A 30 year old vietnamese, working in a wood factory presented to A@E with alleged industrial injury. His left hand got stuck in a wood cutting machine, while working. Post-trauma, no LOC, no nausea and vomiting, no headache. But c/o left hand bleeding with severe pain and deformity. O/E, the left hand was totally crushed. 1st and 2nd finger totally gone and not viable. 3rd to 5th fingers viability questionable. Case was attended by Medical officer with me in the A@E itself. Patient’s BP was intially low, probably due to excessive bleeding, but then later responded to fluid resus. About 5 pints of Gelafundin was run.
This patient will need a hand microsurgery, which is not available in this hospital. He has to be referred to a hand microsurgeon which is about 3 hours journey from here. But another problem, since this patient is not a malaysian, a deposit of at least RM3000 is needed prior to surgery. My MO then consulted his employer regarding this option. As we expected, his employer is not keen to pay RM3000 for him, instead ask us to do wat we can for him.
So we planned a wound washout, wound debridement, K-wire insertion, and toilet and suturing under emergency GA, Keep In View Below Ankle Amputation if the 3rd to 5th fingers are not viable. consulted bout patient and his wife regarding this, and they signed the consent form.
So MO and me went in the surgery. Fortunately, his 3rd to 5th fingers were viable. So we did a wound washout, wound debridement, K-wire insertion and Toilet and suturing under GA. Patient was stable thoughout admission and discharge after 4 days.
Pre-surgery
Post-surgery
I do wonder, will he ever get back to work…. Will his employer give him any compensation…. the life of foreign worker in Malaysia is really a sad case…. Many more are like him….
One little mistake and he lost 2 fingers…. Thinking of this, sometimes I just give thanks to God for whatever I has. Having a full function limbs is already a blessing from God…
