A cutlass wound to the forearm can be devastating.
A young man presented to BMC after sustaining a deep laceration to his left dorsal wrist – evidence of trying to defend his head from being chopped by the cutlass. As we examined the wound, we realized that he had no ability to extend (straighten) his fingers on that hand. His ability to flex (bend) the fingers was preserved.
I brought him to the operating room – along with a detailed anatomy book to help me find all the tendons that had been sliced. Much of the time was spent trying to identify each end of the severed tendons. I found 9 – both ends. Keeping track of each end is not easy. I used a small hemostat clamp on each one that I identified.
Once I was confident that I had successfully identified each tendon and its mate, I began to sew them together. Starting with the deeper tendons, I sewed the tendons with permanent sutures in a way that wouldn’t allow the sutures to rip out with the slightest tension. Once all tendons were together and the wound was closed, I made a splint that kept his wrist cocked up while the tendons healed.
After several weeks, the wound was completely healed and the splint was removed. While the movements were still somewhat weak, both the patient and I were very happy with the final results of a functioning hand.
