We created the best sterile field that we could and numbed up the laceration with as much lidocaine with epi as was safe to administer. We had run the hand under running water to disrupt the clot, and then irrigated with sterile saline.
The distal tendons popped into view easily by simply extending all of his fingers flat against the table. They popped out like little white worms and just sat there. That was easy. The hard part was findign the proximal ends. I gently dissected the tissue back towards his wrist, grasping the overlying skin & fat in forceps then cutting the skin with a scalpel.
I was shocked when I saw a small whitish object hiding under the retinaculum. I quickly grasped it with forceps and pulled it out, placed a stich through it and kept it in sight. I tugged on it and his forearm twitched. We proceeded to suture the 3rd distal and proximal tendons together. While it wasn’t the prettiest knot, it was functional, and what’s even more important, his finger worked again!
THen I set off to find the 4th & 5th tendons. I had luck in only finding the smallest proximal tendon and I’m assuming it was the 5th. So I placed sutures through both the 4th & 5th distal tendons and sewed them to the 5th distal tendon.
In the end, I had a pretty three sided laceration…one side formed by the machete, and the other two formed by me looking for the proximal tendons. I pulled the two sides up and placed a red rubber catheter drain in the lac, and we created an ulnar gutter splint for him.
We fed both he and his brother dinner (tortillas, rice & beans) and the two set off towards home. We offered them a place to stay for the night, but they insisted on walking back home, 5 hours, in the dark.
The boy came back to the clinic 5 days later, after we were gone, to see the nurse. We received an email from her saying that the wound looked good, non-infected, and she removed the drain.
Hopefully in 6 months he’ll come back to the clinic to show us how well his fingers are working. It wasn’t the best tendon repair, but it was the best one he could get at the time.
Everytime I go there, I learn more, come back & study more and am better prepared. I can’t wait for my next machete wound in Hondura!