Moist Wound Healing & the two finger salute!

When I see the hand surgeon I am advised of the benefits of moist wound healing to speed up the recovery of my fingers.  So for any of you out there who may have injured yourself, I can definitely recommend it, and the dressings don’t stick and have to be soaked off like normal dry dressings which just causes more pain.  I can’t say that i was aware of this, or certainly only vaguely in the back of my mind do I remember reading about this, and previously had been advised to let wounds dry out, which is not the best method.

Moist Wound Healing has actually been around since the 1960/70s, when it was proven that there is a 40% shorter healing period with wounds healed in a moist environment compared to a dry gauze dressing or letting the wound dry out and form a scab.  The scab is just the bodies way of preventing environmental hazards entering the wound.  Scab formation delays the healing process.  Instead a simple barrier such as vaseline over the wound, or a specialist dressing, such as Jelonet dressing gives a barrier, keeps the wound moist and stops the formation of a scab and  there is much less scarring at the end.  Just a plaster or dressing is needed over the top of this.  The liquid secreted from the wound apparently contains a number of  agents which support a successful healing process. If the wound dries out this doesn’t happen.   Modern materials used for wound dressing  are designed to promote the moist wound environment. First clinical studies performed during the 1970s document the healing time reduction with this method. Despite this, it took another 30 years for Dr’s to start to implement the moist healing into general medical practice, and the message is still not really getting out there. The main moist wound healing advantages are the 40% shorter healing period and a much lower pain factor.  However in the 1960’s/70’s they didn’t clean the wounds often enough, and left with a moist dressing infections got into the wounds.  All that was needed was simply to wash the wound with water twice a day, and reapply a moist dressing, instead of just leaving a moist dressing in place. Dr’s became concerned that moist wound healing lead to infection which wasn’t the case. This has stopped the adoption of  moist wound healing practice and set us back years.

There is documentation indicating that even the ancient tribes dressed their wounds to keep them moist with fine linen soaked in oil. The Greeks applied animal fat and wrapped the wounds, and the Romans applied ashes, oil and herbs and wrapped the wounds.  Clearly they knew a lot more than us!

Since then, multiple studies have established that a moist wound environment facilitates cellular growth and collagen proliferation. Dry wound tissue is more prone to infection, scarring, delayed healing and pain.  Having had a dry dressing put on at A&E for the first couple of days I can definitely say it was much more painful.  Once I saw the Hand Surgeon and was advised about moist wound healing, it was considerably  less painful and also you are not damaging the new cells forming by pulling off dry stuck dressings.  So I am very grateful I was advised about this by someone very knowledgeable, as I definitely think I will avoid any skin grafts with this method.

My fingers are healing slowly, but I realise because I am having to hold them up out of the way when typing and when doing lots of things due to them still being very painful, I am actually walking around giving a constant two finger salute! Looking a the urban dictionary of the two finger salute it can mean various things.  But I am going for a victory salute!!, and I shall be victorious over my injuries!

fingertip in dustbin!

After two days I am back to the hospital to see the Hand Consultant.  The nurse soaks off my dressings as they are all stuck!  It doesn’t look too good, and has gone black.  The Hand Surgeon takes one look at it, and says “I am really sorry, but the ends are dead the bits stitched back on have not re-attached and we will need to remove it, or the rest of the finger will just get infected”.  He tells me he will need to give me a local anaesthetic, which after the last one I am really not looking forward to!  But obviously all that training has paid off as it doesn’t hurt anywhere near as much as the one at A&E!  I comment on this, and the Hand Surgeon says” yes, we need to give the A&E staff a few injections in their fingers so they know how much it hurts!  There is a technique which makes it much less painful.”  My finger goes numb, and although I can’t feel anything hurting, I can feel the movement and sawing action!  The end of my worst finger is chopped off again, and I am trying not to look, but all of a sudden I see out of the corner of my eye, the chopped off bit being lobbed across the room in to the bin!  I mean I know its dead but it did seem a bit disrespectful to my fingertip and very unceremonious! 🙂 that fingertip has served me well for years! There is something quite odd about seeing bits of yourself getting thrown away. Judging by the amount of stories people keep telling me about their lost bits of fingers, I almost feel there should be a ceremony for them, or perhaps a cemetery!  The lost fingertips burial ground!

I am then advised on keeping the wound clean and using moist wound healing.  Wash off twice a day, apply vaseline to keep it moist and then cover it.  Lovely!  Keep it up for a couple of days again to stop bleeding and reduce swelling.

Off home I go, to start my regime for several weeks!

When I get home my boss contacts me about doing the payroll! Well it doesn’t matter if someone has died, you can’t see, or you have no fingers, people still need to be paid!  I can only type with one hand, but its very slow, and its very difficult if you need to use shift, alt, and ctrl doing it with the wrong hand!  Especially with the other hand up on the desk in the air to help stop the throbbing.  I realise there is going to be a lot I can’t do.  No driving, no reflexology customers, I have to cancel them all, and no restaurant reviews.  I also realise that all of my jobs involve a lot of use of fingers!  its going to be a long few weeks!  I wish I had looked after my fingers a bit better 😦

Off to bed and I have the same reoccurring nightmare, where I look down and see the top of my finger hanging on just by a thread!

Bandages and sling

The Dr. said to me “grip my hand really tightly while we put the local anaesthetic in”,  so you just know its going to hurt a lot! which it did.  I said to the poor Dr afterwards, hopefully you won’t need hand surgery now as well for crushed bones!  My fingers are all cleaned up with saline, the hanging off nail removed, and all put back together.  I look over at my poor mum, who has suddenly gone very pale!  I said to the nurse “is my mum ok?”  “No she isn’t” she said, “quick head between your legs before you pass out”! Next minute my mum has ended up on the bed next to me, so there we are together!  Some time later after dressings, bandages etc my arm is put in a sling.  Then I have to wait for the prescription for strong antibiotics to be brought.  I am told I might need a skin graft if it doesn’t heal well.  Then out of nowhere, coincidentally, a specialist hand surgeon walks by, and seeing my hand all bandaged up asks me what I have done.  He talks to the nurse, and judging by their conversation it seems he is not hopeful the stitched back on bits will survive.  That is not what I wanted to hear!  He asks me to go to his clinic on Monday, so he can assess the damage.  He tells me to make sure I keep my arm up for  a couple of days to reduce swelling, pain and throbbing, and try to move and bend the fingers if possible.  I am sent home.

My mum has to clean up my kitchen when we get back, as blood was splattered everywhere where I went in to get the phone to call for help.  The garden and patio looks like someone has been murdered! Its like the chainsaw massacre.  I look on the internet for info on finger injuries. A common injury it seems.  Apparently Kirsty Allsopp has cut the very ends of hers off with a mandolin in the kitchen!

Even with painkillers it throbs constantly and I have no sleep that night, and how do you keep your hand up while you are in bed?!  Not looking forward to the prospect of having to change the dressings twice a day myself!