Transcription:
Hand Infection

Evo Terra: Hand infections are actually quite common with multiple types and causes. Now, treatments can vary greatly and there can be long term implications from hand infections. Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra. My guest today is Dr. Gina Del Savio, Montefiore St. Luke's Cornwall, Chief Medical Officer and Orthopedic Hand Surgeon. Welcome to the show, Dr. Del Salvio.

Dr Gina Del Savio: Thank you so much for having me today.

Evo Terra: So last weekend, funny story, not all that uncommon for me. I burned my hand as I was attempting to and don't make too much fun of me. I was attempting to season a dish while it was in the oven. Not exactly my finest moment for sure. Luckily it get infected, but I mean, how common are stories like that, that then lead to hand infections?

Dr Gina Del Savio: Well, again, that kind of accent is so typical. You know, you're testing out the roast and seeing if it's done and burning yourself on those hot grills. So again, that's a superficial burn for most people. And certainly if it's not taken care of properly, it can indeed lead into an infection. Burn infections can be usually superficial but extremely painful when you have an infection on top of a burn. So for something like that, I'm guessing that you probably ran it under some cold water. Maybe you washed it up with a little bit of soap and water, which is all the right thing to do.

And then of course, the question would become, do you apply an ointment to it? And again, if you have a weeping burn wound using a topical antibiotic ointment is usually very helpful and usually your pharmacist can guide you if you show up and you show them what your hand looks like with this burn, they can guide you to the appropriate ointment for that type of burn.

Evo Terra: Yeah. that's good. Luckily I didn't break any of your skin. In fact, I didn't even know it was burning until like two days later when I saw the little scar appear. So I think I survived it because I had a superficial one, but I know that burns can be much worse than superficial. Right?

Dr Gina Del Savio: They certainly can and certainly if there is an open wound associated with the burn. Probably the best thing to do at that point is to go to either an urgent care or an emergency room, really depending on the size of the burn as to where you want to go. When we talk about burns, what happens is, is they will heal with scar tissue. So if you have a burn that is circumferential. Let's just pretend for a moment that you fell into the fire. You're roasting marshmallows with your grandkids and you fell into the fire.

And when you pulled your hand out, you actually now had burns that extended from your fingertips up to the level of your wrist on both sides of your hands and fingers. That can actually be a really dangerous injury, not so much from an infection perspective, but from a swelling perspective. So certainly with burns, if you have that kind of severity, you would wanna make a trip to an emergency room. But other kinds of infections are those that are deeper again, things that can happen around your house.

Let's pretend for a moment that you were cutting up the chicken with that lovely sharp boning knife and you managed to puncture your hand. That can be a puncture wound. Perhaps you're in your garden and you're working in the bushes and you have a thorn penetrate your finger. Those are kind of, dangerous wounds as well because they're puncture wounds and because they're puncture wounds, they're really difficult to clean out. But again, with a puncture wound, what you wanna do is make sure that you use soap and water, warm water very, very thoroughly to clean the area.

And then assess if that puncture wound went any deeper than maybe a couple of millimeters or a quarter of an inch. And you don't think that? Adequately clean it out in your sink. That also is worth a trip to an urgent care center where they can maybe numb it up with some form of lidocaine or Marcaine, which fall into the family of Novacan, and then really get in there maybe with a small catheter and really clean out that deep puncture wound. Sometimes those wounds do require some antibiotic coverage as well, but again, someone in an urgent care can make that decision for you.

Evo Terra: Okay. Beyond puncture wounds, I mean, obviously there's the standard laceration wound, right?

Dr Gina Del Savio: Absolutely, you're working on your car and you slide your hand across the back of your hand across something sharp and metal inside the engine. Once again, when we have these kinds of wounds, there's two components to it. There's one, Oh my gosh, how dirty was that thing that we just went through my skin? But then of course there's, Right, but then of course there's the other component of, Oh my gosh, do I actually need stitch?

