The Dremel tool itself had a defective power switch.
It was turned off and placed on a workbench following use.
The motor immediately started up at high speed and jumped off
of the bench describing an arc ending at patient's left palm.
The Injury
- A deep avulsion of the palm about 1-1/4 inches long,
½ inches deep and 1/8+ inches wide.
- Venous bleeding requiring heavy direct or brachial
pressure to slow.
- Approximately two ounces of blood lost initially,
two additional ounces lost during treatment.
- Two hours in ER for stitching. Nine external stitches,
unknown number of internal stitched. Bought dinner for the volunteer
ER EMT on duty.
- Pain level 6+. Offered morphene. (Did
not use, lots of lidocaine only. Much of which ran back out with blood.)
Sure it hurt. The injury hurt more.
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X-Ray image
Notice the severe swelling. This was about three hours post injury.
Post Trauma Care
Hey - it works. You can reruse the cold pack. Just don't reuse it as
food.
Patient had to wear the brace and bandage for about four
weeks to allow basic healing prior to surgery.
- The avulsion seeped blood at a slowing rate for three
weeks.
- It required daily dressing changes and precautionary
antibiotic treatment.
- Codeine based pain killers were prescribed and were
discontinued within one week due to patient’s high pain tolerance.
It hurt all of the time, often greatly, but drugs are a form of poison.
Choose the lesser of two evils for yourself..
- Moderate to miximum doses of OTC pain killers were necessary
for an additional two weeks.
- The image below was taken four days after
the accident. (GRAPHIC!)
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The wound was allowed to close and surgery was performed during week
four.
| Surgical Findings |
- Two completely severed main nerves
- One partially severed main nerve
- One partially severed tendon
- Severed muscle tissue
- Severed vein
- All structures wrapped around each other due to rotary action
of the tool
- Nerve ends had to be squared and nerves loosened and
stretched to allow repair.
- Rotational sub surface graft to replace missing tissue at
injury site.
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Post Surgical Soft Cast
In place for two weeks
Six weeks after the injury (two weeks after surgery), the cast came off.
This did not mean that the injury was healed. That was expected to take
another six months.
An ace bandage replaced the cast. Swelling was still severe and would
be for several more weeks.
There was now the surgical incision to finish healing and then the
arduous task of regaining function.
The surgeon removed the external stitches (14 of them) after removing
the cast.
this is what the hand looked like. Pretty eh?
Once again, the hand needed daily washing, application of antibiotic
ointment and drressing.
After two additional weeks the external part of the wound
achieved closure.
There was extreme stiffness in first and second fingers, swelling
and much loss of strength in the entire hand and arm.
The index finger from the site of the original injury was totally
without feeling except for the back, which constantly felt like it had
a first degree burn. One side of the middle finger was partially without
feeling and partially numb.
The surgeon had the patient begin gentle lengthening exercises
to stretch the too short nerves, muscle and tendon.
At surgery + four weeks, the nerves were sufficiently healed to begin
more intense exercises.
Occupational Therapy started at injury +8 weeks.
OT is like physical therapy but specializes in the hand and arm. It
consists of many facets, the largest being stretching and exercises. It
also involves heat & cold, deep massage, electrical stimulation and
working with rice. Rice can be very theraputic.
The wound healed quickly but developed deep and painful scars. The
last vestiges of the old skin are also visable. Click to enlarge.
This was about 10 weeks after the accident
Notes and Observations
Week 4 Journal Entry
16 May, 2 days post surgery. Still hurts but I've cut way
down on the narcotics. I think I can feel every cut he made. Maybe that's
good!
Week 5 Journal Entry
Since surgery, the pad of the middle finger has been numb
and touching the palm below it causes a minor version of the “funny bone”
sensation. I think Dr Arlis cut other smaller nerves during the surgery.
He had to open up most of the hand to find the pieces for reconstruction.
The skin in the nerve damaged areas is dry and racking. It is beginning
to flake off. Surgeon says this is normal and is a classic symptom of nerve
damage - the sweat glands stop functioning. They should come back as new
skin grows.
Week 6 Journal Entry
26 May, some sensation seems to be returning to the pad
of the middle finger. Only a bit so far but noticeable. Progress!
Week 10 Journal Entry
30 June most of the skin has now fallen off of my injured
fingers. The new skin underneath looks fine but has no callus.
Week 11 Journal Entry
03 July, Week three of OT: Pretty good improvement
in range of motion. Scars are large and thick. Have to stretch them often.
Neuroma still present. Swelling has diminished a lot. Now when I bump
the side of the hand or bounce while driving I feel it. This indicates
less swelling and possible some regrowth of nerve tissue.
I have amassed lots of OT tools. A box of rice. A box of rice containing
small items to pick up. 6" plastic balls. 3" Cloth ball. Two golf balls.
Putty. Microfoam tape. Lots of hand lotion. Marbles. Objects to grip. Small
weights. Everything has a purpose for exercise or stretching.
Week 12 Journal Entry
09 July 2007 Lots of pins and needles when exercising.
Slight tingling distal from scar and in lower part of index finger when touched.
Nerve reconnection starting???
Occasional weird twinges. High temp & humidity today and
yesterday make scar hurt. Range of motion as measured by the therapist
has increased. I need to copy the page with the actual numbers. The hand
is still nowhere near normal. I exercise it whenever possible and am trying
to do everyday tasks with it. Some actually work, others not so well.
I can finally tie my shoes without going insane.
Week 15 Journal Entry
28 July 2007 Definitely pins and needles between cut and
first joint on index. Some of the same moving in to the second part from
the sides. Very minor restoration of touch to parts of index finger. Back
of index still feels burned most of the time. Middle finger now has some
sensation in pad and left side.
The random twinges and short pains continue. They don't come often.
It seems like the nerves are experimenting with new connections.
More range of motion to last three fingers – I’ve been able to touch
my palm for over a week now. Index still very restricted motion. With much
stretching it can touch my palm with thumb in neutral position. Comes half
an inch away when bending. Over an inch to go though.
OT started tens therapy this week in an attempt to increase range and
achieve better motion og the tendons through the scar.
We also started doing wrist bends with small dumbells. Started with
one pound and graduated to two pounds. (Both this week - Whoopie). Boy is
the wrist stiff!
The scar is still hard, deep and sometimes painful. It gets in the
way of bending the index finger. It does show a bit of improvement but
gets tight if I don’t keep stretching and applying lotion.
Range of Motion Chart
Initially about 27 degrees for first two fingers. I believe that 240 is normal.
June
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120
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187
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214
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222
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July
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154
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213
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226
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234
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Week 16 Journal Entry
04 August 2007: The pins and needles and twinges
continue. I am up to 60 reps with the three pound dumbell plus 20 (hard to
do!) with the four pound.
I've been using the hand more for routine tasks in a effort to strengthen
it. I do find myself guarding the index finger at times and I have to look
at to know where it is.
The scar is still my nemesis. On the plus side it's not getting any worse
and I see some signs of new flesh growth on either side of it in the center
of my palm.
Extension - Week 16
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Flexion - Week 16
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Scar - Week 16
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Copyright © 2007 Karl Wick all rights reserved
