Massive hand crush: the role of a free muscle flap to obliterate the dead space and to clear deep infection.
Death of tissue and/or deep infection leading to amputation is not an uncommon course of events after massive crush injuries of the central part of the hand. Management of this injury faces the dual problem of having to carry out debridement in the central part of the hand which is radical enough to remove all dead tissue but which, in itself, creates a huge dead space in the depths of the wound. Inadequate debridement and/or leaving a dead space which fills with fluid and detritus behind the flexor tendons leads on to infection, devascularisation of the fingers and amputation. This paper presents the results of very radical debridement of the hand dorsal to the flexor tendons, including the intermetacarpal spaces, and filling the dead space with a well-vascularised free muscle flap in two hands which were referred in a pre-amputation stage, with one already being infected. Both hands were salvaged.
Del Piñal
F
F
Instituto de Cirugía Plástica y de la Mano, Private practice and Hospital Mutua Montañesa, Santander, Spain. drpinal@drpinal.com <drpinal@drpinal.com>
Pisani
D
D
García-Bernal
F J
FJ
Regalado
J
J
Del Pino
F J
FJ
Ayala
H
H
D000062:Accidents, Occupational; D000328:Adult; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000601:surgery*; D003646:Debridement; D005593:Fracture Fixation, Internal; D018460:Fractures, Comminuted / Q000175:diagnosis / Q000601:surgery*; D006225:Hand / Q000098:blood supply; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009336:Necrosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery; D013933:Thumb / Q000293:injuries / Q000601:surgery; D014680:Veins / Q000637:transplantation; D014946:Wound Infection / Q000175:diagnosis / Q000601:surgery*; D014954:Wrist Injuries / Q000175:diagnosis / Q000601:surgery*