"Flesh Wound" Updates

First, the carnage. If you are curious how bad the actual damage is, here are links to 3 photos taken at a doctor's office today. They are pretty graphic close-ups, so if you are squeamish, don't click on the links.
Chad's reaction to his hand
The whole hand
Close-up of the fingertips

Chad went to two doctors today, one from Rainier Orthopedic in Puyallup and one from Seattle Hand Surgery Group associated with Swedish Hospital.

At Rainier, Chad was assigned to the doctor that was on call Saturday night rather than their hand specialist. We were told that this was because follow-up care always happens a few days after the ER, so they automatically place space in the on-call doctor's schedule for daytime follow-ups a few days after being on call. They took off the dressing, looked at the injuries, redressed it (poorly), and said to come back in a week. That was it.

At the Seattle Hand Surgery Group, they looked at the wounds, cleaned them up some more (they were pretty goopy), went over exactly what will happen, and talked about some cosmetic work. The doctor commented that if Chad's fingers had remained dressed for a long period of time as Rainer had left them the skin would really start to degenerate. (She used a big word that I don't remember right now.)

It turns out that Chad's fingernails will totally grow back. The nail-generating cells are deep in your finger (the doctor indicated about 1/4" deep). In 3-4 months Chad's ring fingernail should completely regrow. The nail follows the contour of the "nail bed" (the skin under the nail). Because a little meat was removed from Chad's nail beds by the saw, he will have a slight depression in his fingernails on his index and middle finger. If the ring finger is left as the ER doc put it together, a lump would develop in the fingernail. Also, the way the ER doctor folded the skin up over the end of the finger left the end of the finger with a mushed appearance, flatter and wider than normal.

Chad will undergo a 30 minute cosmetic surgery tomorrow to give his ring finger a more natural appearance when it heals. The Seattle doc said the surgery should really be done tomorrow rather than later partially because she works in the main OR on Wednesday rather than in the outpatient office, but also so the finger can start healing with the better appearance. This was never mentioned at Rainier. When she redressed the fingertips, she only wrapped the ends of the fingers making it much less obvious Chad has had some trauma.

The surgery will be done by using a regional anesthetic (a "Bier block") rather than injecting the fingers with individual local shots. The whole hand will be numbed by placing an anesthetic IV in the hand and a tourniquet above the wrist. Considering the most excruciating part in the ER was the local shots into each finger, Chad is not looking forward to this part of the procedure.

The X-rays, which we may post when we get them back after the surgery, showed that the "fracture" was really the total severing of the bone in the end of the fingertip. It's just gone, totally annihilated by the saw blade, which left most of the skin intact. This will not regrow.