Nerve and Tendon Lacerations
Finger and hand lacerations, if sufficiently deep, pose a risk to the underlying nerves and tendons. This can be either on the palmar (flexor) surface of the hand, or indeed the dorsal (extensor) surface.
The relevant digit should be examined for signs of tendon and nerve injury. The wound should be thoroughly washed out with sterile saline, and either dressed or sutured. The hand should be elevated in a sling, and in some cases antibiotics started. A tetanus booster should be administered if indicated.
If you have sustained such an injury, you should attend your local A&E department, where the above first aid treatment should be carried out.
If there is any suspicion of an injury to the underlying structures, a formal exploration of the wound should be carried out by a hand surgeon in an operating theatre.
Tendon lacerations of greater than 50% of the tendon width require formal repair. Flexor tendons in particular benefit from a combination of a ‘4 strand core suture’ and a circumferential suture on the outer surface of the tendon. The aim is to provide a repair that is strong enough to allow early motion of the relevant digit(s). A hand therapist closely supervises the rehabilitation of the hand, and a splint is worn at all times for a period of 6 weeks after surgery. The main complications of this injury and subsequent repair are a re-rupture of the tendon, and stiffness due to adhesions between the tendon and its surrounding sheath.
Depending on where the laceration is, an underlying damaged nerve may either be purely sensory (i.e. responsible for skin sensation over a specific area of the finger or hand), or a mixed motor and sensory nerve (i.e. also responsible for initiating the contraction of specific muscles). In either case, exploration of the wound and repair of the nerve as soon as possible is appropriate. This is usually done with the aid of an operating microscope, to ensure an accurate repair of the nerve.
Nerve recovery is a complex process. There are a number of factors which dictate what level of function may be expected after nerve repair. These include the age of the patient, the chronicity and the nature of the nerve injury, and the existence of co-morbidities such as smoking and diabetes. Mr. Gidwani will discuss these factors and the risks and benefits of surgery with you, prior to any operation.