Expertise
Hand injuries
Hands are Intricate in design and function, the hand is an amazing work of anatomic engineering. Therefore, any injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require proper medical evaluation
The most common cause of the injuries was blunt trauma, followed by injury from a sharp object
Hand injuries can be divided into six general categories:
lacerations (cuts), | fractures and dislocations | soft tissue injuries and amputations | infections | burns | high pressure injuries (grease and paint guns). Other than finger injuries | nail Injuries
Treatment depends on:
- The location, type, and severity of the injury.
- How long ago the injury occurred.
- Your age, health condition, and activities (such as work, sports, or hobbies).
Nail Bed Injury
Hand is to explore the things around. Hence nail bed injury is most common in all age groups, particularly in children and those work with tools and machines.
Door crush injury is the most common mode of injury in children with presentation ranges from subungual hematoma to fingertip amputation.
Nail bed injury often misdiagnosed as only dorsal skin laceration or as a avascular fingertip which can lead to unacceptable outcomes.
Proper nail bed repair under loupe magnification under anaesthesia can preserve the nail bed, so that the proper regeneration of the nail plate will have a good cosmetic outcome and functional restoration of the fingertip to explore the world.
Case History
This child studying 2nd standard presented with door crush injury while playing. On examination under anaesthesia she had a stellate laceration of the nail bed which was repaired using 5-0 absorbable suture material and her nail bed was restored.
Compartment Syndrome Hand
Compartment syndrome of hand is defined as increase in intra compartment pressure which leads to ischemic necrosis of muscles and nerves leading to subsequent Volkmann ischemic contracture of the hand causing functional impairment depending on the severity of the injury and the time delay in intervention.
Case History
52 year old female presented with inability to extend the thumb, which was sudden in onset. On examination she had rupture of extensor pollicis longus tendon. Under supraclavicular block with tourniquet control, exploration confirmed the rupture of EPL.
She underwent transfer of extensor indices to distal part of EPL . Post operatively she regained thumb extension with preserved full thumb flexion
Crush Injury Hand
What is Crush injury hand?
Crush injury of hand needs initial thorough clinical examination and appropriate radiographs to foresee the final outcome, so that the best modality of treatment to restore hand function is possible.
Each injury needs different care although the basic concept in reconstruction of the injured structures are same.
Debridement, Skeletal stability and early soft tissue cover can lead a pathway for restoration of the functional hand.
Early mobilization of hand injury is the key to preserve hand function.
Case History
32 year old female had sustained crush injury to her left hand with deformity of left index and middle finger with comminuted fracture of proximal and middle phalanx fracture of both fingers.
She underwent single stage surgical procedure for the salvage of fingers. Wound debridement under loupe magnification and k wire stabilization of fingers and subsequent supervised physiotherapy.
Cut Injury
What is Cut Injury?
Cut injury at distal forearm can lead to injury to vital structures that reaches the hand.These patients may present with torrential bleeding.
Most important thing in the initial management is that “AVOID BLUNT APPLICATION OF HEMOSTAT TO PREVENT BLEEDING” which can cause iatrogenic injury/ or additional injury to the pre-existing injury to the nerves and vessels.
Case History
This 23-year-old female presented with bleeding from the volar aspect of the distal forearm, following knife cut injury, managed with compression bandage and limb elevation at the casualty.
On emergency exploration she was found to have zone 5 flexor tendon injury of all flexors in addition to injury to median and ulnar nerves and ulnar artery.
She underwent debridement, flexor tendon repair, and median and ulnar nerve repair and ulnar artery anastomosis and post-operative supervised physiotherapy from Day 2. 3 months’ post-surgery she has good finger and thumb flexion with wrist flexion; Progessive Tinel sign is indicative of nerve recovery.
Cross Finger Flap
What is Finger Flap?
Finger flap is a vascularised tissue mobilised from the injured /uninjured fingers tosalvage the finger tip injuries.
Fingertip amputation are most common work spot injury, which is managed in most places with shortening and closure of stump.
But most of these fingertip amputations can be salvaged by appropriate local and regional flaps to preserve the functional length of the digits and to preserve the nail bed.
Case History
This patient 46-year-old sustained traumatic amputation of the ring finger due to fall of metal sheet while working. He has volar oblique amputation of fingertip with nail bed loss of ring finger and nail bed injury of middle finger.
He underwent nail bed repair of middle finger and cross finger flap cover for the volar pulp tissue loss.
Free Nail Bed Graft
What is nail bed?
The part that lies beneath the nail plate is nail bed. It includes germinal matrix and sterile matrix.
Germinal matrix is responsible for growth of the nail plate & sterile matrix is responsible for nail plate adherence.
What is free nail bed graft?
Transfer of partial thickness of sterile matrix from toes usually to fingers.
What is the importance of nail plate?
- Cosmetic
- Protect the distal part
- To pick finer objects like pin.
Case History
19 year old female presented with crush amputation of the left little finger with loss of distal part.
Following debridement under loupe magnification,there was loss of sterile matrix of the nail bed with partial avulsion of the germinal matrix.
She underwent free nail bed graft from the great toe and is sutured to the little finger germinal matrix.
Local flap is used to cover the volar defect.
This reconstructive procedure of recreating the nail bed will allow the individual to have a functional length with preserved nail.
FDMA Flap
What is FDMA flap?
First dorsal metacarpal artery based flap is raised from the dorsum of proximal phalanx
of index finger, and is transposed to cover the defect in thumb. Donor defect over the index finger is covered with SSG.
Advantages of regional flap
FDMA flap provides a adequate soft tissue cover without the need for distant flap.
Preserved function of the index finger
Regional flap like FDMA flap will provide soft tissue cover to the repaired flexor tendon, thereby the viability of tendon is preserved, to restore the thumb flexion.
Case History
32 year old male patient presented with soft tissue loss over the volar aspect of left thumb with FPL injury.
He had underwent wound debridement FPL repair and FDMA flap cover.
3 months post surgery he had regained flexion of IP joint of thumb and preserved thumb function.