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HAND INJURY

DR GARGADI, S.I

PLASTIC AND RECONSTRUCTIVE SURGEON (FWACS)

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INTRODUCTION

  • THE HAND DOES PREHENSILE AND SKILLED FUNCTIONS AND IDENTIIFIES INDIVIDUALS THROUGH FINGER PRINTS.
  • FIVE SKILLED FUNCTIONS OF THE HAND INCLUDES :POWER GRIP,PINCH GRIP,CHOCK GRIP,KEY GRIP,AND HOOK GRIP.
  • IT IS VERY VULNERABLE TO TRAUMA

HAND INJURY OCCURS MORE COMMONLY AMONGS MANUAL WORKERS E.G

LABOURERS,TAILORS,HOUSEWIVES

Management of hand injury requires the best and most ingenious surgical skills

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DEFINITION

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THE TRANSFER OF ENERGY TO THE PART OF UPPER EXTREMITY THAT

EXTENDS FROM THE WRIST TO THE TIP OF THE FINGERS SUCH THAT IT

EXCEEDS THE NATURAL RESILENCE OF THE TISSUES.

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CLASSIFICATION

  • CLASSIFICATION closed or open
  • OPEN (Rank and Wakefield) nature of skin involvement degree of contamination underlying tissue involvement immaterial
  • TIDY
  • UNTIDY
  • INDETERMINABLE

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AVULSION INJURY FROM DOUGH LAMINATING MACHINE

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MACHETE HAND INJURY

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CRUSH HAND INJURY

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AETIOLOGY

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  • SHARP OBJECTS SUCH AS KNIVES,NEEDLES,THORNS,GLASS

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  • MECHINERIES SUCH AS DOUGH LAMINATING MACHINE

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  • BURNS FROM HOT WATER ,HOT OILS,CHEMICALS,ELECTRICITY

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  • EXPLOSIVES SUCH AS GUN SHOTS ,KNOCK OUTS AND BOMBS

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DOUGH LAMINATING MACHINE

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PATHOLOGY

  • INURY TO THE HAND CAUSES:
  • LOCAL EFFECTS SUCH AS SWELLING ,REDNESS,HEAT,SWELLING,PAIN AND LOSS OF FUNCTION

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  • SYSTEMIC EFFECTS SUCH AS FEVER, AND DYSFUNCTION OF ORGANS.

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CLINICAL PRESENTATION

  • SYMPTOMS : BLEEDING,PAIN ,DEFORMITY,DYSFUNCTION
  • TAKE HISTORY OF ONSET,CAUSE, FIRST AID,OTHER INURIES, DIEBETES MELLITUS

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  • SIGNS :TENDERNESS,TISSUE DISRUPTION,SENSORY OR MOTOR DEFICIT

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  • APPLY THE PRINCIPLE OF LOOK, FEEL AND MOVE TO ACERTAIN EXTEND OF INJURY

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EVALUATION AND TREATMENT

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  • EVALUATION OF PATIENT
  • HISTORY: IDENTITY CAUSE OF INJURY, DURATION AND DORMINANT HAND OF THE PATIENT.
  • EXAMINATION: IDENTIFY AREA OF SKIN LOSS, MUSCLE LOSS, SEVERED TENDON, BLOOD VESSELS, OR NERVES, BONE INVOLVEMENT,
  • CHECK FOR FUNCTION OF EACH FINGER, SENSATION AND PERFUSION
  • EXAMINE THE NORMAL HAND
  • CHECK FOR INJURIES IN OTHER PARTS OF THE BODY
  • INVESTIGATIONS:
  • HAEMATOLOGY: PCV, GROUP AND CROSS MATCH BLOOD
  • CHEMISTRY: U & E PLUS CR, SERUM PROTEIN AND ALBUMIN
  • MICROBIOLOGY: WOUND SWAB FOR M/C/S IF THERE ARE SIGNS OF INFECTION
  • HISTOPATHOLOGY: BIOPSY OF CHRONIC ULCERS AND SCARS
  • RADIOGRAPH OF BOTH HANDS A.P AND LATERAL TO RULE OUT FRACTURES AND DISSLOCATION OR FOREIGN BODIES.
  • RESUSCITATION FOLLOWING THE ABC OF RESUSCITATION
  • WOUND CARE & REPAIR
  • IRRIGATE WOUND WITH 2LITRES OF SALINE TO MINIMISE SOILAGE
  • RESTORE ANATOMY BY TAGGING TISSUE WITH APROPRIATE SUTURES WITHOUT TENSION

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EVALUATION AND TREATMENT

  • REPAIR DAMAGE, VESSELS, NERVES AND TENDONS IF YOU HAVE THE COMPETENCE OR REFER.
  • DRESS WOUND REGULARLY WITH SALINE, MEDICAL HONEY AND BULKY OR GAMGEE DRESSING, CREPE BANDAGE AND NOT GAUZE BANDAGE.
  • SKIN GRAFTING OR FLAP COVER OF WOUND
  • EVALUATION:
  • APPLY SKIN TRACTION KIT AND ELEVATE AFFECTED HAND ON A DRIP STAND FOR MORE EFFECTIVE RESULT.
  • APPLY A VOLAR CAST
  • ANALGESICS
  • MORPHINE, OR PETHIDINE OR PENTAZOCIN
  • ANTIBIOTICS
  • AUGMENTIN AND METRONIDAZOLE COMBINATION IS REQUIRED OR DRUGS WITH SIMILAR MODE OF ACTION.
  • TETANUS VACCINE
  • PHYSIOTHREPY AND REHABILITATION
  • FOLLOW – UP.

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