Mark Carey, a woodworker for M&S Enterprises, was using his band saw one day last October when it slipped, and sawed through his index finger to the bone and his middle finger through the bone. He and his wife hurried to Trinity's Emergency/Trauma Center where Carey was evaluated and shortly after underwent surgery.
"I didn't think I'd have that one finger for sure, and the other finger I really didn't know about. I worried I wouldn't be able to work, because my livelihood is making stuff out of wood," Carey said.
Dr. William Kivett, a board-certified dermatologist and plastic surgeon who is fellowship trained in orthopedic/plastic surgery of the hand, was called to the ER that day to evaluate and operate on Carey's hand.
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Katina Tengesdal/MDN - - Dr. William Kivett, board certified dermatologist and plastic surgeon, points to a tendon in the hand as he explains Mark Carey’s injuries.
After evaluating Carey, Kivett first irrigated the wound with an antibiotic solution. Then he began microsurgery, a type of surgery performed with specialized instruments under a microscope.
"First we lined up the nerves and arteries, and then we sewed the tendons with larger sutures. We used sutures so small you can barely see them with the naked eye," Kivett said.
"A typical digital nerve is a half a millimeter. The artery is about the same. I put 8 to 10 stitches in that," he added.
During the surgery, Kivett put a metal pin in Carey's finger bone to keep it from breaking. After the surgery was completed, Carey was fitted with a splint that used rubber bands to allow him to move slightly, but not enough to tear the healing tendons.
"Tendons need to be moved at least 5 millimeters to avoid the tendon being stuck down. If you can move the tendon slightly, it will slide enough not to stick as it heals, but it's also allowed to heal without being pulled apart by movement," Kivett said.
Kivett explained that with hand surgery, the surgeon has two conflicting goals repairing the patient's original injury, and leaving uninjured structures intact. When immobilizing a bone, he said, other tissues around it are immobilized as well. The goal is to keep uninjured tissues working while continuing to help injured tissues to heal and function again.
Occupational therapy
Within a few days after his surgery, Carey was referred to Trinity's Hand & Upper Extremity Clinic, where he underwent about three months of occupational therapy with Trinity's hand team.
"It was painful to do the exercises and the stretching, but it's not too bad," Carey said. "It's not unbearable, and it was worth the effort."
"I told him (Carey) that if you can delay work for a season and work on healing, it will pay off for the rest of your life," Kivett said. "He understood that, he complied with all of the requirements, and the results were gratifying."
During therapy, one goal was resensitizing the damaged nerves. During surgery, the nerve carrier tubes were realigned, but new nerve cells needed to grow. Kivett explained that nerve cells grow about a millimeter per day under the right conditions.
As the nerves regrow, keeping the fingers sensitized was important.
"After a finger is numb even for a little while, the place in the brain that has a receptor for those signals is cut off from those signals. It's almost like it forgets it's there," Kivett said.
"You have to stimulate the place where the nerves are to regain sensation," he added. "People think all of a sudden their finger is going to feel normal again, but at first, they'll have an itchy or ants-crawling feeling."
Kivett credits Carey's involvement and dedication to continuing with occupational therapy as a big factor in his recovery.
"He was patient, he applied himself, he tolerated discomfort, and he was communicative," Kivett said.
Another goal of therapy was to minimize scar tissue, with the use of creams and exercises to break up scar tissue.
"Scar tissue is made up of thousands of strands. Collectively, they can destroy you, but individually, they are easy to break. Whether the patient is moving their own muscles or the therapist moves their hands, they have irregular sensations from scar tissue breaking," Kivett said.
Carey now has regained most of the function in his hand, though he still is unable to bend his middle finger due to scar tissue.
"Other than that, I can function fine out in the shop, and I can even deal and shuffle cards," Carey said. "I can do whatever I need to do, basically."
"Thank goodness for Dr. Kivett, and for the efforts of Danielle (Kary, occupational therapist) and the others at the hand unit," he added. "Without them, I don't know what would have happened."