Restorative Strategies for Bilateral Mutilated Hands in a Secondary Care Level: A Report of a Case in Mexico

Abstract

This case report aims to delineate the challenges and management strategies for a patient with bilateral mutilated hands within a secondary care level in Mexico, contributing to medical literature and potentially guiding future patient care. Mutilated hands represent a significant surgical and rehabilitative challenge due to the profound structural damage they cause, leading to considerable functional impairment and psychological distress. The complexity of these injuries necessitates a multidisciplinary approach, particularly in resource-constrained settings. We present a case of a 45-year-old male with no prior significant medical history who sustained bilateral mutilated hands from an industrial accident involving hot rollers. The patient underwent extensive surgical reconstruction and postoperative care, facing complications such as skin graft integration issues and infections, which required a multidisciplinary treatment approach.

Keywords: complex trauma; general trauma surgery; hand and cosmetic surgeon; hand surgeon; plastic and reconstructive surgery.

Figure 1. Initial presentation of left hand with a severe avulsion hand trauma.

Figure 2. Note the complex nature of the trauma with extensive tissue damage and visible bone fragments.

Figure 3. Preoperative X-ray, oblique projection of both hands.

The radiographic image demonstrates the traumatic amputations of the left hand involving loss of proximal, middle, and distal phalanges of the third, fourth, and fifth fingers, and the distal phalanx of the first finger.

Figure 4. Anteroposterior projection of both hands.

This radiographic image reveals the extensive injuries sustained to the right hand, including the loss of middle and distal phalanges of the second finger, and multiple fractures and skeletal disruptions consistent with a crushing mechanism of injury.

Figure 5. Intraoperative view before skin grafting.

Figure 6. Patient’s right hand following debridement.

The image shows extensive tissue damage with visible bone structures, indicative of the severity of the crush and avulsion injury. The preparation of the wound bed for grafting is critical to facilitate successful graft take and optimal functional recovery.

Figure 7. Initial postoperative condition of the skin graft on the right upper extremity following debridement.

Figure 8. This image illustrates the carefully planned and marked donor site on the patient's body, designated for harvesting skin grafts.

The markings indicate the precise area and dimensions of the skin to be excised for grafting purposes. Such planning is crucial to ensure that the size and shape of the harvested skin adequately cover the recipient site, which in this case is intended for a McGregor flap procedure.

Figure 9. Dr Aleman during the intraoperative preparation for the McGregor flap procedure.

The image displays the meticulous surgical technique employed in preparing the recipient site for a McGregor flap on a burn patient.

Figure 10. Postoperative view of McGregor flap and skin graft placement.

This image showcases the immediate postoperative results following the placement of a McGregor flap and skin graft. The flap is meticulously sutured in place, demonstrating the intricate technique required for such procedures. The skin graft, harvested from the predetermined donor site, has been secured over the area, initiating the process of integration and healing. This step is critical in reconstructive surgery, aiming to restore the function and appearance of the area affected by trauma or excision.

Figure 11. Healed surgical site after McGregor flap release.

Figure 12. This image captures the patient’s healed forearm after three months of flap release, undergoing twice-weekly outpatient follow-ups for wound care management.