SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 172

Stiffness persisting for more than two to three weeks in a muscle that has been severely
bruisedmayheraldtheonsetofcalciumdepositionintheinjuredtissue.Rarely,thisprocess
cancontinueuntiltheentireclothasbeentransformedintobone—uptoayear.Theamount
of muscle damage varies and is sometimes significant, so the condition should be recog-
nized and treated to minimize disability.
Wounds of the Hands and Feet
Woundsofthehandsandfeetareofspecialimportancebecausethesestructuresareana-
tomically complex. All wounds in these areas must be thoroughly cleaned, but no tissue
should be trimmed away unless it is unmistakably dead. If fingers or toes are enclosed in a
large bandage, they must be separated by gauze to prevent maceration of the skin from the
dampness produced by perspiration. Such bandages should splint the hand in the “position
of function,” which is the position the hand takes when holding a pencil ( Figs. 12-2 and
12-3 ) .
Figure 12-2. “Position of function” of the hand
Thecolorandsensationinthefingertipsmustbecheckedfrequentlytoensuretheband-
age is not too tight. For severe injuries, antibiotic therapy should be instituted at the time
of injury and evacuation begun immediately.
Ring Removal
For any hand injury, rings should be removed immediately to prevent circulatory prob-
lems in the fingers. With the “thread technique,” rings often can be removed from a some-
what swollen finger. The technique works well with fine fishing line, dental floss, or a fine
nylon thread extracted from a climbing rope. The more slippery the thread, the easier is re-
moving the ring.
One end of a 50- to 70-cm-long thread should be inserted carefully under the ring (per-
haps with a knife blade) with the long end in the direction of the fingertip. The ring should
be pulled toward the knuckle as far as it goes and the thread should be slowly wound
around the finger including the knuckle. The thread must be wrapped carefully with each
layer touching the next one. The procedure may hurt a bit and the finger may become blue.
When the thread is completely wrapped, the end of the thread near the hand should be
pulledslowlyandfirmlywhileholdingtheendofthethreadnearthefingertip.Byunrolling