# heads up and some questions (slightly graphic)



## compforce (Feb 5, 2016)

warning!  Small open wounds below.  Pardon any typos, I'm typing one handed as you'll see.

So this one is somewhat to educate, but mostly to ask a few questions of the medical types on the board.  Back in 1991 after returning from DS/DS I had a stress fracture in my hand.  After it had healed, there was a small bump at the bottom of my ring finger.  Like most hard chargers, I ignored it thinking it was just a break healed badly.  Fast forward 24 years of neglecting it and repeated reinjury and it looked like the following.  Here's the warning.  1 in 4 people have a genetic predisposition for the condition, which is called Dupuytren's Contracture.  If you see this:




It will eventually turn into this (if not treated)


That is my hand with the fingers flexed as far open as they would go.  Basically, the bump is collagen that is building up on the tendon and causing the fingers to draw in.  Here's a diagram of it:


Ultimately, that was my warning.  If you see something similar to the first pic on yourself or one of your troops check to see if the hand will still lie flat on a table.  If not, go see the orthopedic hand surgeon.


Now for my questions (and the ugly pics).  Please, if you are not a doctor or SOF medic do not try to give me advice.  I just had it treated on Wednesday via needle aponeurotomy




. 

Today was the first time I took the bandage off.  At first glance it appears to be fine to me.  Here's a pic of it immediately after removing the original bandage:


I'm a little concerned that it feels slightly warm to me.  Is that normal?  I'm not worried about the tears, those make sense because he was stretching out the fingers and the skin had long since tightened in the area.  I'm also assuming the bulge on the ring finger is just normal swelling.

Here's what it looked like after cleaning (water and saline solution).  Do you see anything that would concern you?  After cleaning I let it dry, used a Q-tip to apply neosporin inside and on the edges of the wound and then wrapped in guaze.


Last, Here's a pic of the worst wrapping job in history.  Does anyone have any tricks for wrapping an awkward location like this?  I don't have anyone to do it for me so I'm having to one-hand it.  Basically I did something that looks like the yellow ribbon (deployed ribbon) around each of the two fingers with the tails coming down the back of my hand and then wrapped the two sets of tails around my palm and taped it.  Does that sound right?


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## Devildoc (Feb 5, 2016)

You said it's warm....the site, the whole hand, up your arm?  Any other symptoms?  If it's just at the site it could be just inflammation and healing process.  As long as you don't have redness, swelling, pus, fever, etc., it's likely just procedure-related.  Looks good, so does your wrapping job.


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## TLDR20 (Feb 5, 2016)

Is the redness moving through specific places? Almost like a river?


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## compforce (Feb 5, 2016)

Devildoc said:


> You said it's warm....the site, the whole hand, up your arm?  Any other symptoms?  If it's just at the site it could be just inflammation and healing process.  As long as you don't have redness, swelling, pus, fever, etc., it's likely just procedure-related.  Looks good, so does your wrapping job.



0.5 degree higher around the site and along the knife edge of the hand.



TLDR20 said:


> Is the redness moving through specific places? Almost like a river?



No redness other than the immediate wound site and palm.  No tracks.


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## Muppet (Feb 5, 2016)

Motrin, water, foot powder, face out and pull security.  You see an ortho / infectious disease doc? 

M.


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## Red Flag 1 (Feb 5, 2016)

Tell me about the open areas in the skin on your ring, and little finger. What caused the skin breakdown, and how is it being treated?

It is geneticly linked. My son and I both have them on the same hand. I have not needed treatment because I have never had the contracture. If you have trouble putting your hand in your trouser pocket because of the contracture, it is time for treatment, IMHO.


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## 8654Maine (Feb 5, 2016)

Compforce, no matter what I or anyone here says, if it bothers you, get it checked out by the surgeon (no one else), ASAP.

Dupuytren contracture is a a fibrosing disease involving the palmar flexors.  A similar disease involves the penis, Peyronie Dz.

Remember, the healing process involves a cascade of events that includes vasodilatation, release of cytokines and involvement of multiple blood cells.  There should be some immediate hyperemia, edema, capillary leakage.  This will result in swelling and some warmth.   There will be discomfort and/or pain involved with this.  It is a normal process of healing.

There will be localized temperature difference.  This is not a fever.  A fever is a cytokine mediated increase in body's thermostat.


Unfortunately, this is also the same process with infection.  The only way to differentiate is by a good exam.

Cellulitis is not the biggest concern.  It is Suppurative Flexor tenosynovitis leading to fasciitis or myositis or compartment syndrome.  Look up Kanavel sign for some clues.

From your pics:  it looks like normal post-op findings.   Please don't take that as gospel.

As for wrapping/dressing, try this:

(1)  Get a good covering of Bacitracin or Triple ABX on the wounds
(2)  Put a 2x2 or 4x4 dressing between the ring and pinky, or wrap them individually.  It keeps the skin from being macerated.
(3)  pinch the ring & pinky finger together.  This will hold the dressing in place.  Make a "Spock the Vulcan" hand sign.
(4)  Get some Kerlex and wrap the ring/pinky finger together and then keep wrapping around the palm and then the wrist.  (This will keep it from sliding off the hand.
(5)  tape the end the Kerlex wrap.  You can use Coban on it as well.

Finally, GET IT CHECKED OUT by your hand surgeon if it concerns you at all!


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## Red Flag 1 (Feb 5, 2016)

g


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## DocIllinois (Feb 5, 2016)

I concur with all written by 8654 and RF1.

You had a good doc doing the procedure, IMO: I've seen portals that look like they were done with an 8 guage needle with consequent inflammation (and probably pain.)

If you're posting this here because you have any feeling that things may not be okay, or you'd like to continue to maximize hand function, there should be a hasty re-consult with the surgeon with intimate knowledge of your case.


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## compforce (Feb 5, 2016)

Red Flag 1 said:


> Tell me about the open areas in the skin on your ring, and little finger. What caused the skin breakdown, and how is it being threated?
> 
> It is geneticly linked. My son and I both have them on the same hand. I have not needed treatment because I have never had the contracture. If you have trouble putting your hand in your trouser pocket because of the contracture, it is time for treatment, IMHO.



The skin breakdown is from the procedure.  The skin had tightened.  When he released the fingers, the skin ripped.  He told me this was likely to happen during the consult.  They leave it open to heal because if they stitched/stapled it, it would pull the fingers in and there wouldn't be enough skin to stretch out to where the fingers could potentially be (without a long long PT journey).  By leaving thm to heal open, I'll end up growing more skin (although the potential for scarring is there also).  AB ointment, keep it clean and dry and Tramadol as needed for pain.

I actually have it on both hands and one foot (it forms on the tendon in the arch, very very painful to run on).  Technically I have Dupetryn's Disease, not just the contracture.  According to both surgeons I consulted if you put your hand palm down on a flat surface like a table and the palm doesn't touch, you're a candidate for the surgery.



8654Maine said:


> Compforce, no matter what I or anyone here says, if it bothers you, get it checked out by the surgeon (no one else), ASAP.
> 
> ...
> 
> ...



If there was any real question, I'd have gone down there to see the doc.  It's literally 10 minutes from the house.  I wasn't super concerned about the temp, it was just an anomaly.  I don't like unanswered questions, especially with something like my hands.



> Cellulitis is not the biggest concern.  It is Suppurative Flexor tenosynovitis leading to fasciitis or myositis or compartment syndrome.  Look up Kanavel sign for some clues.
> 
> 
> From your pics:  it looks like normal post-op findings.   Please don't take that as gospel.
> ...



That was how the doc said to wrap it.  Couldn't quite seem to get it to work.  Dropped the dressing about 10 times.



