Emergency medical question: potential nerve damage?
September 26, 2012 4:20 PM Subscribe
After a deep cut to the hand, what are the proper precautions to prevent nerve damage?
My friend cut his hand pretty bad, across all four fingers, maybe to the bone. The immediate short-term issues (e.g. bleeding) have basically been addressed, but at this point he is worried about potential long-term effects. One finger feels numb, like when your leg goes to sleep, and although he can move all four fingers, there are some places where he says he has no feeling if you touch it.
Being in a smallish city in China with generally low quality medical care, he is going to try to get to a bigger city with a more modern hospital, but there are some additional complications and it may be a day before he arrives. The question is how serious is this likely to be (he is worried about potential nerve damage, and the future use of his hand, or even potentially losing a finger or something), as well as what specific things he can/should be doing right now to ensure the best possible outcomes, until he can make it to the hospital. Thanks.
My friend cut his hand pretty bad, across all four fingers, maybe to the bone. The immediate short-term issues (e.g. bleeding) have basically been addressed, but at this point he is worried about potential long-term effects. One finger feels numb, like when your leg goes to sleep, and although he can move all four fingers, there are some places where he says he has no feeling if you touch it.
Being in a smallish city in China with generally low quality medical care, he is going to try to get to a bigger city with a more modern hospital, but there are some additional complications and it may be a day before he arrives. The question is how serious is this likely to be (he is worried about potential nerve damage, and the future use of his hand, or even potentially losing a finger or something), as well as what specific things he can/should be doing right now to ensure the best possible outcomes, until he can make it to the hospital. Thanks.
Best answer: Get it repaired now at the nearest reputable medical center. There is a window for repair and if he goes too long then it is not safe to have it repaired at all and he's at much greater risk for infection and will have a huge scar, too. What the time window is depends on how dirty the wound is. The dirtier the wound, the shorter the window. Upper limit for a very clean wound like this for me would be about 12 hours, I have no idea what they go by in China.
If the nerve has been damaged, it has been damaged (and the numbness suggests it has). The best thing now is to try to prevent infection and to ensure there is no tendon damage by getting it looked at by a physician ASAP, since that would be much more concerning than nerve damage. The nerves can slowly grow back in some cases if he finds that reassuring.
Wash it out as well as possible (like run it under a strong flow of potable water for 5-10 mins, not just a few seconds!), and do not put betadine, iodine, or chlorhexidine or any such stuff IN to the wound - that stuff is bactericidal but it is also tissue toxic and will impede wound healing. Then bandage it using some antibiotic ointment on a clean gauze bandage or other non-adherent bandage if he can get one. Then find a doctor. Take a hand injury like this very seriously.
I'm not your or his doctor and this is not medical advice!!
posted by treehorn+bunny at 5:30 PM on September 26, 2012 [1 favorite]
If the nerve has been damaged, it has been damaged (and the numbness suggests it has). The best thing now is to try to prevent infection and to ensure there is no tendon damage by getting it looked at by a physician ASAP, since that would be much more concerning than nerve damage. The nerves can slowly grow back in some cases if he finds that reassuring.
Wash it out as well as possible (like run it under a strong flow of potable water for 5-10 mins, not just a few seconds!), and do not put betadine, iodine, or chlorhexidine or any such stuff IN to the wound - that stuff is bactericidal but it is also tissue toxic and will impede wound healing. Then bandage it using some antibiotic ointment on a clean gauze bandage or other non-adherent bandage if he can get one. Then find a doctor. Take a hand injury like this very seriously.
I'm not your or his doctor and this is not medical advice!!
posted by treehorn+bunny at 5:30 PM on September 26, 2012 [1 favorite]
p.s. do NOT soak it.
posted by treehorn+bunny at 5:44 PM on September 26, 2012
posted by treehorn+bunny at 5:44 PM on September 26, 2012
Best answer: If the finger is numb, nerve damage has already been done and all he can do is wait for the nerve to heal - which could take months or years. I'd be more worried about infection and possible tension damage, at this point; there's nothing to be done for nerve damage.
