Many of my readers and/or patients probably don’t know this, but I still do take emergency room call. Why? I have asked myself this question sometimes. Most patients do not have insurance or means of paying and although I do get paid through the Emergency Medical Fund System, the amount of money received is a fraction of what we bill.
I take call, because for me, it is still fun. A hand or facial trauma patient forces me to think and be creative in a short amount of time. Although these surgeries are rarely emergencies, they need to be addressed soon and most require surgery within 1-2 days. I have to work with what “trauma” has given me and sometimes there are fractures, tendon and nerve injuries and missing tissue.
This unfortunate patient was trying to fix the spring in his garage door and the spring “sprung” and the patient sustained a high energy blunt force to the back of his hand. He sustained an open wound and the inability to extend (straighten) his middle finger. At the time of surgery, I was unable to find a tendon going directly to the middle finger and my thought process was that perhaps the tendon had retracted into the forearm, where all the extensor tendons of the fingers originate from. The wound was closed and an MRI was obtained which showed a possible tendon or muscle mass in the proximal forearm.
The patient was taken back to the operating room the next day and I explored the extensor tendon compartment in the proximal forearm. Still, no tendon could be found! Does this patient have an anatomical variation where this tendon is missing? This, I thought, was the most likely diagnosis. I then attached the tendon to the connections present between the tendons in the finger and extension was maintained after the repair.
I told the patient the intra-operative findings. During his follow-up appointment, the patient brought me what looked like a beef jerky strip in a Zip-loc bag. Low and behold, it was the tendon! The patient, after being told of what was found, saw a white strip hanging from the garage door chain and on examination, figured out it was the tendon which had been “ripped” from his hand.
It is cases like this which keeps me going!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 16 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.