadequate to control bleeding, and commercially available hemostatic products may be more costly and not widely available.ObjectiveTo present a simple method to achieve permanent hemostasis of these injuries using a tourniquet and tissue adhesive glue.ProcedureA tourniquet is placed around the proximal digit, and the digit is exsanguinated and elevated to achieve short-term hemostasis. Several layers of commercially available tissue adhesive glue are applied sequentially over the avulsed region of the digit and allowed to dry. The tourniquet is then removed. A clean, bloodless dressing is created over the avulsed fingertip.ConclusionThis technique provides a rapid, simple, and likely safe means to control bleeding from a fingertip dermal avulsion injury.Copyright © 2015 Elsevier Inc. All rights reserved.

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