So it is super duper important to understand that when you have a deeper wound, right, it is open and you're looking at it and you're thinking to yourself, I'm no doctor, but I think that might require stitches. If you are having that thought, it's absolutely worthwhile to visit an urgent care center or an emergency department for a couple of reasons. One is it's gonna be hard for you to clean out that wound adequately. So go let a professional do it for you.

Two, if it's deep enough, you may actually need a dose of intravenous antibiotics and maybe your prescription for oral antibiotics. Again, also, depending on what type of injury it was. Did this happen off of a lawnmower blade that's covered by all kinds of, we don't, I don't even know what kinds of stuff. It's on that lawnmower blade, right? Or did you do it with the butcher knife that you just finished cleaning with soap and water? So again, an emergency room or an urgent care can help you with that.

And then three, make a decision as to whether or not the wound warrant having any stitches, steri strips, or skin glue applied without increasing your risk of infection. Because the one thing we worry about with hand infections is if you close up a wound inappropriately, you can actually get an infection. It's one of those reasons why if you cut yourself today at 11 o'clock at night, and let's say you just have, Well, I'll just wait till tomorrow morning before I go to the emergency department. They're not gonna sell it closed.

Standard rule is if we're going to sew closed a wound, we wanna do that usually within four hours of the injury. And if you show up after four hours, we'll clean it, we'll dress it, we're probably not gonna close it for you. And that's not a big deal, but it can lead to an uglier scar than you might otherwise have had.

Evo Terra: Yeah. Yeah. So early, is a better thing than later.

Dr Gina Del Savio: Absolutely. And then of course there's always things like animal bites, which again, it depends on what kind of animal. If you get bitten by a dog, not to put down any kind of dog, but they tend to be rough and tumble creatures. And when they bite you, the wounds aren't necessarily deep, but they're rather jagged and they drag and they'll open up your skin and they can leave sort of. Ugly looking wounds. The good news is that those wounds tend to be slightly more superficial.

You should still absolutely go to an emergency department so that they can wash that out. Now, before you leave your house again, if you can wash out with some soap and water, maybe pour some peroxide over it. But then get yourself to an emergency department where they can clean that out really thoroughly, and you absolutely will require a dose of intravenous antibiotics as well as oral antibiotics, because we all know dogs mouths are not clean. Right. And then the second part of that is that different animals, including humans and cats, have different risks.

So for instance, a cat. If a cat bites you, well that's like their teeth are like little syringes. And that goes back to the idea of a puncture wound. For a cat bite, you must go to an emergency department. Why? There is bacteria, really bad bacteria, deep underneath your skin and knowledge you need an emergency department to flush that out with a catheter. You absolutely, again, will require antibiotic coverage. Neglected cat bites, give some of the worst infections as a hand surgeon that I ever see. So really important not to ignore it, just because, Oh, it looks like it's a tiny little hole. Well, yeah, but it's deep and you can't clean it out.

So come to us and let us take care of that for you and prevent that from. And then the other kind of animal bite, unfortunately is the human bite. and I don't mean somebody bit you, I mean, perhaps you got in an altercation and maybe per chance by accident, your hand hit them in the mouth and their tooth cut you. Right? We call those fight bites, right? Fight bites. And human mouths really are even dirtier than cats and dogs. So again, If by accident you have sustained a wound somewhere on your body and it's a result of human teeth again, once again, very important that you get yourself to an emergency department or an urgent care. One, for it to be cleaned out and two, for treatment with antibiotics.

Evo Terra: Hmm. all good advice. So you are an orthopedic hand surgeon. When do you get involved? People who didn't follow the simple, straightforward rules you just put forth today?

Dr Gina Del Savio: Yeah. And then that's why this talk is on infections, because that's unfortunate. I sometimes will get called for folks who have a fresh abrasion, if there's tendons that have been damaged, nerves that have been damaged, bones that have been damaged. And then I'll have to step in and immediately. But oftentimes for these wounds that we just discussed, I get called because someone didn't actually get to an emergency room or an urgent care for care, or they did, but they still, even despite doing all the right things, still ended up with an infection.

