Finger Avulsion

here is is a description of a simple technique for the management of dermal avulsion injuries. It serves as a compendium and update to my publication from the Journal of emergency medicine earlier this year describing a technique using a combination of limb elevation, a tourniquet and tissue adhesive glue in order to stop these wounds from bleeding.

The first new additional step is to soak the digit in 1% lidocaine with epinephrine prior to beginning the procedure let's hear from a patient what

it feels like Sting's a little too bad not see that this step simultaneously adds vasoconstriction and anesthesia the technique was first described in the academic life and emergency medicine blog the second additional tip is the

use of a just-right finger tourniquet so I find that when you use most commercially available finger tourniquets or if you just take a regular tourniquet and tight around the finger it's kind of an all-or-none

phenomenon it's going to be really tight on the patient's finger they're not going to be able to tolerate it for very long and probably not long enough for the glue to dry in this procedure so here's a trick take a sliver of a

tourniquet cut as shown and a pair of human hemostat or needle drivers place that piece of tourniquet around the finger secure the needle driver around the piece of tourniquet and then just simply crank it up to a level that's

just right by just right I mean enough to get hemostasis but not so much that the patient can't tolerate it as previously described you're going to want to elevate that limb in order to decrease regional blood flow and another

important step is to milk that digit from proximal to distal to completely exsanguinated and decrease the risk of bleeding while the glue is drying which can ruin the procedure a key step before you apply the glue you want to observe

for complete hemostasis of the wound no bleeding at all from that fingertip wound then and only then can you proceed with the next step which to apply layers of tissue adhesive glue over the injury site multiple layers can be used to

ensure adequate coverage and hemostasis as you see that glue forms a thick pool especially in deeper pits of wounds so let me describe a third tip that will help you to combat this problem take a piece of suction tubing

attach it to your compressed air source and create a mini blow dryer which you can basically apply to the wound in order to speed the drying of that glue finally once the glue is dried you can release that tourniquet from the wound

again just by unwinding that needle driver and releasing the tourniquet at this point you should have a completely haemostatic seal over the wound as you see here as with all applications of tissue adhesive glue it'll remain

present for about five days will naturally slough off and you will have created a completely haemostatic wound cover for the initial stages of healing for this and other videos on wound care visit w wa serration repair calm