Joe A Shaw PA-C - 1/5/2013

Question
Hi Joseph A Shaw PA-C: I hope your holiday was great w/no cuts, bruises or injury.  While using my bowsaw to cut some small logs for my fireplace, the sawblade skipped off the log while making my final cut! The blade cut into my holding hand causing a very deep incision
running from just below the forefinger knuckle diagonally almost to the pip joint/approx. an inch. Using direct pressure I stopped the bleeding & ran to Emergency Room. Visual inspection by doctors revealed the saw blade had cut thru the layers of skin and nicked the tendon. Asked to bend  the forefinger, I was able to do so without much pain or flinching. X-rays revealed no injury to the bone. 8 stitches were required to close the incision. I was given antibiotics, My QUESTION: ASSUMING NO INFECTIONS/COMPLICATIONS, HOW MANY DAYS SHOULD STITCHES REMAIN IN PLACE BEFORE REMOVAL? Thanks, Ken
HOW MANY DAYS

ANSWER: Kenneth,
Sorry had computer issues w this acct. I would say generally 10-14 days at max. Usually if on the extensor side (top of knuckle where it bends) you leave them in longer because of the tension when bending knuckle ..10-14days, If not under tension ie non bending surface 7-10 days..hope this helps.After healed up nicely use a bowl/bucket of warm water Epsom salts and make fist/ extend fingers etc 5-10mins 2x day..for 2 wks ,this will be like physical therapy and should help prevent stiffness,adhesions of scar tissue

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QUESTION: Joseph! Thanks so much for your wonderful response.(I will write up a very positive recommendation re them). One more question & answer if you will? Saw my primary care Dr. today [(15 days since trauma) with 1/out of 8 stitches still remaining]. Less than half of the wound appears to be closing. Dr.'s opinion:  "I allowed the cut to get wet!Wearing a finger-splint,I couldn't keep it dry!" (1) Does wetness/dampness on this type of cut prevent healing? He indicates cut will now heal from the inside! T/F?
(2) Since it is approx. 15-16 days since the accident [with 1 suture still remaining], can I start your finger-dexterity exercises without delaying healing  to the cut or tendon? Throughout healing process, I had been wearing a metal splint, preventing my bending finger; or  stretching the involved tendon.(3)Should I discard the splint or still use it[at intervals]?  Thanks so much for your input!! Ken

ANSWER: Kenneth,
No problem,,Yes that happens in fingers a lot from sweating,bandages etc..where the wound gets too wet. Water /moist tissue can prevent healing or drying up of lacerations 's edges thus causing it to split open a little. It sounds like it will have to heal by secondary intention..just means will heal from the inside out. Nothing to worry about they generally do well.I wouldn't do the home made whirlpool just yet since it is still not healed up..it needs to be completely sealed up before doing this ,just let it heal,probably will take several weeks now,but then you should be ok to start range of motion warm soaks etc,,wash with soap and water 2 x day keep dry let air out,cover lightly with bandage if needed at work etc..

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QUESTION: Joe: Last of the LAST QUESTIONS(you're saying "I hope!"):from your statement, .."wash w/soap & water 2 x day;keep dry etc....," does this mean I can presently wash the hand but be sure wound is thoroughly  dried  afterwards?
Also, Happy New Year to you. You've unhinged most if not all of my fears. P.S. I play the piano and organ for my church. May be reason I appear overly anxious about the healing process and outcome. Again, thanks for 'knocking out' my fears.

Answer
Kenneth,
Yes if it has been over 2 wks ,generally should be good to wash with soap and water (liquid-anti-bacterial kind that you can get almost anywhere) and let dry out. I personally don't advise the neosporins etc..they are mainly vaseline and keep the wound too wet. Obviously your provider their who has seen the wound would be best to make final recommendations. Signs of infections increased redness,pus, foul odor are things you need to be seen about.