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Hand Trauma Management Insights

1) Hand trauma is a common injury, accounting for over 400 cases seen at PIMS, Islamabad over 9 months. 2) The majority of injuries were skeletal injuries with or without soft tissue involvement from machinery accidents. 3) Management prioritizes preserving viability, providing soft tissue coverage, skeletal stabilization, and restoration of nerve, tendon and joint function through various reconstructive procedures like flaps, skin grafts and replants. 4) Complications occurred in about 10% of cases and included wound infections, flap necrosis and hand stiffness, but there was no in-hospital mortality.

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71 views73 pages

Hand Trauma Management Insights

1) Hand trauma is a common injury, accounting for over 400 cases seen at PIMS, Islamabad over 9 months. 2) The majority of injuries were skeletal injuries with or without soft tissue involvement from machinery accidents. 3) Management prioritizes preserving viability, providing soft tissue coverage, skeletal stabilization, and restoration of nerve, tendon and joint function through various reconstructive procedures like flaps, skin grafts and replants. 4) Complications occurred in about 10% of cases and included wound infections, flap necrosis and hand stiffness, but there was no in-hospital mortality.

Uploaded by

Frontiers
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Hand Trauma

Muhammad Saaiq
Department of Plastic & Reconstructive
Surgery. Jan 19,, 2009
HAND TRAUMA: MANAGEMENT EXPERIENCE AT PIMS, ISLAMABAD,
PAKISTAN.

By: Muhammad Saaiq

International Bhurban Conference on Applied


Sciences and Technology (IBCAST 2009)
At:
Centres of Excellence in Sciences
and Applied Technologies ( CESAT ), Islamabad.

Jan 19, 2009.


The Hand
„
Skeletal Injury alone
Soft tissue ± Skeletal injury
Loss of Digits / Hand
Various Fractures
Carpal Injuries
„
„
„
„
„
„
„
„
„
INITIAL ASSESSMENT
AND
MANAGEMENT
RECONSTRUCTIVE PRORITIES
1) TO PRESEVE VIABILITY / RESTORE CIRCULATION

2) GOOD SOFT TISUE COVERAGE

3) SKELETAL ALIGNMENT AND STABILIZATION

4) RESTORATION OF NERVE FUNCTION

5) RESTORATION OF JOINTS MOBILITY

6) RESTORATION OF TENDON FUNCTION


RECONSTRUCTIVE LADDER
Split Thickness Skin Grafts / Full Thickness Skin Graft
Turn-over Flap
Atasoy Kleinert Flap
Cross-finger Flap

„
Abdominal Flap
Groin Flap
Posterior Interosseous Artery Flap

„
Toe Transfer ?

„
Preparation for Definitive Surgery

Soaks
VAC Dressing
Storage of Amputated Parts
Physical Rehabilitation
Psychological Rehabilitation
K-Wire Drivers
Modified Gustilo Classification/ Grading
I - Tidy laceration <1cm length,
No soiling, crush or tissue loss.

II - Tidy laceration <2cm in length,


Inside out, No soiling or tissue loss,
Partial muscle laceration.

III a - Laceration >2cm,


Penetrating or puncturing projectile,
Frankly soiled.
Adequate bone coverage.
III b - 3a plus Periosteal elevation and
stripping.
III c - 3b + Neurovascular injury.
Our PIMS’

( Jan 2008 to May 2008 )


Gender Distribution (n=403)

Female
18%

Male
82%
Age Distribution (n=403)

120 109
103
NUMBER OF PATIENTS

100
80
80

60 47
40 33
24
20 7
0
0-10 11 20 21-30 31-40 41-50 51-60 61-70
AGE ( YEARS)
Distribution of the Causes (n=403)

FAIs 2

Sports 3

Assaults 6

Burns 7

Electrical 15

Fircrakers 23

Household 25

RTAs 101

Machines 221

0 50 100 150 200 250


Distribution of Hand Injuries Overall
(n=403)

INJURY NUMBERS
1 Skeletal injury alone 89
2 Soft tissue ± Skeletal injury 314
3 Loss of fingertips 13
4 Loss of digits 24
5 Loss of Hand(s) 27
Associated Injuries (n=21)

ASSOCIATED INJURY NUMBERS


1 Long bone Fracture 7
2 Head Injury 4
3 Abdominal/ Thoracic Injury 8
4 Pelvic Fracture 2
Surgical Procedures Undertaken among Hand
trauma Victims (n=403)

Procedure Numbers
1 K-wire Fixations 151
2 Flaps 53
3 STSGs 61
4 Fasciotomy/ Compartment 12
Release
5 Replants 02
6 Miscellaneous 33
COMPLICATIONS

COMPLICATIONS NUMBERS
1 Wound Infection 23
2 Flap tip Necrosis 4
3 Hand Stiffness 3
4 Failed Digital Replant 1
Rate of Hospitalization : 10.91%

Average Hospital stay: 11 days ( Range 5-


33 days)

Inhospital Mortality: Nil


CONCLUSION
&
MESSAGE
Muhammad Saaiq
Department of Plastic & Reconstructive Surgery.

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