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Corte no dedo: O que fazer?

Prof. Dr. Alvaro Cho, Cirurgia da Mão
Publicado em 19/07/2017 - Atualizado em 23/05/2019



Os ferimentos corto-contusos (FCC) nos dedos são um dos principais acidentes domésticos do dia-a-dia. Os cortes ocorrem nas mais variadas situações envolvendo facas, copos e louças quebradas.

Essas feridas costumam sangrar muito no momento do acidente, pois as mãos e os dedos são regiões muito vascularizadas. O recomendável, logo após o acidente, é lavar a ferida com água corrente e estancar o sangramento com um pano limpo pressionando a ferida. Deve-se evitar compressão circular excessiva devido ao risco de comprometer a circulação do dedo. Após essas medidas iniciais, o ideal é que o paciente procure um pronto-socorro de ortopedia para uma avaliação mais detalhada.

 

Todo corte é igual? É grave?

Nem todos os cortes são iguais. Depende muito da profundidade do corte e da localização.

O FCC ou corte pode comprometer somente a pele e o subcutâneo e nesta situação de menor gravidade, a limpeza cirúrgica sob anestesia local e a sutura de pele resolvem o problema.

Quando há perda de movimento do dedo após o corte, deve-se suspeitar de uma lesão tendínea. Se houver perda da capacidade de flexionar ou “dobrar"o dedo, o tendão flexor foi comprometido e o corte se localiza na face palmar do dedo.

Se houver perda da capacidade de extender ou “esticar"o dedo, o tendão extensor foi comprometido e o corte se localiza na face dorsal do dedo.

Um outro aspecto de fundamental importância é a avaliação da sensibilidade do dedo. Os nervos digitais dos dedos são frequentemente acometidos nos cortes de dedos e o sintoma típico é dormência numa das bordas dos dedos, associado a sensação de choques na região do corte. Cada dedo é suprido por 2 nervos digitais que são responsáveis pela sensibilidade das bordas radial e ulnar do dedo. Se o nervo digital radial for lesado, a borda radial do dedo ficará dormente. Se o nervo digital ulnar for lesado, a borda ulnar do dedo ficará dormente. Em cortes mais extensos, os 2 nervos podem ser lesados em conjunto com os tendões flexores.

Em suma, a gravidade do corte depende mais da profundidade e da localização do que o tamanho do corte em si. Cortes extensos de 2 a 3 cm podem ser superficiais e não comprometer nenhuma estrutura considerada mais nobre, enquanto que cortes puntiformes e profundos podem comprometer tendões e nervos importantes.

O que fazer em casos de lesão de tendão ou nervo? É urgente?

Na vigência de uma lesão de tendão ou nervo, o paciente deve ser encaminhado com urgência a um cirurgião de mão para avaliação e tratamento adequado das lesões. Se houver uma boa infra-estrutura hospitalar  no pronto-socorro e equipe de retaguarda disponível de cirurgia da mão, o paciente pode ser operado na urgência. Caso contrário, o melhor é lavar, suturar a ferida e imobilizar. O paciente deverá ser encaminhado dentro de 1 semana para agendamento da cirurgia definitiva: tenorrafia e microneurorrafia.

Um atraso demasiadamente prolongado (maior que 3 a 4 semanas) na avaliação e na cirurgia, pode comprometer o resultado final da movimentação e sensibilidade do dedo.

Um tendão flexor lesado tende a encurtar e entrar em contratura miostática. Além disso, o sistema de túneis ou polias pode estreitar e impedir a passagem do coto de tendão inchado.

Um nervo digital lesado também retraí e as bordas dos cotos lesados degeneram, criando um defeito de nervo muito grande para ser reparado de maneira direta. Nessa situação, a neurorrafia direta fica inviabilizada e um enxerto de nervo deve ser interposto para possibilitar a reparação do nervo. A utilização de um enxerto de nervo de interposição significa uma incisão cirúrgica a mais no paciente, além de provocar uma área de dormência numa outra parte do corpo onde a sensibilidade é menos importante que a sensibilidade do dedo lesado. Funcionaria como uma troca vantajosa para o paciente. Por esta razão, é preferível o reparo direto do nervo lesado sempre que possível.

