Severe Hand Injuries Research Articles

Informe sobre el trasplante de 250 dedos del pie a la mano consecutivos. Indicaciones, resultados, fracasos y nuevas aplicaciones

Purpose Toe-to-hand transfers are an essential part of hand rehabilitation after loss of a finger. Despite this, the likelihood of failure and the hypothetical morbidity in the donor area, made this procedure not very popular among surgeons. The purpose of this paper is to present our clinical experience, highlighting the pitfalls and the new indications. Material and methods Between February 1995-January 2010 we performed 250 toe-to-hand transfers for finger amputations. In metacarpal hands (23 cases) we transferred the hallux from one foot and the 2nd and 3rd from the other, to achieve a three-fingered (tripod) grasp. The rest of the patients had multi-digital, simple or partial amputations. In 69 the thumb was reconstructed and the rest of transfers were for finger reconstructions. Results Re-operation rate due to acute ischaemia was 16% (10% intraoperative) and the overall success rate was 98.8% (3 failures). There was no partial necrosis in any case. Regarding the donor side, one patient was operated on due to a painful neuroma; the rest did not have complaints in the donor area. Conclusions In our experience toe-to hand transfers are a safe and reliable method to rehabilitate severe hand injuries. Donor site morbidity is directly related to the number of toes harvested, and is well-tolerated by the patients, especially in severe injuries.

Report on 250 consecutive toe to finger transplants. Indications, results, failures, and new applications

Purpose Toe-to-hand transfers are an essential part of hand rehabilitation after loss of a finger. Despite this, the likelihood of failure and the hypothetical morbidity in the donor area, made this procedure not very popular among surgeons. The purpose of this paper is to present our clinical experience, highlighting the pitfalls and the new indications. Material and methods Between February 1995-January 2010 we performed 250 toe-tohand transfers for finger amputations. In metacarpal hands (23 cases) we transferred the hallux from one foot and the 2nd and 3rd from the other, to achieve a three-fingered (tripod) grasp. The rest of the patients had multi-digit, simple or partial amputations. In 69 the thumb was reconstructed and the rest of transfers were for finger reconstructions. Results Re-operation rate due to acute ischaemia was 16% (10% intraoperative) and the overall success rate was 98.8% (3 failures). There was no partial necrosis in any case. Regarding the donor side, one patient was operated on due to a painful neuroma; the rest did not have complaints in the donor area. Conclusions In our experience toe-to hand transfers are a safe and reliable method to rehabilitate severe hand injuries. Donor site morbidity is directly related to the number of toes harvested, and is well-tolerated by the patients, especially in severe injuries.

Severe hand injuries resulting from Samurai sword assaults: a Dublin case series

Severe hand injuries resulting from Samurai sword assaults: a Dublin case series

Algorithmen zur Versorgung komplexer Handverletzungen

The primary treatment strongly influences the course and prognosis of hand injuries. Complex injuries which compromise functional recovery are especially challenging. Despite an apparently unlimited number of injury patterns it is possible to develop strategies which facilitate a standardized approach to operative treatment. In this situation algorithms can be important guidelines for a rational approach. The following algorithms have been proven in the treatment of complex injuries of the hand by our own experience. They were modified according to the current literature and refer to prehospital care, emergency room management, basic strategy in general and reconstruction of bone and joints, vessels, nerves, tendons and soft tissue coverage in detail. Algorithms facilitate the treatment of severe hand injuries. Applying simple yes/no decisions complex injury patterns are split into distinct partial problems which can be managed step by step.

Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury - can sense of coherence be an indicator for rehabilitation focus?

BackgroundOur objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence.MethodsA postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed.ResultsAlmost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations.ConclusionsSOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus.

Survey and analysis of the pain status in the patients of emergent hand injury

Objective To learn the pain status in the patients of emergent hand injury and analyze the relative factors which influenced the pain. Methods A total of 210 patients of emergent hand injury were investigated with short McGill pain questionnaire and anxious status scale. Results The VAS at the injury happened and at the visit in 210 emergent hand injury patients were (4.87±2.42 ) and (4.70±2.31 ). During the visit, the PRI was ( 3.34±2.35 ), feeling PRI was ( 3.17±2.26 ), emotional PRI was (0. 17±0.67 ),PPI was (2.80±0.26) ,The variance analysis found the VAS of patients had different degree injury in the past had different VAS of this visit ( F=2. 29, P < 0. 05 ). Relative analysis found the severity of this hand injury ( r = 0. 262, P < 0. 01 ) and the S-AI of this visit ( r = 0.390, P < 0.01 ) had positive correlation with the VAS of this visit. The education ( r = - 0. 172, P < 0. 05 ) had negative correlation with the VAS. Conclusions The pain in the patients of emergent hand injury was medium, releasing the anxiety of the patients at the visit could reduce the pain at that time. Key words: Hand injury; Pain; Relative factors

Patterns of work-related traumatic hand injury among hospitalised workers in the People's Republic of China

ObjectivesThis study describes the type, location and severity of work-related acute traumatic hand injuries of 560 workers treated in 11 hospitals in three economically active cities in the People's Republic...

