Current Principles in the Management of a Mangled Hand

Abstract

Mangled upper-extremity injuries can have devastating consequences for the patient. The goal of treatment was to recreate a functional hand with a minimum of three sensitive and opposable fingers to achieve an acceptable quality of life. Early management of injuries is critical to treatment success. Initial assessment begins in the emergency department where the injury is quantified and the amputated segments are evaluated, particularly the possibility of replanting them or using them as spare parts as tissue bank. In the operating room, careful debridement is essential for any reconstruction. Despite advances in reconstructive techniques, the management of these injuries is a challenge for the surgeon. The main treatment guidelines and a step-by-step approach to the mangled hand are presented to achieve acceptable results.

Keywords: Mangled hand; Reconstructive microsurgery; Replantation; Revascularization.

Figure 1

A Clinical presentation of crush injury on the metacarpophalangeal joint of a left hand, B radiologic aspect of the lesion, C bone cement spacer used to keep the space in the fourth MP joint for a possible secondary reconstruction and was impossible the synthesis of the metacarpal head, D x-ray at the end of surgery with synthesis of fractures, E secondary reconstruction with an endoprosthesis of the head of the fourth metacarpal on the place of the cement “spacer,” and F, G clinical result with a good flexion of all MP joints. MP, metacarpophalangeal.

Figure 2

A Clinical preoperative presentation, B radiologic preoperative view, C clinical immediate postoperative static result (thumb reconstruction using ring finger used as sparing part; reduction and fixation of middle finger with longitudinal K-wires; avoiding reconstruction of the little finger), D clinical 6 months postoperative static result (radial forearm flap for volar surface of middle finger), E radiologic 6 months postoperative view, and F functional 6 months postoperative two fingers pinch.