Frequently patients present to the Emergency Department for lacerations, partial amputations, and abscesses of the fingers. After repairing the wound or injury, however, a bandage can be a bit unwieldy to apply and difficult to secure. To me, an ugly bandage just seems to detract from all of the diligent work that you just put into a plastic surgeon-quality wound repair.
What's my solution?A soft, cotton tubular gauze is widely available commercially. It often comes with a commercially available gauze applicator instrument. However, if your ED is like mine at SF General, anything small, portable, and NOT bolted to something heavy and unappealing will disappear before you can say "abracadabra ". Thus the tubular gauze applicator is often missing.
As an alternative, our creative nurse practitioner Tina King, devised what I like to call the DIGI-SPECULUM. I use a plastic pelvic speculum, which is always available in the ED. After loading the tubular gauze on the speculum, 3-5 layers of the gauze can be applied. Be sure to twist the gauze a few revolutions just beyond the tip of the finger when applying layers to help secure the gauze in place. Tie the bandage in place at the wrist, after cutting the remaining tubular gauze longitudinally to generate 2 tails.
This photo was from my shift last night of a patient with a small thumb avulsion which kept oozing blood because of the vascularity of the nail bed. The bandage helped apply strong direct pressure over the wound to achieve hemostasis. He chuckled at our Digi-Spec.Warning: Be careful of applying this circumferential bandage on patients with an underlying sensory neuropathy of the digit. There are very rare case reports of digital necrosis from such bandaging in patients who can't tell you that there's more pain from tissue ischemia.
Pearl: Be sure to twist the gauze only when beyond the finger tip rather than at an area overlying the finger (to avoid a tourniquet effect). Also, be sure that the dressing is not too tight before discharging the patient.
