Any laceration of the hand has the potential to damage the nerves and tendons. In cases of suspected tendon lacerations, it is usually recommended to explore the wound and check the integrity of the tendon by direct visualisation.
If a tendon has been lacerated, direct repair is often possible. Following suturing of a tendon, recovery can take a while - it takes at least 12 weeks for a tendon to heal after a repair.
During the first six-week period, most patients are splinted full-time to prevent stretching at the repair site. It may take an extended period to regain smooth movement of the tendon and joints affected. Hand therapy is a very important part of rehabilitation following tendon repair surgery.
Unfortunately, many patients present with deep lacerations to their hands. Often, they will have damaged deep structures such as nerves of tendons. If there is any suspicion that a laceration extends deeply, an exploration in the operating theatre is often recommended.
The best way of assessing the integrity of the nerves and tendons is to explore the wound and view the structures directly.
Surgery for deep laceration
Once a nerve has been cut, the patient may lose sensation in the area supplied by the nerve. The aim of surgery is to reconnect the nerve tube, through which the nerve cell grows. Once the nerve cell has been cut, the distal (the furthest from the body) end of the nerve will die back.
It is very important to reconnect the nerve ends to each other so there is a pathway for the regenerating nerve to grow along. The process of nerve recovery is very slow. Following surgery, the region may require a period wearing a splint to protect the repair.
The recovery in sensation however can take many months and it may even be up to two years before the final outcome is achieved. If a nerve has been cut that supplies muscle function, this may result in weakness and wasting of the muscles.
If a nerve has been lacerated and the patient chooses not to have a repair, there is very little chance of recovery.