PMC4765334_01
Deep, defiled and circumferential wound interesting Zone III and the ulnar border of the right hand associated to an open distal interphalangeal joint dislocation of the 5th finger
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General exam at admission in emergency department showed stable hemodynamic status; right hand examination objectified deep, defiled, and circumferential wound interesting Zone III and the ulnar border, there was no fractures but open distal interphalangeal joint dislocation of the 5th finger; flexor tendons were intact in this zone, but abnormally wrapped; flexion of the 2nd and 3rd fingers was impossible; neuro-vascular exam showed digital hypoesthesia without pulp ischemia (Figure 1).
Radiograph of the right hand showing distal interphalangeal joint dislocation of the 5th finger
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Radiograph of the right hand showed distal interphalangeal joint dislocation of the 5th finger (Figure 2).
Surgical view of the right hand showing laceration of the 2nd and 3rd flexor tendons, after extensive debridement of non-viable tissue, abundant lavage and removal of foreign body
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After tetanus serum injection, the patient was transferred to the operating room, where hemostasis was addressed with electrocautery, concurrently with extensive debridement of non-viable tissue and abundant lavage with removal of foreign body (Figure 3).
Flexor tendons repair with modified Kessler sutures in musculo-tendinous junction
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We realized anterior approach of the distal forearm, followed by modified Kessler sutures using PDS 4.0 of the sectioned tendons (Figure 4).
Restoration of finger flexion
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After 3 month, follow-up showed interesting results; apart from keloid palmar scar and 5th finger retraction, functional hand was restored without any infection stigmata (Figure 5, Figure 6).
Restoration of functional right hand
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After 3 month, follow-up showed interesting results; apart from keloid palmar scar and 5th finger retraction, functional hand was restored without any infection stigmata (Figure 5, Figure 6).