operation

Warning! This may contain material not suitable for the weak.


The Anatomy Lesson of Dr. Nicolaes Tulp
Rembrandt, 1632

Okay a few weeks ago I saw one of the Turks in the clinic due to an injury he sustained to his finger. He smashed his finger while at work and they brought him to us for help. His injury caused an open wound to the nailbed and created a flap of skin that consisted of half his nailbed. So after obviously obtaining some xrays of his finger, the process began to close this wound and restore the anatomy of his finger tip (good think I know a little about the hand).
So the first thing we had to do is numb his finger. The Turks are quite stoic. I am sure he would have allowed me to suture his finger without any anesthetic but I just could not do that to him (yea I know I am a pretty nice guy). I thought what better time to train some of our medics in digital blocks and suturing? So under very careful and watchful observation, almost OCD-like (Dr. Morgan would be proud), I coached Sandefur on his first digital block. What a great job he did. I do have to admit though, I had him do it the "ER" way not the hand surgeon way. He still did a good job.
Now that the finger is nice and numb it's time to clean it and fix it (sounds almost like we just got done deer hunting). So next up is Edwards. She stepped up to help me. Here I showed her how to handle the fine suture and the delicate nailbed. Suturing a nailbed is much different than suturing skin on the arm or leg. It is much more friable and if you are too rough or use to big of a suture then it will easily tear. So with great patience and care I showed Edwards how to pass the suture and gently tie the knots. Since we are limited on the type and number of suture I had to use the best we had. For the nailbed I like to use an absorbable suture so that I do not have to go back in and take them out. I have to say Edwards did a really good job!


Lastly, we have to put a covering over the newly repaired nailbed so what better to use than the original nail? So back up is Sandefur and time to clean the nail. The nail was soaked in chlorhexidine (hebiclense) and then prepared for reimplantation. Basically what it involves is just putting it back in place and suturing it down. You leave this on for about a week just to protect the nailbed and to keep the proximal nail fold from healing to the nailbed. By keeping it lifted off of the nailbed you allow for a clean pathway for the new nail to grow through. This limits nail deformity.
So the nail has been cleansed and here we are putting it back in place. Perfection!
Last I heard our friend was getting back into hand modeling. I'm not sure if he was ever in the hand modeling business and if he was why he is here, I'm just saying that's what I heard. Our Turkish friend is now back in business and working like a champ.