The StoryPatient is a 42 y/o caucasian male, presented to the ED with an amputated left great toe. The patient states that he works at a metal sheeting plant and that while loading sheets into the press, his left foot got caught underneath one of the presses and cut off his left toe. The patient was wearing steel toed boots, but the force of the press was so great, that it sliced through the steel toe, and subsequently his left great toe. Digits 2-5 luckily remained intact.
Treatment
Patient tetanus status was undetermined, so tetanus immunization was administered.
Copious amounts of sterile saline was used to flush the wound. Attention was then directed to the left hallux. The proximal phalanx of the hallux was all that was left distally. A rongeur was used to trim back the proximal phalanx so that proper skin closure could be attained. The distal end was also filed so as to not have any sharp edges or boney spicules present. The skin was resected in a fashion that resembled a fish mouth incision, and adequate closure was then properly achieved. On a side note, this procedure took place within the trauma bay. Patient will return to clinic for follow up.