Coping strategies in daily occupations 3 months after a severe or major hand injury

Coping strategies used in performing daily occupations 3 months after a severe or major hand injury were explored. A semi-structured interview was performed with 13 participants with hand injuries based on Hand Injury Severity Scoring System and analysed using content analysis. Six groups of strategies were identified: 'Changing performance of daily occupations', 'Actively processing trauma experience', 'Changing occupational patterns', 'Receiving assistance', 'Using emotional strategies' and 'Keeping up a social network'. The problem- and emotional-solving strategies identified in this study can be used to support other patients early in rehabilitation. Patients with few coping strategies should be recognized. Information and practical handouts to patients, therapists and relatives should stimulate and help patients with hand problems enabling in meaningful occupations and preventing unnecessary stress. Furthermore, social support should be encouraged and family should be actively involved in rehabilitation. To insure trustworthiness, member checks were used on four randomly selected participants, but could possibly be used with all participants. Further research is needed in a longitudinal study to explore which coping strategies or adaptation patients use to perform daily occupations at a later stage.

Hand injuries in a human caused by a South American porcupine (ouriço-cacheiro)

Human injuries caused by South American porcupines (in Portuguese, ouriço-cacheiro) are rare. This study reports severe hand injuries provoked by the body spines of the animal in a human and discusses the circumstances involved in the accident, with emphasis on environmental factors.

The Use of Mitten-Shaped Thin Abdominal Flap for the Coverage of Extensive Compound Dorsal Hand Defect in a Pediatric Patient

Background: Severe hand trauma in small children has special social, psychological, aesthetic and functional implications that mandate comprehensive treatment strategies. Because of the miniaturized size of the limbs and the incautiousness of the little kids, the injury tends to have a substantial severity and extent. Moreover, the physicians will encounter considerable difficulties while attempting the reconstructive task and implementing the post operative care, also owing to the tiny structural components and the uncooperativeness of the toddlers. Aim and Objectives: To reconstruct the severe hand injury in Pediatrics by using the abdominal flap was an efficient and safety method. Materials and Methods: This report describes an 18-month-old boy who sustained 3rd degree contact burn over his left dorsal hand with multiple extensor tendon loss, joint and bone exposure, and large skin defect due to autonomic cup-sealing machine injury. He received abdominal flap transfer for wound coverage in conjunction with immediate tendon and lateral bands reconstruction using tensor fascia lata graft. A whole body spica was used to prevent premature detachment of the limb from the abdomen donor site during the two weeks period of immobilization. A special ”mitten like” flap design was utilized, which served to ensure a stable limb anchorage and enable maximal contact surface between the two parties with minimal enrollment of unnecessary donor tissue. An optimal thinning of the flap thickness can be achieved without safety concern. The flap was divided two weeks later and two more surgeries were conducted subsequently to separate the syndactylous fingers. A reasonable final functional result was obtained without significant donor site morbidity. The rational and technical details as well as the special measure of postoperative immobilization were described in this article. Results: No flap partial necrosis or total necrosis was found in each surgery including of reconstructive and division operation. No donor site co-morbidity was noted. Three hundred eighteen days after abdominal flap surgery, or 155 days following complete flap division, no significant complication related either to the donor or recipient sites and an acceptable functional performance is achieved. Conclusion: The method of traditional abdominal flap transfer, is easy to execute, highly accountable, vastly flexible and versatile in flap design, and would be particularly valuable for young aged individual.

The importance of hand anatomy in the accident and emergency department: assessment of hand anatomy knowledge in doctors in training

Good anatomical knowledge is essential for the early recognition of severe or significant hand injuries in the Accident and Emergency (A&E) department, in particular nerve, vascular or tendon injuries. In 1992, Murphy and Olney assessed hand anatomy knowledge in junior doctors. We have repeated this study 16 years on. The 2008 cohort performed worse in response to every question asked and in some areas significantly so. We discuss the results in relation to the recognition of serious injuries and also with regards to anatomy teaching in medical schools and at postgraduate level.