Como é o pós-operatório? Precisa ficar imobilizado?

No período pós-operatório, o paciente permanece com a mão e os dedos imobilizados por uma tala ou órtese, por um período que varia de 2 a 6 semanas de acordo com a gravidade da lesão e as estruturas acometidas. Também é fundamental o início precoce da terapia ocupacional para reabilitação adequada do dedo comprometido.

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  677. Olá gostaria de saber o que eu faço cortei o dedo com a makita tomei oito pontos no momento antes de tomar os pontos senti o dedo dormente e já tirei os pontos e continua dormente bati raio x o médico falou que não atingiu nada e ainda está enxado e já tem 17 dias

  678. Ola gostaria de ter respostas cortei o dedo na mao levei dois pontos o medico mostrou-me o tendao dava para ver mas nao cortei ja passou um mes e doi e cada ves k eu dobro o dedo estala parece um clac o k podera ser vale a pena consultar novamente,ou ainda vai passar o medico quando tirei os pontos disse se daqui a quatro meses estalar consulte novamente mas eu aaxo muito tempo

  679. Tirei uma ferpa de madeira do meu dedo há quatro meses mais até hoje não sicratizou A carne fica saindo para fora gostaria de saber valores para cirurgia

  680. Cortei o tendão do indicador direito,não move a ponta do dedo,deve estar morto,fica roxo frio,quase gelado,a unha não caiu mas tá diferente, após a cirurgia até mão ficou pior o q fazer? exercício faço mas fico com dor o q fazer???

  681. Cortei meu dedo ao tentar pegar um prato q deixei cair. Ao se chocar na pia o prato quebrou e um vidro pontiagudo cravou no meu dedo na parte de dentro da mão. Não consigo nem mexer o dedo. Dói mto. Estou fazendo imersão em agua morna pq alivia. Será q atingiu o tendão ou algum nervo??? Dói mto mesmo. Sensação de cãimbra na ponta do dedo....

  682. Fui pegar algo atrás da geladeira onde em baixo da mesma é constituído de um metal que me cortou na hora tiver uma sensação de um choque no dedo indicador esquerdo porem não sei se realmente tive um choque da geladeira ou foi uma sensação do corte profundo que tive. , Mas percebi um dia após levar os cinco pontos a ponta desse dedo está meia dormente e acredito que não seja mas o efeito da anestesia, o que faço?

  683. Minha menina cortou o dedo na maquina de lava o dedo praticamente foi pendurado o médico deu 12 ponto já tem 15 dia e no local tem uma parte preta e normal como eu faço

  684. Olá Cortei meu dedo com uma faca e tive corte profundo, ja passei por cirurgia porém mao consigo flexionar meu dedo, e agora o médico irá me operar novamente, com o tempo será possível flexionar o dedo novamente???

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  687. Boa noite. Cortei meu dedo mínimo da mão direita há 20 anos e não consigo flexionar a primeira falange do dedo lesionado. A habilidade de toda a mão é afetada em atividades rotineiras. A pega da mão também não é tão firme, embora ainda possa segurar objetos razoavelmente. Sinto dor na mão do dedo lesionado após um tempo de atividade. Passa de um mero desconforto a dor em toda a mão e antebraço. A falta de movimento no dedo mínimo afeta realmente a habilidade dos demais dedos da mesma mão?

  688. Oi boa noite cortei meu dedo com uma faca no trabalho no outro dia esse dedo já estava avermelhado e inchado fui ao medico bati raio x e ele disse que não afetou nada agr já se passaram dez dia de antibiótico e o dedo só continua pior a infecção já esta tomando minha mao oq faço

  689. Boa noite tive um corte no polegar esquredo levei 4 pontos mas dois dia depois notei uma dormência no dedo. Após 9 dias tirei os pontos e continuou ,então marquei um ortopedista. Sendo q continua com a dormência e com choques e dor fui na emergência ortopédica então ele disse q precisa operar. Gostaria de saber como seria essa cirúrgica e o tempo de recuperação. Obgada

  690. Sofri uma lesão do meu tendão do pé, foi feita a cirurgia no mesmo dia, mas se passaram alguns meses e eu ainda não sinto o meu dedo, nem a pele por cima. Posso voltar a sentir novamente ?

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