title: A novel, simple method for achieving hemostasis of fingertip dermal avulsion injuries.
abstract: BACKGROUND
  Distal 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.
  
  
  OBJECTIVE
  To present a simple method to achieve permanent hemostasis of these injuries using a tourniquet and tissue adhesive glue.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  This technique provides a rapid, simple, and likely safe means to control bleeding from a fingertip dermal avulsion injury.
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente, San Francisco, California and Emergency Department, University of California San Francisco, San Francisco, California.
authors.forename: Brian Wai
authors.initials: BW
authors.lastname: Lin
mesh_terms: D003487:Cyanoacrylates / Q000627:therapeutic use*; D005383:Finger Injuries / Q000150:complications*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D012421:Rupture / Q000150:complications; D012867:Skin / Q000293:injuries; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014111:Tourniquets
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate
keywords: fingertip avulsion; hemostasis; tissue adhesive glue