Red Flag 1 said:


> My impression was a post-op dressing change. The open skin troubles me some, and a trip back to the doc is thing I would suggest, even for how to dress the wounds.



I have a followup on Monday.  Your impression is exactly correct.  It's the first bandage change 48 hours after surgery.

Gentlemen, Thank you much.  This is the first time I've had surgery other than a CTAngio, which is a whole different ballgame.  I researched the hell out of it while I was fighting with BCBS about network benefits (3 years before they figured out I was right!).  These were just the questions that weren't answered by the research.  I don't have any suspicions that anything is wrong.

BTW, mine was so far advanced that there is likely to be another trip to the OR to finish the job in the future.  We're reassessing after this part heals.  I SO want to ask the doc if I'll be able to play the guitar when we're done, but I'm sure he's heard that a million times.

wow, that's a lot of one handed typing....


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## medicchick (Feb 5, 2016)

Nothing to add except I'm glad this finally happened for you, I remember you saying something a year or so ago about it.


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## Marauder06 (Feb 5, 2016)

@compforce I'm sorry this happened to you.  Thanks for posting it, this (like all of SS's medical threads) has been highly educational for us lay people.


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## Red Flag 1 (Feb 5, 2016)

compforce said:


> The skin breakdown is from the procedure.  The skin had tightened.  When he released the fingers, the skin ripped.  He told me this was likely to happen during the consult.  They leave it open to heal because if they stitched/stapled it, it would pull the fingers in and there wouldn't be enough skin to stretch out to where the fingers could potentially be (without a long long PT journey).  By leaving thm to heal open, I'll end up growing more skin (although the potential for scarring is there also).  AB ointment, keep it clean and dry and Tramadol as needed for pain.
> 
> I actually have it on both hands and one foot (it forms on the tendon in the arch, very very painful to run on).  Technically I have Dupetryn's Disease, not just the contracture.  According to both surgeons I consulted if you put your hand palm down on a flat surface like a table and the palm doesn't touch, you're a candidate for the surgery.
> 
> ...


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## compforce (Feb 5, 2016)

Red Flag 1 said:


> Could you play guitar before this ?


Exactly my point  :)


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## compforce (Feb 5, 2016)

> A similar disease involves the penis, Peyronie Dz.



I could have lived my whole life without knowing about that one.  and men with Dupuytrens are at higher risk  :wall:



Marauder06 said:


> @compforce I'm sorry this happened to you.  Thanks for posting it, this (like all of SS's medical threads) has been highly educational for us lay people.



No need to be sorry, it's not your fault    I posted because I blew this thing off for 20 years just because it didn't hurt.  I thought maybe someone else might recognize it in themselves and get it fixed before they go through what I have.  (BTW, it makes pushups really hard to do, especially when it's in both hands)


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## Ranger Psych (Feb 5, 2016)

I'm just glad you're finally getting that shit taken care of. Worrying about your hands going away while working IT is enough to give you an aneurism......


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## x SF med (Feb 5, 2016)

@compforce and I had a nice long talk today about this...  glad that my take on the minor warmth and the wound care protocols agree with the MDs on the board.  I suggested for the dressing that he move to Kerlix as the wrap, lighter and more air flow.

Now if he wasn't falling apart and turning into a mummy....:wall:


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## DA SWO (Feb 5, 2016)

Losing use of his hand is gonna cut his love life by 50%.



get better.


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## compforce (Feb 5, 2016)

DA SWO said:


> Losing use of his hand is gonna cut his love life by 50%.
> 
> 
> 
> get better.



*sigh*  I knew someone would go there.  I just didn't expect it to be you   Now I'm gonna have to get out all of my tall jokes (even though I've only got hearsay to go by).


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## policemedic (Feb 5, 2016)

Coming into this late, but your pics didn't show me anything I wouldn't expect to see at this stage. 

I completely agree that the warmth you're feeling is consistent with normal healing s/p a procedure like that. 

I'm happy you're getting it taken care of.


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