Andrew Undergoes Surgery!

A pantry door incident on Tuesday resulted in finger surgery and general anesthesia for five-year-old Andrew on Friday. It's sort of astounding the damage an interior door can do to a little finger.

In the aftermath of Andrew's finger getting closed in hinge-side of the pantry door, Joe and I looked at it and thought the top part (cuticle end) of his finger-nail had been ripped off. (Gruesome, I know.) The nurse on call that evening, based on our description of the injury, said to soak it in ice water and call the pediatrician in the morning. What we didn't realize through the mess is that it was actually the skin from the cuticle up toward the first knuckle that was raised (along with a bit of the nail in the area that would normally be under the cuticle). Let me just say, without getting too graphic, than when things are looking this bad, it's hard even for concerned parents to tell what's what.

Upon looking at Andrew's finger on Wednesday, the pediatrician advised us to just soak it in soapy water three times a day and re-bandage it each time, in order to prevent infection. He told us that Andrew would lose his whole nail, but that he had high hopes that it would grow back. Essentially, his advice was to do nothing other than basic cleaning and dressing changes.

Enter, on a white horse, Dr. Greg Latham (drum roll), my anesthesiologist brother at Johns Hopkins. My motherly intuition had told me something was not right. So I had emailed Greg a couple of gruesome close-up photos of Andrew's finger injury so we could get a second opinion. Upon reviewing the photos, Greg immediately contacted us and told us NOT to soak the finger, despite the pediatrician's recommendation. His concern was that if the nail matrix and/or nail bed had suffered damage, soaking would make matters much worse in terms of potential for future nail re-growth. It could also introduce infection. Meanwhile, he consulted with two surgeon colleagues, showing them the photos as well. When Greg got back to us, he reported that both surgeons felt that Andrew needed to be seen immediately by a specialist and would likely need surgery to give him any chance of ever growing a nail on that finger again someday.

On Thursday, two full days after the injury (time lapse due to our following the pediatrician's watch-and-wait approach), we had an appointment with a surgeon. It didn't take him more than two seconds of looking at the finger to tell us: Andrew definitely needs surgery. The nail matrix where nail growth originates had been seriously damaged and would not heal on its own, thus preventing any future nail growth. (Incidentally, they did x-rays and also found a small fracture.)

They were able to move their surgery schedule around a bit and get Andrew in on Friday morning (yesterday). To make a long story short, under general anesthesia they surgically removed what was left of Andrew's damaged nail, stitched the nail matrix to the nail bed in order to give a new nail the best chance of growing, cleaned up the nail bed, and replaced the old nail as a temporary cover (both to avoid infection and for cosmetic purposes). The expectation is that Andrew will soon start growing a new nail (underneath the old one), popping off the old nail as the new nail comes in about half-way (approximately three months from now).

The bottom line is that, had we followed the advice of our pediatrician (whom we've always trusted and respected), Andrew would have been left without a nail on his left ring-finger.

Interestingly, the hand surgeon who worked on Andrew told us that hand injuries are the most notoriously underestimated in terms of the need for specialized treatment by pediatricians and general practitioners.

The moral of the story: Trust your motherly intuition (and your brother!), and get a second opinion when you think it may be warranted.

As for Andrew, he'll be missing swimming, gymnastics, and contact sports (including light saber duels with his big brother) for a while. But all's well that ends well, and it looks like he'll heal very nicely.

And, yes, for those of you who are counting, that's two surgeries for the Leones in less than three months. (William had hernia surgery in the spring.) We made it more than twelve years with no Munchkin surgeries. I guess 2009 was our year for medical surprises. Let's hope the medical adventures are behind us for a while.