HAND TRAUMA: CAN THIS FINGER BE SAVED?

No one likes to think about the possibility of losing a finger. But all too often, I am called to a local emergency room to help save or re-attach a finger or thumb. Usually the result of an industrial or handyman accident, these injuries are normally less severe if the patient was wearing protective gloves. Successful treatment and recovery usually depends on the severity of the injury, the location of the injury to the hand, and the overall health of the patient.

In the case of a partial laceration or amputation, the chances of successfully re-attaching the finger are good if the cut is a clean one with minimal additional trauma to the digit. ‘Crush’ injuries may damage a finger to the point where the blood vessels are not viable, making a repair impossible.

A laceration or amputation of the index finger warrants a serious discussion with the patient. Repairing an injury to zone 2–the area of the finger between the knuckle and middle joint–often results in severe stiffness and scarring of the tendons. A great deal of physical therapy is required to regain functionality after an injury to this area, and the finger will most likely never be ‘as good as new’. The reality is that the loss of an index finger often results in a minimal decrease in function because the other fingers compensate quite well. Patient and physician need to seriously weigh the cost and benefit of replanting an index finger.

An injury to the thumb normally warrants the most aggressive course of treatment because this digit is the most critical to preserving function of the hand. Unfortunately, the prostheses which are currently available for the upper extremity have relatively poor functionality since none restore the sensation which is critical to the use of the hand.

If you or a loved one are at risk of suffering a laceration or amputation of a digit, keep the following tips in mind:

• Wearing protective gloves can make a big difference in minimizing the severity of an injury
• In the case of an amputation, the finger should be placed in saline-soaked gauze, then in a plastic bag with ice
• Treatment will require a full complement of specialists and technology, so an immediate trip to a well-equipped emergency room is critical—urgent care centers will probably not be able to handle this emergency
• Recovery will be a long process, with months of physical therapy necessary to restore functionality. It is not unusual for rehabilitation to go on over the course of six months to a year.