(I cut my thumb pretty badly a couple of years ago and it went numb pretty much instantly. Sensation had been returning slowly ever since but it's still nowhere near what it used to be.)
posted by Xany at 6:21 PM on September 26, 2012
(I cut my thumb pretty badly a couple of years ago and it went numb pretty much instantly. Sensation had been returning slowly ever since but it's still nowhere near what it used to be.)
posted by Xany at 6:21 PM on September 26, 2012
treehorn: awesome answer, follow up that might help OP, would a hypothetical person in this situation benefit from packing the wound with something, if so what and why?
posted by RolandOfEld at 6:24 PM on September 26, 2012
posted by RolandOfEld at 6:24 PM on September 26, 2012
Best answer: IANAD, but Xany has it nailed - He either did, or did not, damage nerves in the original injury. What he does next really makes little difference. A "nick" will probably heal over a few months, an actually severed nerve you can pretty much write off - They do occasionally heal, but pretty much totally at random, not fast, and not usually (though pre-pubescent improves the odds substantially).
That said, your friend should worry a lot more about things like "massive infection" than the risk of losing feeling in one or two fingers. It takes more than a little soap and water to clean out deep cuts such as you describe. Listen to treehorn+bunny's advice, and get to a clinic ASAP.
posted by pla at 6:41 PM on September 26, 2012
That said, your friend should worry a lot more about things like "massive infection" than the risk of losing feeling in one or two fingers. It takes more than a little soap and water to clean out deep cuts such as you describe. Listen to treehorn+bunny's advice, and get to a clinic ASAP.
posted by pla at 6:41 PM on September 26, 2012
IANAD, but I cut myself fairly deeply and damaged a nerve near my knuckle once. I had numbness part way up the length of one finger, which gradually (over the course of months) receded. I still do have some numbness there (more like a weird tingle) when I touch the area, but it's just the area right around the cut that's affected. I suspect it'll be there forever (it's been years now) but I don't really notice it. The Dr. who treated it said taking Vitamin K and gently massaging the area once the wound heals may help healing, but I didn't try, so I don't know. He said it'd be a slow process regardless, and there's not much you can really do about it. It'll just heal more or less or not at all.
I agree that the most important thing is to prevent infection. Please have your friend go to the clinic ASAP, even the most basic clinic should have antiseptic stuff.
posted by miss_kitty_fantastico at 7:49 PM on September 26, 2012
I agree that the most important thing is to prevent infection. Please have your friend go to the clinic ASAP, even the most basic clinic should have antiseptic stuff.
posted by miss_kitty_fantastico at 7:49 PM on September 26, 2012
Roland - packing can be useful depending on the wound, but typically it's used more when you have a cavity due to an infectious process and you don't want it to start healing over the top, you want it to heal up from the bottom. The packing allows the top of the wound to stay open while the bottom heals.
You can use other fancy types of non-adherent dressings on a wound like this, for example xeroform gauze (impregnated damp gauze) can be used on the wound bed (not needed on the healthy skin) if you're going to just let the wound close on its own, but I assumed the OP is hopefully just headed out to go get this wound repaired, in which case any basic clean dressing is probably fine, and that he/she probably doesn't have access to any fancy dressings.
posted by treehorn+bunny at 8:51 PM on September 26, 2012 [1 favorite]
You can use other fancy types of non-adherent dressings on a wound like this, for example xeroform gauze (impregnated damp gauze) can be used on the wound bed (not needed on the healthy skin) if you're going to just let the wound close on its own, but I assumed the OP is hopefully just headed out to go get this wound repaired, in which case any basic clean dressing is probably fine, and that he/she probably doesn't have access to any fancy dressings.
posted by treehorn+bunny at 8:51 PM on September 26, 2012 [1 favorite]
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posted by leslies at 4:41 PM on September 26, 2012