Purpose: To compare the costs and length of disability for conservative treatment versus skin grafting of distal finger and thumb tip amputations. Methods: Thirty-five zone I finger or thumb tip amputations in thirty-five workers in the Southeastern United States were included in this study. Twenty-four were treated with conservative treatment (bandaging to protect the wound). Eleven were treated with skin grafting. The total cost of medical care, total cost including wage replacement, and the length of disability were compared between the two groups. Impairment at the end of treatment was considered. Results: Even when the cost of wage replacement was taken into account, the total cost for skin graft treatment for these injuries is significantly higher. The length of disability was not statistically different between the two treatment groups. There was not a significant difference in impairment reported at the end of treatment. Conclusion: This study did not demonstrate any economic or medical advantage for treating zone I finger or thumb tip amputations with skin grafts. The size of the defect in the skin graft group was significantly larger, though, and the results obtained in this comparison may not allow us to draw valid conclusions about the comparison of these two treatments.