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[nenjin]

To the medicals out there.

Got my middle right finger pinched in a fork lift about three weeks ago, the bottom fleshy portion of the finger above the first joint.

There was *some* skin which the ER dutifully sowed back on, but in her words there wasn't enough left to fully cover the exposed area of flesh on the finger.

So the top portion has some flesh stitched back on and its mending, sort of. But there's a portion of finger about the size of a pencil eraser just above the joint with no skin on it.

Now, I'm not worried about aesthetics or I would have gotten a skin graft. But I am worried about the wound healing cleanly, and not forming an infection.

My 10 day supply of Cephalexin ran out a couple days ago, and so far the wound looks fine and uninfected. But that bottom portion just has a thick crust of blood over it.

The urgent care clinic that took the stitches out said it was ok to shower it and let it get wet, and that makes sense. These scabs are thick has hell and will need some help to break up. But every morning afterward, I noticed more fresh, dried seepage from the part with no skin covering it. It's always formed a crust and isn't freshly weeping fluid in the morning. But I know it's fresh because it's "shiny" and catches the light. And I'm just worried that, with no skin or real scab to cover it, it's just going to break, ooze and dry over and over again while the rest of the finger heals up until I eventually develop an infection.

Generally just looking for some good post-wound care tips and things to look out for. And maybe some guidance on how long I should reasonably expect this to take so, when the scabs come off, something workable has grown back there. I lift weights very regularly and have put it all on hold out of fear of tearing the wound back open, scraping the scabs off or raising my blood pressure to the point blood wants to exit the wound in force. It's been three weeks to the day of the accident so far, and I was figuring about a month at least. But I get nervous every time I take a shower, worried that the whole scab and half-dead skin is going to come loose and I'll be staring at more exposed flesh. At which point I WILL need a skin graft. I can feel the scab and sutured skin moving at this point, and not exactly in attachment with my finger flesh. I'm not even sure some of the skin she sowed back on is alive....although at least its acting as durable sheath over the wound while the body does its thing. The clinic that took the stitches managed to rip out the bottoms of the scab/flesh when they removed them....so the scab is already starting to come up at the bottoms. Scab? Skin? It's hard to tell quite what it is anymore.

I don't have much pain. Just the occasional mild stinging sensation at the edges of my scabs and parts where it's splitting apart, and reasonable discomfort where the scab is deep in the wound. Nothing that strikes me as out of the ordinary.

I gotta say I was not impressed with the urgent care clinic's dutifulness. I had to ask a lot of questions about post care followup.

Thoughts? Pictures available on request I suppose. I could post them now but I won't subject the forums to this mess unless it's necessary. I'm not worried enough yet by any signs that I feel the need to go back to urgent care or my primary doctor. But it's preoccupying my thoughts enough because I'm staring at it 3 hours a day mapping its fucked up topography that I thought I'd make a post.

(It seriously looks worse than it.)

[wierd]

Sounds to me like it is healing fine.  If there is no redness around the site then you are good. This sounds like one of those "let it dry out" style wounds. (there are some you want to keep somewhat moist.) Just keep it covered with a lose bandage or gauze, let it breathe, and avoid picking off the scab.

The body has pretty good defenses against microbes. While the intact dermis is the primary defense against infection, If your wound is weeping yellow fluid instead of blood, then your bottom layers are still mostly intact, so if you do get an infection it will be superficial and treatable with topical antibiotics like bacitracin. It will take several weeks to regenerate a significant patch of skin, so just be patient. If the site becomes warm to the touch, inflamed, and has redness around the scab then go see your primary. Otherwise, just take a chill pill and avoid disturbing the scab until it heals.

[Shazbot]

Cover with gauze and a thin sheen of triple-antibiotic ointment. I had a similar sized chunk out of the back of my thumb removed while roofing, and while it turned green, is now imperceptible a few years later.

[nenjin]

The recommendation of the urgent care clinic was to NOT cover it or use anything topical on it. And tbh, it looks better now after drying than it did for the 7+ days I had it under vaseline gauze and finger gauze.

It's hard to say what's better, honestly. A dry scab that pulls and tightens but stays attached, or a moist scab that gives a little but is prone to infection from all the trapped moisture.

Although I will say, as much as I dread getting this thing wet, it does look less freakish when it's gotten a little wet and dried out. Versus 24 hours of dryness. It's such a fiddly thing.

[ChairmanPoo]

IIRC current standards of wound care do suggest that antibiotic ointments and hydrogel dressings do result in better outcomes. But it's not something I regularly deal with so I cannot give you specific wound care advice.   Doesnt your GP or hospital run a wound care clinic?

