Surg Today (2009) 39:456–458DOI 10.1007/s00595-008-3858-8

Reprint requests to: C.-H. HsiehReceived: August 8, 2008 / Accepted: October 2, 2008

How to Do It

An Easy-to-Use Tool for Dressing Finger Injuries Painlessly

CHENG-HAN HSIEH

Department of Plastic and Reconstructive Surgery, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wenchang Road, Shilin District, Taipei 111, Taiwan

AbstractFinger injuries are among the most common injuries treated in the emergency department. After surgical management, surgeons fi nd that patients with fi nger injuries will sometimes experience severe tenderness when dressings are being changed. To reduce patients’ discomfort an easy-to-use tool for painless fi nger wound dressing has been developed.

Key words Finger injury · Dressing · Tube gauze · Applicator · Pain

Introduction

Upper extremity injuries accounted for 19% of United States emergency department visits in 2004 and wrist, hand, and fi nger injuries account for 65% of all upper extremity injuries.1 Finger injuries, the most common type of upper extremity injuries, range from minimal cuts to wounds with serious damage to tendons, liga-ments, nerves, vessels, and bones, and even amputation. The hand is second only to the face in its representation in the somatic sensory cortex of the brain.2 Not only hand trauma itself causes pain, but medical procedures induce further pain. Pain is an intolerable problem for these patients, especially if caused by any medical pro-cedure or accidental touch to the injured area. After surgical management, surgeons sometimes fi nd that patients experience severe tenderness during the chang-ing of dressings in the outpatient department. To reduce patients’ severe tenderness and avoid additional pain, an easy-to-use tool has been developed for painless fi nger wound dressing.

Technique

The fi rst step is to prepare a single-use plastic syringe, a small hand saw and bandage scissors. Remove the plunger of the syringe and measure the inside diameter of the syringe to make sure it is larger than the cross diameter of the patient’s injured fi nger. A 50-ml syringe (Terumo, Tokyo, Japan) is adequate for most adults, a 20-ml syringe for children and a gastric feeding syringe for fi ngers with an unusually large diameter. The distal part of the syringe is cut with a hand saw along the “10 ml” mark (Fig. 1). The cut edge is then trimmed smooth using bandage scissors.

When treating the injured fi nger, place a proper amount of antibiotic ointment and a piece of Adaptic (Johnson & Johnson, Langhorne, PA, USA) non-stick sterile gauze pad directly on the wound.3 Then open a 2 × 2-inch gauze pad and wrap around the wound without fi xing with micropore paper tape. Simply insert the prepared syringe applicator into the tube gauze. Insert the gauze-dressed injured fi nger into the open distal end of the prepared syringe applicator (Fig. 2). Carefully allow the tube gauze to remain over the injured area and pull the pre-working syringe applicator out smoothly and carefully. The tubular gauze is twisted as shown in Fig. 3. The applicator is then passed back over the previously dressed injured fi nger. The residual tube gauze automatically dresses over the previously dressed tube gauze to hold it more securely in place. The fi nger wound dressing is complete (Fig. 4).

Discussion

Finger injuries are among the most common injuries treated by emergency physicians and hand surgeons. Some inexperienced medical service providers usually focus on the injury itself, but sometimes minor post-operative consequences such as wound dressing are

C.-H. Hsieh: Tool for Finger Injury Dressing 457

ignored.4 Clinically, pain is always the chief complaint of patients when dressings are changed. A simple, safe, rapid, and painless dressing procedure can therefore be an important advantage for both patients and surgeons.

Theoretically, the severity of superfi cial acute pain is infl uenced by the distribution of nociceptors and the frequency of nervous impulses.5 In fact, the nociceptors are present in large numbers on the face and hands, particularly the fi ngers, so pain is experienced more often in these regions. To decrease pain while changing the dressings of an injured fi nger, the only option is to reduce the intensity of harmful stimuli.

