What will my healed thumb look like?

June 21, 2012 3:25 PM

You're not my doctor, and you don't have a crystal ball. But can you speculate what will happen to my thumb after I took a pretty good slice at it yesterday? Bonus worker's comp question.

I was cutting a piece of paper with a brand new xacto blade and I very nearly took off the top quarter inch of my thumb, including through the nail. A few hours in the emergency room and 7 stitches later, I'm left wondering what will happen to my nail, the flap of skin on top, how the nail bed will heal, etc.

Here's a photo, which you should not click on if you're squeemish.

The nurse who stitched me up said she basically couldn't guess what would happen, but that the "flap" didn't look great. She said it might not heal like normal tissue, that it might be thicker or rougher. I also thought that things looked a bit... crooked. The edges of the nail didn't seem exactly aligned. I realize it's not like putting blocks of wood together, it's a fleshy squishy thing, but should I be worried? This was a pretty ritzy hospital if it makes a difference.

I haven't scheduled any follow up appointments yet. ER told me 12-15 days until stitches out. My RN mom told me to go see a Dr in 1-3 days to check healing and infection.

I have a physician (who's an LPN if it makes a difference) and I like her, and have been seeing her for a while. She's at a family practice. My employer also has a worker's comp MD. While I'm sure they'd reimburse whomever I saw, where would I get better treatment?

Should I see a plastic surgeon? Do you know someone with an injury like this? How'd it end up?

posted by fontophilic to health & fitness (20 answers total)

Totally not a doctor - My father had the tip of his index finger cut off by his brother with a hatchet when they were children - just slightly more than you, but nowhere near the first knuckle - this would have been in the early-mid 50's. They ran to the doctor who stitched it back on - dad's finger healed, but the nail is a bit off-kilter on that finger (and had to grow back in place), the skin is a bit thicker and tougher, and he doesn't have the same amount of sensation in it as the others. When he was tiny my son would chew on Granddad's finger, and Pop laughed that it didn't bother him, finally trying to save that wooden block had paid off.

Other than the reduction in feeling, it's not really bothered him. You didn't cut that much off, but I'd bet It's going to take a while for that part to get back to normal-ish.
posted by pupdog at 3:33 PM on June 21, 2012

If the skin flap "takes" and starts to heal up, then you should be fine. Probably a scar.

I've taken chunks out of my fingers like that, and they healed up fine.
posted by gjc at 3:33 PM on June 21, 2012

On second look, that bit of nail will probably come off, so I wouldn't worry too much about it not being lined up.
posted by pupdog at 3:35 PM on June 21, 2012

I can't tell you what will happen to you, but I had damage to my nail bed several years ago, and I can tell you what happened to me.

I basically sliced off the middle third of my ring fingernail, including the nail bed. This is what it looks like now. Most of the middle third of the nail grew back, but there's still a pocket between the nail bed and nail, plus weird squished-ness. (I can't feel anything different, but it looks like there's some tension on it.

I think it'll grow back normally, except for a scar on the fingertip, and possible funky whiteness in the end of the nail bed.
posted by supercres at 3:37 PM on June 21, 2012 [1 favorite]

"Nature hates a hole" as my doctor would say; he also mentioned that the skin on the palm of your hands and fingertips is pretty tough because it has to be.

Why do I know this? I've sliced and diced several of my fingers during my years as a cook. A few years ago I had a large growth remove from the nailbed of one finger. It looks fine now, although for several years the fingertip was noticeably less in diameter than the other fingers.
posted by KokuRyu at 3:37 PM on June 21, 2012

Also NAD (though I have cut my thumb rather badly), but this part doesn't matter: The edges of the nail didn't seem exactly aligned.

