Approach to mutilating hand injuries

Abstract

Mutilating hand injuries are a challenge to manage due to the complex nature of the injury and the variety of structures that are damaged. Good results can only be achieved by careful planning and meticulous management. The ultimate desired outcome is achievement of a normal function of the hand and upper limb. Mutilating hand injuries occur in a variety of settings and the extent of injury and the prognosis varies according to the aetiology of the injury. The management approach focuses on the attention to the repair and reconstruction of individual parts of the hand including the bones, vessels, nerves, tendons and skin cover. Consistent results can be achieved by early aggressive management of damaged structures followed by regular physiotherapy which are the keystones for restoration of form and function of the mutilated hand.

Keywords: Hand injuries; Mangled hand; Mutilating.

Fig. 1

Showing a mutilated hand following a cracker blast injury with amputation of index finger and partial loss of middle finger, ring finger, little finger and thumb tip with unhealthy raw areas.

Fig. 2

A 32-year-old male suffered a sharp laceration across the palm with incomplete amputation of the thumb at the level of base of proximal phalanx.

Fig. 3

A fracture of the proximal phalanx of the middle finger being treated by open reduction and internal fixation by miniplating.

Fig. 4

A defect of the long flexor in the zone II region being reconstructed by a tendon graft in the little finger.

Fig. 5

A compound defect in the mid palm and distal wrist resurfaced by a free radial artery forearm flap.

Fig. 6

Early physiotherapy and rehabilitation helps in faster recovery.