Dr. Miller: Hand trauma and the hand surgeon. We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi I'm Dr. Tom Miller and I'm here with Dr. Andrew Tyser. He is an orthopedic surgeon specializing in hand surgery and also microvascular surgery of the hand. Andy, talk to us a little bit about what types of hand trauma you see in your practice.
Dr. Tyser: Hand trauma is unfortunately a pretty common thing to happen to people. It turns out the hands are the way you interact with environment in many different walks of life, on the job, for play, and sometimes just randomly things that happen to your hands. In that case, sometimes the trauma can range from fairly common, simple fractures of the fingers to fairly severe, even loss of fingers and thumbs and things like that.
Dr. Miller: And you mostly see these in perhaps automotive accidents or industrial accidents.
Dr. Tyser: We do. I think most commonly for very severe hand trauma, for instance if you were to lose fingers or a hand, that's involving industrial type accidents, or people working with table saws in their own garage.
Dr. Miller: So if one is to lose a finger or even a thumb, which would be a catastrophic loss, you can re-attach those at times.
Dr. Tyser: We can, at times. It's for select indications as we say. So not every single person is a perfect candidate to have their finger put back on, depending on where it's cut off or the mechanism. However, that's the first consideration that we have here at the university is we try to put things back on when able.
Dr. Miller: Let's say that a patient or a person cuts off that finger by mistake using a table saw, while they're trying to build a table in their garage. What do they need to do? Do they need to put the finger on ice, I mean we see in the movies and all the TV shows about ER, what steps should they take if that thumb is to be saved or that finger is to be saved? What do you recommend?
Dr. Tyser: That's a great question. I think the first thing that patients in that situation should do is make sure that they have their bleeding controlled, either with a pressure dressing, or having even a little tourniquet on their finger because we don't want them to lose too much blood and compromise everything else.
The second thing is trying to find the parts. Sometimes if it happens with a table saw, it actually can kind of fly off into the saw dust or something like that, and we want them to find the part, and surprisingly, people will sometimes come to the emergency room without the part and then it's pretty hard to put it back on.
Dr. Miller: If they do find the part or the digit that has been amputated, what do they bring it to the emergency room in? Should they put it on ice or cool water, put it in a plastic bag, or does that even make a difference?
Dr. Tyser: Yeah, great question. We have a recommendation. We're not sure how much of a difference it makes. I think the main thing is finding the part and bringing it with you. But we typically tell people to put it in a soft kind of damp rag or gauze if you have it, and then put that inside of a plastic bag and then that bag inside of another plastic bag that has ice inside of it so to keep it cool.
Dr. Miller: What is the likelihood of success of reconnecting the amputation? Is there a time limit to that? Is, I suppose the type of trauma related to whether that's successful or not?
Dr. Tyser: Yeah, that's a great question and it's one we're commonly asked, and we tell them the same thing, which is please come as soon as you can. Ideally be within about eight hours to have the best results. I think the overall success rate really varies in the literature if you critically look at it. However, most recently with relatively large level-1 academic centers involved with the studies, it's about a 50:50 chance of making it work.
Dr. Miller: Now fortunately, these types of accidents, these amputation accidents are more rare than they were maybe 15 years ago.
Dr. Tyser: Yeah, I think that's true. It's something we talk about in hand surgery. It's kind of as a consequence of the loss of lot of industrial jobs in the United States unfortunately, and also a consequence of the increased occupational standards that we have in America. I think that in general that we see less amputations of fingers and hands and things like that.
Dr. Miller: Now that's not the only problem or injury that people have to their hands, crush injuries, degloving injuries, could you talk about those a little bit, and actually what would be the most common injury that you would see in a hand injury?
Dr. Tyser: We talked about table saws a little bit earlier and the table saw injury right around Christmas time in particular when people are making things for the family, unfortunately it's kind of a sad story when that happens. However, table saws typically don't actually cut off the finger completely. They just damage it pretty significantly.
That is very common. Using knives for cooking and other things when people accidentally slip and cut their fingers and many times can lacerate either tendons or nerves or arteries or all of the above. Those are common.
Dr. Miller: What do you see in automotive accidents?
Dr. Tyser: In automotive accidents, we call that more typically blunt trauma and that's typically fractures due to things like crushes or high-energy impacts.
Dr. Miller: Are those difficult to repair?
Dr. Tyser: They can be. They can be very complicated. At times it's not just the bones that are fractured but it's also the soft tissues that are injured around the bones and that can lead to need for not just one surgery but sometimes multiple, depending on the severity of the injury.
Dr. Miller: It sounds like if you have a hand trauma you need to get to an emergency department as quickly as possible and then obviously if you amputate a digit, you need to try to recover that digit, prepare it as you suggested, and then bring that to the emergency department in the hopes it could be reattached microscopically.
Dr. Tyser: Yeah, I think that's very accurate. And I think we have a very well-run trauma unit here at the University of Utah, staffed by hand surgeons who are very comfortable with all sorts of trauma and it's part of our job that we actually really enjoy restoring function to people's hands, if possible.
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