What's Next for Jason Pierre-Paul?

A look at the early stages of what may be a very long and difficult recovery for Jason Pierre-Paul

pierre-paul has finger amputated, skin graft

UPDATE: Shortly after I published this feature, Adam Schefter posted images from Jason-Pierre-Paul's medical record. They showed Pierre-Paul underwent amputation of his right index finger and had a skin graft to his lower right forearm. Multiple media members have since confirmed the amputation.

As discussed below, despite avoiding traumatic amputation at the time of the injury, the length of time Pierre-Paul has been in the hospital and reports of extensive burns to his hand suggested a very severe injury. The decision to have the amputation -- which included his entire finger and knuckle -- was reportedly Pierre-Paul's and done to accelerate his recovery time. That suggests his index finger may have been damaged so badly that grafting wasn't an acceptable option. 

The amputation, which will end worries about infection (though any post-surgical wound can be infected), scarring, contracture, loss of function in the remaining tissue of the finger, doesn't mean Pierre-Paul is completely out of the woods, however. The image from the operating room schedule also shows Pierre-Paul had a skin graft to the lower part of his right arm today. It's possible he's had other grafts already or will need them shortly.

UPDATE #2: Late Wednesday evening, Ed Werder reported Pierre-Paul has multiple thumb fractures (again, not a surprise given the severity of the blast injury) and has undergone multiple surgeries.

Please read on for my earlier thoughts on Pierre-Paul's rehab and recovery...

Details are limited on Jason Pierre-Paul’s hand injury, but Dan Graziano and Adam Schefter reported that Pierre-Paul suffered burns to his palm and three fingers after a fireworks accident on July 4. Initially, the tone on Twitter was one of relief that Pierre-Paul didn’t lose his hand or any fingers.

Though Pierre-Paul has yet to allow anyone connected with the team to visit him in the hospital, the consensus among media members is that the injury will not be career-threatening. That may prove true, but it’s too soon to know how much Pierre-Paul will be affected by his injury.

While Pierre-Paul may have avoided a traumatic amputation of his fingers or hand, burns to the palm and fingers – especially those necessitating a multiple day hospitalization – can be devastating to hand function.

Burns and explosive injuries to the hand are troublesome for lots of reasons.

why pierre-paul's injury is significant despite no loss of fingers

The muscles, tendons, nerves, and joint capsules of the hand are protected by a layer of skin but not much else. Any loss of skin and flesh exposes those structures, all of which are specific and critical to control the fine motor function of each finger and hand. The blast and burn injury to Pierre-Paul’s fingers and palm may have irreparably damaged any of those structures or fully exposed them.

It’s no surprise that Pierre-Paul remains in the hospital four days after his injury. Fireworks injuries are rarely clean, stitch, and splint situations. The wounds have to be carefully debrided – that is, cleaning out any debris and removing tissue that hasn’t or will not survive the injury. Often, these wounds must be debrided more than once. The medical team has to monitor the injury closely for signs of infection and for swelling which can cut off blood supply to healthy tissue.

Skin grafting or moving flaps of skin over the open wounds is done as early as possible, but cannot be done until the wound is free from any dead tissue or infection. The sooner skin grafting is done, the better, but surgeons have to be certain the area is ready to accept the graft.

Grafts heal remarkably quickly. They often regenerate blood supply within seven days. But successful grafting is only the first phase of healing. Injuries like Pierre-Paul’s often shrink or contract in time as the wounds scar. Such contractures and scarring are particularly tough around the palm. But any contractures around the joints of the fingers will affect the ultimate function of the hand. Splinting, special gloves, and early physical therapy may limit the extent of the scarring, but are unlikely to prevent it entirely.

Without knowing the severity of Pierre-Paul’s injury, it’s hard to know how extensive his treatment has been. But four days in the hospital – and his unwillingness to allow the team to see the full extent of his injury with an ongoing contract situation – is telling. And Jason Cole of Bleacher Report reported two days after the injury that Pierre-Paul would need skin grafts.

can pierre-paul recover?

While it’s entirely my own speculation, it seems likely that Pierre-Paul’s injury was bad enough to require debridement and grafting. At minimum, such an injury will require multiple weeks of recovery, splinting, and rehab. There’s very little chance he’ll be ready until the later stages of training camp. Cole also reported the Giants are considering putting Pierre-Paul on the NFI list, which would keep him out of action for at least six weeks of the regular season.

Unfortunately, there’s no guarantee Pierre-Paul will be recover to near baseline function. Though I saw multiple tweets suggesting hand injuries weren’t as devastating to pass rushers as skill position players, don’t minimize the importance of hand use to a defensive end. Engaging the offensive line, shedding blocks, and ripping and swimming in pass rush all require strong and flexible hands. There's a good argument that strong, heavy hands are as important as an explosive first step for a pass rusher.

Pierre-Paul may recover well enough to handle those tasks – or play with a splint fashioned to allow him to do so. Hopefully, he’ll recover quickly and fully, but there’s likely still a long road ahead.

I'll have more on Pierre-Paul as more details emerge.

IDP implications

If Pierre-Paul isn't ready for the regular season -- and I think it's likely he won't be -- the Giants lose a vital member of their pass rush. Damontre Moore has yet to prove himself a capable two-way player, but will be forced to take more base defensive snaps. Robert Ayers flashed last season, but the Giants undoubtedly hoped he'd be a rotational player again this year. Rookie Owa Odighizuwa has lots of promise, but rookie defensive linemen require lots of developmental time. There has also been talk the Giants could use Cullen Jenkins outside on base downs. There are options for New York, but no clear replacement for their pass rush. That may also affect the secondary. Fantasy owners should move on Moore (high variance DL2) and Ayers (high floor DL2) now and watch the early camp notes on Odighizuwa closely.

Check back for more injury analysis throughout training camp and the regular season. Also, follow on Twitter @JeneBramel for breaking injury news, commentary and analysis of this injury and others around the NFL.

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