You didn't cut through the base of the nail where the nail actually grows from, so the nail will behave completely normally. You'll have some scar tissue around the fleshy parts, of course. There might be a bit of numbness or nerve damage, which may or may not heal over time, and the tip of your finger might be permanently, slightly misshapen. I don't think this is going to be a big deal at all.
posted by jon1270 at 3:39 PM on June 21, 2012 [1 favorite]

(Unless you're a nail polish model)
posted by jon1270 at 3:39 PM on June 21, 2012 [2 favorites]

I have cut off a side flap of my pointer tiger and had it stitched back on (through the nail!) due to a workplace mishap (meat slicer, ouch). I did not see a plastic surgeon and my hand is fine, just with scarring. It took a few years to get complete sensation back in that part of my finger though. It looked pretty gross for a while - drying blood and stitches and swelling all combined to be disgusting and I was worried the bit would just fall off but it didn't, though the dead skin sloughing off was a bit nasty.
posted by hepta at 4:13 PM on June 21, 2012

Recently I cut just about that much off the tip of my left index finger, only I didn't have the piece to put back on. Surprisingly little pain, finger tip and nail both grew back and look normal. Now its a little sensitive if I press on it or play piano, but it seems like that is tapering off.
posted by StickyCarpet at 6:18 PM on June 21, 2012

Similar cut to my pinky finger with a knife last year - 2-3 stitches. It was sore for a long time and still feels a little numb to the touch. The nail chunk gradually came off and the nail grew normally after that. You cannot see any difference now. The stitches were done by a regular MD (not plastic surgeon) at a Patient First. (I was the first Thanksgiving cut of the day which they told me tends to be a big day for it).
posted by maxg94 at 6:33 PM on June 21, 2012

I cut my thumb the same way (x-acto blade #11 for the win!), at the same location and angle. My flap was hanging on just by a bit of outer skin so the doc trimmed it off. I did not see a plastic surgeon, just an emergency room doc. Here's what it looks like many years later: finger pad side, nail side.

There's a little thick scar on what was the cut surface, it's lighter in color than nearby tissue. It is thicker but not so thick that it affected nail growth. The surface of the scar is as sensitive to touch as the surrounding skin but just sends odd signals, for example, if I touch something with just the scar, the thing feels much bigger than when I touch the same thing with the same area on my other thumb. Also, I'm more comfortable having a bit of fingernail protecting it as the scar gives off a weird zing feeling if poked or if a lot of pressure is applied to it.

It took about a year from the time I cut to to it looking like it does now. For the first few months, my finger had a hilariously abrupt angle to it, but then the flesh plumped up behind it and grew a curve. It looked a lot like a new lava cone growing out of a leveled volcano.
posted by jamaro at 7:01 PM on June 21, 2012 [2 favorites]

Know that feel, and it hurts like the dickens. I cut the tip of my thumb off in almost the exact same angle. Course mine was under somewhat different circumstances. It grew back fine. Save your "repair" money for something important like tattoo removal or dental implants. I should add that if I showed my granddad that injury he'd say something like, "I've had bigger sores than that on the tip of my $#@!."
posted by vozworth at 8:15 PM on June 21, 2012

Band saws, mat knives, pocket knives, and I don't know what else. I've done them all. That one doesn't look pretty, but it will heal just fine if you keep it clean and covered. I would show it to your LPN just so she can agree that it is not showing any sign of infection. Keep it dry (wear a plastic bag over it in the shower) and don't bump it into anything while it heals. Those photos up above look pretty much like what you can expect the way it will look in a few months.

Sharp blades are kinda dangerous. They really need your full attention. This will help you remember.
posted by Old Geezer at 8:46 PM on June 21, 2012

I cut about that off the tip of an index finger a few years ago. Mine was still connected by a hinge of skin, so I reasoned, hey, bloodflow! and slapped the dangling bit back on and superglued around it because I was "too busy" to go to the ER. Of course it all went totally pear-shaped and I ended up needing to go to an urgent care in an unfamiliar city and get heavy-duty antibiotics etc. They got rid of the dead meat and had to debride the wound further to clean it. Yuck.

