45-year-old right-hand-dominant healthy male construction worker who presented to ED after circular saw injury involving multiple fingers of right hand. Occurred approximately five hours prior to arrival. Amputated distal portion of right ring finger at bedside. No other acute traumatic injuries.
Median/radial and ulnar motor function grossly intact with thumb and finger adduction/abduction. Sensation intact in radial, median and ulnar distribution.
Multi-digit injury of right hand after circular saw injury, including near amputation of LF through DIPJ and amputation of RF through shaft of middle phalanx.
Digital block achieved by instilling 20cc of 1:1 mix of 2% lidocaine and bupivacaine to the affected four digits. Wound thoroughly irrigated with 500cc NS mixed with Betadine.
All digits were again thoroughly irrigated again with 500cc NS. Patted dry.
2. 1-month post-injury: All digits healing appropriately. Dressing changed to daily Bacitracin and Band-Aid.
3. 3-month post-injury: Improved wound healing to all digits with resolving tingling to LF. Plan is to return to clinic in 3 months to discuss further treatment. Diligent hand therapy encouraged in the interim.