Severe mutilating injuries to the hand: guidelines for organizing the chaos.
Major hand injuries have become a rarity in Western countries. The fact that there are well trained teams devoted to their management, should not obscure the fact that the first emergency surgeon has the major role of setting the foundations for a reconstruction. Understanding the goal to be sought: the 'acceptable hand' (one with three fingers, with near normal length, near normal sensation and a functioning thumb), is hoped to be of great help in primary care. Preservation of vital structures such as joints, flexor tendons, and vessels, in the initial debridement, which will help to build this 'acceptable hand' are discussed. The general guidelines for management of finger amputation and soft tissue problems are also given.
del Piñal
Francisco
F
Unit of Hand-Wrist and Plastic Surgery, Hospital Mutua Montañesa, Spain. drpinal@drpinal.com
D000672:Amputation Stumps / Q000601:surgery; D000673:Amputation, Traumatic / Q000601:surgery*; D003286:Contracture / Q000517:prevention & control; D005383:Finger Injuries / Q000601:surgery; D005385:Fingers / Q000601:surgery; D006230:Hand Injuries / Q000145:classification / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008663:Metacarpus / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery