Made To Stick Heath Epub 12 ((LINK))

A small skin tear was encountered in the region of the proximal palmar crease and deep to the flexor digitorum superficialis (FDS) tendon. The flexor sheath was windowed and the deep FDS tendon meticulously inspected for signs of extrinsic tendon pathology or excessive retraction. There was no evidence of either and the skin tear was repaired by absorbable cross-pin suturing. The hand was immobilised as above and examined daily and had no signs of infection. 48 hours later a further multistrand absorbable (Polyglactin 9-0) No.2-0 suture was made across the window and the skin incision closed. The hand was mobilised with the elbow in extension and then flexed and extended with forearm in neutral rotation. The plaster was then applied over the hand and applied below the level of the proximal incisions. Splintage and dressing were also reapplied.

The wound was explored and examined daily. The skin incision was noted to have 'healed remarkably well'. The superficial sutures were resutured and the deep sutures cut and tied. The deep FDS tendon was examined again and found to be of good appearance. The hand was examined for LWD and neurological signs. There was no comment regarding injury to the flexor tendons.

At dressings review, two weeks later, the skin incision was noted to have healed quite well. The skin was not hypertrophic and the scar was well camouflaged. There was no lateral unwinding of the flexor tendons or other signs of LWD. There was no transfer of sensation to the pulp and show of LWD was readily detected. The patient was informed as to the limits of his abilities and that he might need further reconstructive procedures in the future. He was fit and healthy without any sequelae.

Surgical decompression was undertaken through a Brunner incision. The flexor sheath was windowed in the A3 pulley. Lipid based fluid was released under high pressure. A further window was made at the A5 level and the flexor sheath was thoroughly irrigated. The skin incisions were left open. The hand was dressed and placed in a back-slab plaster in the 'position of safety'. The hand was elevated and neurovascular observations were performed regularly on the ward. The patient received intravenous Cefuroxine antibiotic. Forty-eight hours later secondary closure of the wound was performed in theatre and the patient was discharged four days after admission with a supply of oral Cephalosporin antibiotics. d2c66b5586

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