Giresun İlinde Fındık Tarımı ile Uğraşan Çiftçiler Arasındaki Ciddi El Yaralanması Vakaları : Retrospektif Çalışma

Bu calismada Giresun ilinde findik tariminin aktif olarak yapildigi Temmuz ve Agustos aylarinda artan ciddi el yaralanma vakalari gozden gecirildi. Bu amacla 2006-2008 yillari Temmuz ve Agustos aylarinda hastanemize ciddi el yaralanmasi ile basvuran 70 hasta retrospektif olarak incelendi. Hastalar yas, cinsiyet, yaralanmanin tipi, tedavinin sekli ve fonksiyonel sonuclar acisindan degerlendirildi. Hastalarin 51’i erkek, 19’u bayandi ve yas dagilimi 20-65 arasinda degisti. Vakalarin 20’sinde cilt defekti, 40’inda ise kompleks yumusak doku defekti mevcuttu. 45 vakada parmak amputasyonu mevcut olup bunlarin 32’si Distal Interfalangeal Eklem (DIP) duzeyinden ve 24’u birden fazla parmak amputasyonu seklindeydi. 22’vakada ise amputasyon parsiyeldi. Kompleks yumusak doku defekti olan hastalara birden fazla sayida operasyon uygulandi. Tam ya da kismi ampute parmak vakalarinda, replantasyona uygun 6 vaka disindakilere amputasyon ve guduk onarimi yapildi. Sonuc olarak bu ve benzeri calismalardan elde edilecek veriler isiginda toplumda maddi ve manevi kayiplara neden olan ciddi el yaralanmalarinin onlenmesinin mumkun olabilecegini dusunuyoruz. Severe hand injury cases in hazelnut farmers in Giresun: a retrospective study In this study, we analized severe hand injury cases that were frequently seen between June and August months in Giresun. Seventy patients with severe hand injuries that had been admitted to our hospital in 2006-2008 were handled retrospectively. Patients were explored according to sex, pattern of injury, type of treatment and functional results. 51 patients were men and 19 were female. Age pattern was 20-65 year. Skin defects were in 20 cases, complex soft tissue injuries were in 40 cases. 45 cases with digital amputations were seperated as single, multiple, complet, partial, from distal interphalangeal joint (DIP), proximal (PIP) and metacarpophalangeal joint (MCP) level. 32 cases were from DIP level. In 24 patients, amputation was multiple and 22 amputation cases were partial. Patients with complex soft tissue injuries were treated by multi-stage operations. In total or partial digital amputation cases, only six cases were performed replantation. The other amputation cases were treated by stump reconstruction. In conclusion, in light of the obtaining this knowledges from the literature, it has been opinion would be able to prevent severe hand injuries those giving rise to important spiritual and material losses in societies.

Free Flap From the Superficial Palmar Branch of the Radial Artery (SPBRA Flap) for Finger Reconstruction

Functional reconstruction after a severe hand injury is best achieved by obtaining primary, stable soft tissue coverage to avoid delayed wound healing, prolonged immobilization, and joint stiffness. A wide range of procedures from spontaneous healing to local flaps has been proposed to treat soft tissue defects in appropriate circumstances. However, these pedicled flaps are insufficient in covering larger finger defects, so we used flaps from the free superficial palmar branch of the radial artery (SPBRA) for such cases. Between June 2003 and May 2007, 11 people with traumatic finger injury were treated with SPBRA flaps. The blood supply of the flap is derived from the SPBRA, which can be palpated and confirmed by Doppler flowmetry 18 mm proximal to the palmar wrist crease. Anastomoses of vessels were performed under a microscope, linking the SPBRA to the digital artery and the concomitant vein to the digital dorsal vein. The defects were located at the fingertip in seven patients, in the dorsum of the proximal phalanx in two, and at the interphalangeal joint in two. The average flap size was 8.4 cm with the largest flap being 12.5 cm2 (50 mm x 25 mm). All the flaps survived completely and the wound healed satisfactorily, except for one partial necrosis. All the donor sites were closed primarily without complications or obvious scarring. Most of the fingers involved achieved a full range of motion and showed a good contour. Two-point spatial sensory discrimination was recorded for six patients and adequate protective sensation was attained. The SPBRA flap provides a thin, pliable, reliable, and good glabrous skin flap for covering medium to large finger defects. Only one operative field is required and the major vessels are preserved. This approach can add to the armamentarium of the plastic surgeon for covering large defects of the finger.

Outcome Prediction in Microsurgery by Quantitative Evaluation of Perfusion Using ICG Fluorescence Angiography

The purpose of this prospective study was to evaluate the clinical efficacy of laser-induced fluorescence angiography with indocyanine green (ICG-FA) for perioperative monitoring of tissue perfusion in hand surgery. Different quantitative parameters of the uptake, distribution and clearance of dye-marked blood were evaluated for their sensitivity and prognostic value in comparison to each other and to clinical parameters. One hundred and fifty-five measurements were performed prior to, or following, surgery for severe hand injuries. All quantitative parameters of ICG-FA detected intraoperatively were found to be of significant predictive value for outcome, but clinical parameters were not. For the dye uptake, a minimum slope value of 0.01 was significantly related to sufficient perfusion and good prognosis. There was no correlation between the quantitative ICG-FA results or any of the clinical parameters. Since clinical evaluation of perfusion in this surgery remains difficult, the additional use of ICG-FA may improve surgical decision making and, thereby, lead to better clinical results.