And that's where I, as a hand surgeon will then step in. Why? Well, some infections require just some intravenous antibiotics. Those are called cellulitis type infections, and that's where there's no puss, there's redness, there's warmth, there's heat, there's tenderness. There's pain with motion, but there's no actual puss that usually can be managed with some long term intravenous antibiotics, but I usually get to hear about it the. The more urgent patients are those patients who come in and they do have puss, right?

That tooth, that thorn, that automobile part, that penetrated your skin, left behind some germs, and you now have a pocket of puss, like an internal pimple almost, where that infection has set up, and there's no amount of antibiotics in the world that will make pus go away. That has to be physically, mechanically washed out. And again, as a hand surgeon, that's where I get involved, those pockets of puss. Now, sometimes those pockets are superficial, like just underneath your skin, and we can sometimes do that in an operating room, but it's a fairly straightforward process.

Other times, think about the hand, think about the meat in the palm of your hand. If something like a thorn or a cat tooth goes deep enough that bacteria is now near your arteries, your nerves, your at tendon, or even deep within the muscle itself. That can lead to very extensive procedures where sometimes you'll need to be admitted to the hospital for intravenous antibiotics and multiple washouts because that infection has lots of little nooks and crannies to get into, if that infection has taken place and set root deep inside, particularly on the palm side of your hand.

Evo Terra: Yeah, let's try and avoid that at all costs.

Dr Gina Del Savio: Absolutely. Absolutely. And I think for people you know out there, if you're wondering whether or not you should go to an emergency department, if indeed you have warmth or redness over a sight of any penetrating wound, Immediately go to the emergency department. Hopefully you're catching something early, maybe in the cellulitis phase, and it can be treated with just some antibiotics. But what you certainly don't wanna do is play the weight and see, because the weight and see can lead to these more significant infections, which can then require not small surgeries, but actually pretty big surgeries and sometimes multiple surgeries.

Not only can that lead to significant. But the puss itself is actually quite toxic. And it can damage your tendons. It can damage your nerves, it can damage the tendons, and that can lead you with some permanent deficits even after the infection itself is resolved.

Evo Terra: Absolutely. Is there anything else we should cover that we didn't? We did a lot and we've covered a lot. I'm good, but if there's something else you want to ask you, I'm happy to do it.

Dr Gina Del Savio: So I think that there are other signs of infection that you shouldn't ignore. Things like seeing a red streak up your arm. If you see a red streak running up your arm, that usually signifies that you have a pretty significant infection and that's not gonna be managed with some antibiotics for mouth. So if you're heading off to a place to be treated, probably should choose an emergency department because you're most likely going to need to be admitted to the hospital for intravenous antibiotics. I'd also warn my neighbors who have any underlying conditions which make them vulnerable to infections.

So let's say you're on some sort of Prednisone or some other drug for rheumatoid arthritis, or for your asthma or for poison ivy, if you are on some sort of steroid medication, it renders you very vulnerable to getting these infections. Same if you're a diabetic and your sugars aren't well controlled, so people who are vulnerable to getting infections be super duper aggressive about getting early treatment for your infections. Please don't wait because again, those infections can escalate very, very rapidly and have pretty significant consequences.

Evo Terra: Excellent advice, Dr. Del Salvio. Thanks for all the information.

Dr Gina Del Savio: Thank you. It's always a pleasure speaking with the teams about these medical conditions. Hopefully somebody out there will hear this and, we can avoid any serious consequences from their infection.

Evo Terra: And once again, that was Dr. Gina Del Salvio, Montefiore St. Luke's Cornwall, Chief Medical Officer and Orthopedic Hand Surgeon. Thank you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. For more information, please visit montefioreslc c.org. That's M O N T E F I O R E S L C.org. I have been your host, Evo Terra. Please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts Be well.