[Therapy of soft tissue trauma in the acute phase of severe hand injuries].
BACKGROUND
Complex hand injuries are characterized by a combination of soft tissue injury and additional trauma to functional structures such as nerves, bones, tendons, vessels and joints. A good functional result requires the reconstruction of the injured structures and early mobilisation. Good vascularized soft tissue and stable osteosyntheses are the major prerequisites to avoid infections and to allow early mobilisation. The optimal timing for soft tissue reconstruction remains controversial with respect to the incidence of infections.


METHODS
We have evaluated retrospectively our series of complex hand injuries addressing the question whether a delay of soft tissue coverage for up to 72 hours causes significant increase of infection rates.


RESULTS
48 patients were treated with complex injuries of the hand within a three year period between December 1998 and December 2000. The lowest incidence of infections occurred in the group, where soft tissue coverage was completed as an emergency procedure.


CONCLUSIONS
Ideally primary reconstruction of complex hand injuries should be strived for to minimize scar formation as a result of secondary operations and further immobilisation periods. This includes, if necessary, free tissue transfer. Exceptions are situations where the vitality of soft remains uncertain. In these cases, definitive surgery is delayed for a maximum period of 72 hours.
Lassner
F
F
Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, RWTH Aachen.
Becker
M
M
Pallua
N
N
D000208:Acute Disease; D000328:Adult; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005593:Fracture Fixation, Internal; D006230:Hand Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007103:Immobilization; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps; D014946:Wound Infection / Q000000981:diagnostic imaging / Q000601:surgery