The Butcher’s Silver Skin – Part 3

With the bleeding finally controlled and an adequate view of the gory injury, I took a few deep breaths and finally stood up straight. I stretched my shoulders back with hands still held in front of me, between head & waist, in sterile fashion. My collar bones cracked on each side.

For the first time I looked the butcher in the face and smiled…of course, he couldn’t see me behind my mask.

“How do feel?” I asked.

“I feel fine, a paper cut hurts worse than this,” he replied.

I started to give him a tour of the damage he had caused to his forearm.

“See this whitish rope? That’s palmarus longus, a tendon that attaches to your palm. You don’t really need it and I can’t find the other end anyway. You’ll do fine without it.”

As if in disbelief, he opened and closed his fingers again. Yep, they were still working.

“What’s more concerning is the muscle fascia. You’ve cut that completely open and your forearm muscles are bulging out,” I continued to explain.

I grabbed one edge of the silvery, tough membrane and pulled it away from the fat and muscle so he could see it.

“Is that like the silver skin on a cut of meat?” he asked.

“Yes, it’s exactly the same thing,” I said.

“You’re right, that stuff is tough, it’s really hard to get off, isn’t it.”

“Yes, and that’s good news and bad news for you.” I went on to explain how it was easily sewn back together because it was so tough. But because of it’s inelasticity, the likelyhood of dangerous swelling in his forearm was high. If I sewed it together and the muscles continued to swell, he could lose circulation and require subesquent surgery.

I was torn on whether or not to tack it loosly together and allow for swelling, or to sew it tight and try to return normal functioning to his forearm.

Finally, the surgeon arrived. He looked over the bloody scene and confirmed my gut instinct, which was to sew it up tight using a “baseball” stitch. The surgeon grabbed a pair of sterile gloves, picked up some instruments and stood on the other side of my table. He began to pull tissue layers out from the mess, clarifying my view. As I started to run a continuous stitch, he followed me, meaning he held my suture tight as I tied each subesquent one. The sewing went rapidly and at the other end, the entire muscle compartment was back in one piece.

THe patient opened and closed his hand several times, marveling at the odd sensations in his forearm. Not numb, not tingly, not painful, just strange, like a tightness in his arm.

The surgeon stepped out and I finished the repair with an additional layer of stures and finally a row of staples up his forearm.

The other arm had additional cuts, not nearly as bad, but also closed with a row of staples. The butcher was proud of his frankenstein appearance, but his wife was horrified.

I gave them both all the warning signs of compartment syndrome, and insisted that he spend the next 2 days with his arms above his head. Partly in jest, but also to emphasize the importance of minimizing the swelling.

Later that week I went to his restaruant. He was still at home recuperating, but I had the most amazing beef brisket I’ve ever tasted. The butcher truly knows his craft.

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