title: Current guidelines for management of severe hand injuries.
abstract: BACKGROUND
  Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite investing significant funds in their management these injuries often exclude young people from professional life. It is often due to improper management conducted by untrained personnel lacking appropriate instruments. The goal of this work is to review the literature on the problem and attempt to organize this information.
  
  
  METHODS
  A review of available literature on mutilating hand trauma, amputations in the hand region, replantation and scales used for assessment of the severity of injury and hand function, both in Poland and internationally.
  
  
  RESULTS
  Hand injuries may be managed through three approaches: concomitant definitive, delayed and secondary. The best results are achieved through the first approach. However sometimes, due to the character of injury or lack of trained personnel, the team is forced to apply temporary dressing and, subsequently, initiate complex further management. HISS scale is a useful tool allowing for precise determination of the severity of injury and, used together with DASH questionnaire, prediction of long-term treatment outcome.
  
  
  CONCLUSIONS
  Necessary changes need to be implemented in the healthcare system in order to achieve better results of treatment of severe hand injuries. Proper guidelines for everyday practice should be also introduced. Changes should encompass precise determination of competences of individual centers as well as the mode and indications for patient transport between them. Training of doctors should be modified in such way to ensure that at least one person in each center would be capable of performing proper immediate management of such injuries, making further treatment possible. At the same time, financing, as a strong motivator, should promote appropriate management.
authors.affiliation: Department of Orthopedics and Traumatology of the Locomotor System, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Stępień
authors.affiliation: Department of Orthopedics and Traumatology of the Locomotor System, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Szczęsny
mesh_terms: D000671:Amputation, Surgical; D006225:Hand / Q000601:surgery; D006230:Hand Injuries / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D012092:Replantation; D015599:Trauma Severity Indices