So anyway, I totally lost the top bit of my finger, but it eventually grew back, normal-looking nail and all. It was weirdly flat for a long time, maybe two years, but slowly filled out. The sensation there was strange, and the new skin felt different...but eventually it evened out to normal-ish. Today, there's a little change in skin tone and texture around the area of the wound—it's like it's thicker but more delicate at the same time—but it's not noticeable unless you're really looking. Your body likes to fix things when it can.
posted by peachfuzz at 9:02 PM on June 21, 2012

It'll be fine.

The end will probably dry up and slough off, leaving a very tender pink rawness underneath, but you've not hit your bones, your nail root, any major veins of nerves.

Fingers have kind of evolved with this kind of danger; they are remarkeably good at getting over the shit you do to them; short of cutting major structural or functional bits off.
posted by BadMiker at 5:19 AM on June 22, 2012

Hand surgeon here, but not yours, not medical advice, etc. If the flap lives, it will heal uneventfully and the nail will be normal. The way it's lined up now doesn't matter. The flap may die (necrosis) and it will turn dusky purple, eventually fall off like a big old scab and the tissue underneath will be normal. That one corner of your nail may look a little off.

Nurses don't put in stitches (assuming you are in the US) and LPNs aren't doctors so your terminology is confusing. See the workplace Comp MD who will likely have you see someone like me. The real reason to go this route is so your worker's comp paperwork is filled out correctly. If it isn't, you end up being the one who needs to get it corrected and that's a headache you don't want.
posted by karlos at 7:40 AM on June 22, 2012 [1 favorite]

In slicing a piece of bread I basically fileted my nail from my finger. (I totally, totally feel your pain!)

It healed up fantastically, so there's hope.
posted by Ruthless Bunny at 8:58 AM on June 22, 2012

I sliced through about 3/4 of the tip of my middle finger (including across the entire nail bed - the ER doc had to pry off the nail in order to do the stitches). My cut was more jagged than yours. Five stitches and 6 years later, everything is healed and I had a normal nail. It probably took around 6 months for everything to heal and grow back completely. There's a slight indentation on one side where the scar is, and if you apply pressure to the nail you can faintly see the scar underneath it. Other than that, completely normal looking and no loss of sensation.
posted by twoporedomain at 10:10 AM on June 22, 2012

Thanks all for the comments, and especially the photos. I was in a bit of anxiety when I wrote this post, and it's all been reassuring.

Jamaro, it was a #11! Graphic design battle wounds for sure.

Karlos, the person putting in stitches was an LPN, and I suppose I meant to say my Primary Care Provider is also a nurse practitioner. I did end up going to the workers comp MD, who seemed totally competent.

He (and I too) thought it was a bit odd that the ER had totally covered my thumb in steri-strips so that there was no way to see how it was doing, if it was getting infected, no way for it to breathe, etc. When I say totally covered, the first 2 strips were just covering up more steri-strips underneath. So we peeled em off.

It seems that maybe 60% of the flap took, looking happy and pink. The far edge (the index finger side) is looking pretty black and dead, which makes sense, being the thinner edge. I guess I had only ever associated black dead tissue with civil-war style infection. I never thought dead and living tissue could co-exist, and that dead doesn't necessarily mean it'll spread and get infected. Hearing from him, and the people here that it's a bit more like a big scab which will pop off and have new tissue underneath is very reassuring.

The dr put a pretty minimal dressing on, (just 2 layers of tube gauze) and gave me instructions to more or less leave it alone, change the dressing daily, and if I really want to, put a bit of triple-bac ointment on it. I could put a bit of gauze if I wanted more padding, but otherwise, keep it loose so air can get in. No dunking my hands in water, or swinging it around. As he put it, the dressing is really to remind myself that I hurt my thumb. It's going to do all the healing on it's own.

Thanks again for all the comments!
posted by fontophilic at 8:54 AM on June 23, 2012

Alright, a month later, stitches out almost 2 weeks ago. The "flap" more or less had become a big callous/scab which popped off this morning leaving new pink skin behind. It's a bit lumpy and funny looking, but I can see it toughing up and getting back to normal.
posted by fontophilic at 6:33 AM on July 18, 2012