There are very few instances when a Hand Surgeon cannot anticipate severity of injury en-route. Two of the most devastating injuries are explosions and table saws. Both wreak havoc of a patient’s hand with devastating consequences. A myriad of injuries are possible. These usually include a combination of all; tendon, nerve blood vessel, bone and ligament injury.
One such patient arrived at ROC last week. He was using a table saw, which accidentally lacerated the patient’s forearm. He immediately knew something was wrong, because all of a sudden his fingers did not move and there was a lot of blood pouring from the wound. He was devastated, because he knew that his life could change forever. It did not help, that some of his co-workers have had much smaller injuries that left them permanently impaired.
Dr. Shuhatovich saw the patient immediately. The examination revealed that the patient had 8 tendons lacerated, but his nerves and bones were intact. The doctor reassured the patient, that he would have a very good outcome. This was based on the fact, that at ROC we see massive injuries all the time and the experience is large. Pure tendon and bone injuries fair the best out of the spectrum of possibilities. The patient was emotionally relieved and an emergency surgery was planned.
The two of the worst possible scenarios are when either nerves or blood vessels are injured. Immediate repair of the nerves results in the best restoration of the motor and sensory function of then hand. The closer the injury to the patient’s shoulder, the worse the functional outcome. This is because after repair, the nerve takes 1 inch per month to regenerate. While the nerve is regenerating, the muscles at the end of that nerve begin to atrophy (die). This causes a significant loss of function. To the patient, that means that they may require secondary reconstructive procedures in the future. Blood vessel injuries act like a time clock. Without blood, all tissues will quickly die. Beyond a certain time threshold, amputations are common. That changes the patient’s life forever.
After surgery, the patient, barely awake, was asking Dr. Shuhatovich if everything went well. To his satisfaction, the doctor encouraged him to make a full fist, move his wrist and forearm. The patient could not believe that he had full motion of all structures, despite just having surgery. While the road ahead of him is long and tendon healing will occur within 6 weeks, the incredible amount of hope that this patient got from his initial result is priceless. This patient will not have any residual impairment in his hand, wrist or forearm long term and will be able to return to all his activities and job.