No matter how detailed a surgical procedure, postop-erative wound exudates, discharge, and even blood clots are sometimes noted, especially in trauma patients. Tra-ditional gauze dressing typically sticks to the wound. Even the outer adhesive gauze often needs to be wet with normal saline to release it from the wound. Inex-perienced medical service providers will often use micropore paper tape to fi x the gauze, followed by a bandage or tubular gauze. After several hours or days of dressing, the porous tape will make the dressing gauze more diffi cult to remove, especially after wetting. If non-stick dressing material is applied over the wound with a gentler maneuver the discomfort during wound dressing can be signifi cantly reduced.

Traditional tubular gauze applicators are not always available in all types of medical institutions. The old-fashioned applicator design, because of its hollow-wire architecture, will lead to some interruption with the underlying expanded gauze over the wound and the tube gauze above during application. The syringe tool described here has two structural advantages. First, the syringe wall is smooth, extends completely around the fi nger with a constant diameter, and it is transparent.

Fig. 1. Tools to prepare: plastic syringe, hand saw, and bandage scissors

Fig. 2. Insert well-dressed injured fi nger into open distal end of adapted syringe applicator lined with tube gauze

Fig. 3. Pull out syringe applicator and twist tube gauze

Fig. 4. Tube gauze dressing is complete

458 C.-H. Hsieh: Tool for Finger Injury Dressing

This type of syringe surface therefore will not create any gaps on either side of the gauze. Transparency allows for the position of the gauze on the inner surface to be visible. Second, this device has fl anges that allow it to be held and easily manipulated so as to determine the degree of twisting of the tubular gauze in the wound dressing. An adequate assessment of the degree of tubular gauze twisting is important for proper fi xation and to avoid unnecessary complications. If the circula-tion of the injured fi nger tip is a concern or should be monitored, the ability to visualize the twist and pass-back procedure and view the fi nger tip is recommended to avoid any compression complications.6–8

In addition, single-use or personal-use tools can elim-inate the risk of cross- contamination between different patients. Furthermore, the traditional reusable applica-tor is much more expensive and often cannot be taken home by patients for self-care of wounds.

The simple syringe tool described herein is easy to use, inexpensive, and suitable for all fi nger sizes. The tool-making procedure is easy, time saving (less than 3 min), and the materials are available worldwide. Using this tool, not only medical service providers but patients or their families can learn this easy way to dress fi nger wounds. It can be very useful when patients require additional wound dressing on subsequent days; the inner expanded gauze is easily removed from the wound without micropore paper tape fi xation. The tool and

method can reduce the tenderness and discomfort of changing dressings and reduce the possibility of cross-contamination. It can be used after the very fi rst wound dressing procedures or those that follow in the operat-ing room, emergency room, or outpatient department.

References

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2. Parham A, Ganch WP, Lee A. Finger tip reconstruction. In: Mathes SJ, editor. Plastic surgery. 2nd ed. vol. 7. Philadelphia: Saunders Elsevier; 2006. p. 153–70.

3. Pannunzio ME, Pederson WC. General principles. In: Mathes SJ, editor. Plastic surgery. 2nd ed. vol. 7. Philadelphia: Saunders Elsevier; 2006. p. 109–24.

4. Lin CY, Hsieh KC, Yeh MC, Sheen-Chen SM, Chou FF. Skin necrosis after intravenous calcium chloride administration as a complication of parathyroidectomy for secondary hyperparathy-roidism: report of four cases. Surg Today 2007;37(9):778–81.

5. Thomas VN. Pain mechanism. In: Pain: its nature and manage-ment. London: Bailliere Tindall; 1997. p. 1–19.

6. Fattah A. Dressed to kill: pressure necrosis secondary to fi nger dressing. J Plast Reconstr Aesthetic Surg 2006;59(1):105–6.

7. Norris RL, Gilbert GH. Digital necrosis necessitating amputation after tube gauze dressing application in the ED. Am J Emerg Med 2006;24(5):618–21.

8. Giandoni MB, Vinson RP, Grabski WJ. Ischemic complications of tubular gauze dressings. Dermatol Surg 1995;21(8):716–8.