But, just for the record:
Do not stick your finger into the spinning blades of a lawnmower.
Uploaded with Skitch!
This wound poses some interesting management issues. As you can see, it's a fairly clean amputation just beyond the distal interphalangeal (DIP) joint. The patient, optimistically, brought in the amputated portion nicely iced, but reimplantation at this level is not feasible. The blood vessels there are too small and distorted to anastomose. Such a relatively long section to re-install requires good blood flow or it will simply necrose and fall off. So I had to disappoint the patient and tell him it could not be made whole again.
However, the technical issue is that with this very clean amputation there was not enough soft tissue left to close around the stump. Ordinarily, I would take a bone rongeur to nibble away at the residual bony stump until there was enough slack in the skin to pull it across the stump and close it. But this guy had just a bit of intact distal phalanx. I would have had to remove the entire thing, which is not preferable since the flexor and extensor attachment points were still intact. Taking out the rest of the bone would have made the finger weaker and less mobile.
So, in the McGyver-like fashion that ER docs must emulate, I improvised. I took the devitalized fingertip and started harvesting. I excised the bone and the nailbed, leaving only the finger pad and a generous fat pad underneath. I thinnned the fat pad a bit, and trimmed the skin to fit the stump, then tacked it on like a cap. It looked pretty good, and I am optimistic that my little graft will survive. If it does, the fact that I left a fat pad will give him a little cushion over the bone and a relatively functional finger.
But still, the principle remains. Fingers and spinning blades of any sort should not mix.