Anesthesia and Direct Wound Examination

Anesthesia and direct wound inspection is necessary because partial tendon lacerations or intraarticular injuries are not always readily apparent. Sensation and range of motion should be tested before anesthesia. In general, if a laceration needs to be extended in order to properly view the wound, hand consultation is in order. A bloodless field can be facilitated by milking the digit proximally and then applying a local tourniquet or Penrose drain around the base of the digit. The tourniquet should not be stretched to more than 150 percent of its length, and it can be held in place with a hemostat. The digit can be milked by wrapping another Penrose drain circumferentially around the entire digit, going from distal to proximal or by reconfiguring a 4 * 4 gauze dressing into a narrow band and wrapping that circumferentially around the entire digit. Only moderate compression should be used to avoid compression injury to the digit. The tourniquet should not be left in place for more than 20 min. Contaminated wounds should be copiously irrigated with normal saline and antibiotics administered. Tetanus toxoid should be administered as needed.

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