16.05.2010 Chopped fingers

It was a very amusing tale: A mother brought her 8month boy who three hours ago had his fingers executed by his five year old brother with the bush knife.
Mother brought the chopped pieces with her, wrapped up in tissue in her coat pocket.

Now the distal ends of the right middle and ring finger were almost sliced at the DIP joints. The freshly cut fingers now posed a problem (for him as well as me), never having dealt with closures of this kind I found myself a bit stuck. I knew the distal ends were probably not salvageable at this stage so it was am matter of closing the chopped ends.

That day all the seniors were out and about - I tried to get hold of one who directed to me to a purple book in the library that has a good hands section. I dutifully went to the 'library' (archaic collection of books from 1800s left and donated by people) and sought out the purple book. Lo and behold I couldn't find it, after another phone call, I managed to get a name for the book and diligently sought out he hands section. Ironically the book was called non-traumatic injuries. (?oxymoron). After painstaking page turning I realised their was no advice on chopped fingers to be found.

The end result was I didn't quite ascertain what the correct management was so with some help from another junior colleague we figured that interrupted sutures used to pull the skin taught over the bone would do.

The ideal technique I consequently learnt would have been to obtain a bone grinder and grind the distal ends of the phalanges down so the skin could be closed with less tension. Luckily in children they have such malleable skin and bone with excellent potential for healing we did not need to fiddle any further with his fingers (relief on my part).