Severe hand injuries in children related to farm tractors: a report of 70 cases.
BACKGROUND
The purpose of this study was to review tractor-related childhood hand injuries.


METHODS
Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits.


RESULTS
The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed.


CONCLUSIONS
The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries.
Ozgenel
Güzin Yeşim
GY
Department of Plastic and Reconstructive Surgery, Medicine Faculty of Uludağ University, Bursa, Turkey. gozgenel@yahoo.com
Akin
Selçuk
S
Ozbek
Serhat
S
Kahveci
Ramazan
R
Ozcan
Mesut
M
D000383:Agriculture / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006230:Hand Injuries / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D015541:Off-Road Motor Vehicles; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome