Classification and sequential management of hand avulsion injuries

Abstract

objective To introduce classification of avulsion injuries of the hand and the treatment methods. Methods Based on conditions of the injury and various surgical treatment options, avulsion injuries of hand were classified into six types. Corresponding to different injury types, we proposed the concept of sequential management. Type specific measures were taken including segmental blood vessel repair, alternating debridement, limited closure and fixation, localized pressing dressing and sporadic draining. Results A total of 144 eases were treated. Follow-up period was over 10 years in 49 cases. 5 years in 42 cases, 3 years in 24 cases, 1 year in 20 cases and 9 months in 5 cases. Among 15 cases of total avulsion of the hand, only one had partial necrosis at the dorsum of the hand that required secondary skin graft and partial necrosis of the little finger that led to amputation. In the rest cases the avulsed hand or fingers all survived. The appearance of the skin was satisfactory and hand function as good. Conclusion The 6 type classification of hand avulsion injuries is practical in clinical situation. Sequential management based on the classification facilitates timely salvage of the soft tissues. The key techniques solved the difficult problems in surgical treatment of hand avulsion injuries. The relevant assisting measures increased survival area of avulsed skin. Therefore. this strategy opens a new venue for treatment of the avulsion injury of the hand. Key words: Hand injuries; Treatment outcome; Hand degloving injuries