Principles of management of open wounds of the hand

Abstract

The principles of care of open wounds have developed from an appreciation of the factors dealing with wound healing and from a knowledge of the source of wound contaminants. The introduction of chemotherapeutic drugs and of the antibiotics have not altered the principles of wound care. These general principles of care are: (1) Immediate and continuous protection from contaminants; (2) primary surgical care at the earliest moment; (3) mechanical cleansing of the wound ; (4) surgical excision of devitalized tissue; (5) careful hemostasis; (6) anatomic restoration of the tissues; (7) closure of the wound; (8) compression dressing; (9) putting the part at rest and (10) elevation. Specific principles, in addition to the above, apply to the hand because of technical and functional considerations. These are: (1) General anesthesia for all but the simplest procedures; (2) bloodless field secured by bloodpressure apparatus; (3) save all viable skin tags; (4) save all possible finger length; (5) tendon repair only in suitable wounds; (6) nerve repair in all wounds; (7) splint the hand in position of function except following nerve and tendon repair and (8) functionally, the hand is a grasping, pinching, sensory end organ.