Treatment of complex hand trauma using the distal ulnar and radial artery perforator-based flaps

The clinical value of distal ulnar or radial artery adipofascial perforator flaps is shown in a series of 30 patients with severe hand and wrist injuries and major soft tissue defects requiring coverage. There were 22 men and 8 women, aged 16-73 years. The defects were dorsal and/or palmar, with or without transpalmar or transcarpal amputation, or amputation of the thumb and/or the digits. Tendon injuries have been treated primarily or secondarily, or reconstructed using silicon rods. In all cases, after surgical debridement of the wound, reconstruction of the defect was done using distal ulnar (21 patients, in 3 patients primary reconstruction) and distal radial artery (11 patients; in 2 patients primary reconstruction and in 2 patients after necrosis of distal ulnar perforator flap) adipofascial perforator flaps. Minimum follow-up was 6 months. Two ulnar flap showed partial necrosis and were revised successfully by distal radial adipofascial perforator flaps. One radial and one ulnar flap showed 50% and 60% necrosis, respectively, and were revised by groin flaps. All donor sites healed uneventfully. Functional and cosmetic result was very good in 15 patients and good or satisfactory in the remaining. Range of motion of the wrist and hand joints was almost within normal limits (less than 25 degrees extension or flexion deficits). Distal ulnar and radial artery adipofascial perforator flaps for traumatic defects of the hand and wrist offer several advantages compared to other local flaps; they are easy to obtain and cover effectively both dorsal and palmar defects without significant functional deficits or donor site complications to the upper limb.

The Psychological Impact of Severe Hand Injury

The final outcome of severe hand injuries is not solely determined by the residual functional impairment, but is also a function of non-functional criteria, including the sequelae of the accompanying psychological trauma. This paper reviews the literature with respect to the psychological impact of severe hand injuries, including the special impact of amputations, adaptation processes, adaptation stages, prognostic criteria and aesthetic issues influencing the final individual outcome, including present recommendations for promoting a positive outcome. Motivated and psychologically stable people are reported to do well irrespective of the severity of a hand injury. In patients who find it difficult to cope mentally, successful treatment strategies have been proposed. Their implementation is in a constant state of evolution and includes not only improved surgical techniques and advanced pharmacological pain management but also early psychotherapeutic input and involvement of patients in decision making for treatment.

Combined composite tissue transfer for severe hand injury repair and one-stage functional reconstruction

患者男,18岁.2006年12月,右手因操作轧钢机时不慎被机器(高温)挤压伤,1 h后送入我院.临床检查:右手掌、背侧皮肤软组织自腕关节起至指根向远端逆行套脱,套脱组织因热压变性.大鱼际肌全部外露,拇指近节指骨外露,远节手指及近节软组织缺失。

A-0140 Early mcp arthroplasty in severe hand injuries with joint destruction and bone loss

A-0140 Early mcp arthroplasty in severe hand injuries with joint destruction and bone loss

Impairment and Disability After Severe Hand Injuries With Multiple Phalangeal Fractures

Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.

Distal radial and ulnar arteries perforator‐based adipofascial flaps for covering hand traumatic defects

The clinical value of adipofascial flaps based on distal ulnar or radial-artery perforators is demonstrated in a series of 14 patients with severe hand injuries and significant soft tissue defects requiring coverage. There were 10 male and 4 female patients, aged between 23 and 72 years. The defects were 7 dorsal, 4 palmar, 1 combined dorsal-palmar, and 2 with thumb or total digit amputation. In the patients with a dorsal defect, the extensor tendons were intact in 2 cases, reconstructed in 2 cases, and reconstructed in 3 cases using silicon rods. Following debridement, a fascial flap based on a distal ulnar (12) or radial (4, 2 primarily and 2 secondarily) artery perforator was fashioned and used to cover the defect. A split thickness skin graft was used to cover the defect and the hand was immobilized for 2 weeks. All cases were followed up for at least 6 months. The donor and recipient sites healed uneventfully, and the functional result was very good in terms of wrist and hand joint range of motion, which approximated the normal rates. The extension or flexion deficit was less than 25 degrees. The esthetic result was satisfactory. Two ulnar flap partial (involving approximately 35% of the area) necroses have been treated using reversed radial-distal perforator flaps. The described fascial flaps offer several advantages over other local flaps, and are rather easy to perform and cover effectively both dorsal and palmar hand defects without causing significant functional deficits to the upper limb.