[nenjin]

GP does not. Clinic was on the verge of sending me to wound care at one of the local hospitals based on the outcome of a swab test, but it came back negative for bacterial growth, so they took the stitches out and called it good. That was a week after a separate doctor at the clinic said I might need a skin graft for the portions where no skin was stitched back on. The doc who took the stitches out disagreed with that and said I would not need one.

But again...I thought these were the kind of things they were supposed to tell you before letting you walk out of there. I had to ask, and got some vague answers in return. In truth, the 70+ year old doctor who took my stitches out was so unnerved by the wound and how gunked up the stitches were (and how much pain he caused me taking them out. You know it's a good one when a doctor says "please don't hit me.") that I think he just completely forgot to give me all the prudent doctorly post-care advice they're supposed to give.

Soooooooo.....guess I'll make an appointment with my GP. It's not that I think it won't heal eventually on its own. I'd just like to accelerate the process if I can, and maybe do something so I spend fewer months peeling layers of dead skin off my finger. Because right now the parts they sowed back on, despite having color and having some obvious blood flow, have the consistency of concrete. And that's the half of my finger I think is healing ok. The other half........still feels like concrete and also looks less alive by the day.

I guess one thing I'll be looking for my GP to tell me is "yeah, that shit is dead and you should get rid of it sooner rather than later." As usual I'm probably over thinking most of this, but after this many weeks I'm a little tired of this injury disrupting my normal schedule.

(Also thanks CP, you were kind of the one I was attempting to summon to this thread )

[wierd]

when I suggested loose gauze, it was not for moisture control, but to prevent abrasive removal of the dry scab. I specified loose gauze.

some wounds do better with a dry scab-- that said, treatment with a dry antibiotic (like a quick treatment with betadine that is then allowed to dry) would be useful and prudent I think.

Also, genuinely necrotic tissue turns a nasty shade of black, and almost always has infection in/around it.  Purple, red, or white are disturbing colors, but not necessarily indicative of necrosis. If there is blood flow through the tissue, then it probably is not necrotic.

Damaged tissue will have inflammation, which is what likely is causing the firm texture. You can test this yourself; pop a tylenol, and see if the firmness of the tissue reduces.

[martinuzz]

Cover with gauze and a thin sheen of triple-antibiotic ointment. I had a similar sized chunk out of the back of my thumb removed while roofing, and while it turned green, is now imperceptible a few years later.

No, no antibiotics
Use antibiotics ONLY in life-threatening situations, like pneumonia, or other severe bacterial infection.

Using antibiotics for every little silly thing is what got us fucked with MRSA strains in the first place.

[nenjin]

Topical antibiotic ointments don't necessarily = ingested antibiotics.

[nenjin]

Well the scabs have started to break loose and I can see what's underneath part of the wound now. Nice, pink issue. Still got a large scab over half the finger that comprises the parts that healed the least cleanly....but I imagine it will be ok. Think I'm gonna soak it tonight and see if I can get the rest of the crud off.

[Doomblade187]

Well the scabs have started to break loose and I can see what's underneath part of the wound now. Nice, pink issue. Still got a large scab over half the finger that comprises the parts that healed the least cleanly....but I imagine it will be ok. Think I'm gonna soak it tonight and see if I can get the rest of the crud off.

Do try and take it easy on the scab. I almost always draw blood when removing scabs- they're there for a reason.

[nenjin]

Oh I'm being super gentle. The left side, which looked better, came up without issue. The right side, where the stitched skin basically turned black after two weeks.....that's a little more attached, as it's not clear where dead skin starts and healthy skin begins. So I'm taking it very slowly. I do think it needs a real soak instead of just getting wet in the shower. The scab is like 1/4 thick, so it's more like a process of chiseling it away than peeling it off.

[wierd]

leave the thick scab alone.  If it does not peel away easily, there is not healthy tissue underneath, and you risk infection.

[nenjin]

Too late!

Did have a spot where the skin was still attached even though 90% of it was dead. That......phew. That took some doing. Some part of my finger was still attached to the top layer of dead skin and....yeah, a knife was required.

Glad I know where I stand though. It's disconcerting to have a still open wound after a month but.....hopefully once this last spot heals over I'm in the clear.

[martinuzz]

Never take of a scab. Don't soak them, don't scratch them off, don't cut them off. They are there for a reason. Some of the thick ones can take a while to fall off, you need to be patient and endure an occasional itch, until it falls off.

Guess my advice is too late now. But for next time, leave that thing be.