Hand infections are common and range from minor nail fold or pulp infections to severe necrotizing sepsis (often in the presence of other significant co-morbidity). We discuss general principles of the surgical management of soft tissue infection, the microbiology of hand infection and antibiotic policy. Cellulitis, abscess, and specific hand infections are covered, including flexor tendon sheath infection, intra-articular sepsis, and bites (human and animal). The chapter concludes with osteomyelitis and chronic infections, including leprosy, and other conditions which can mimic infection.
The principles of upper limb reconstruction are to perform careful wound excision, fix the skeleton, reconstruct vessels, nerves, tendons, and bone as required (either immediate or delayed), and to obtain primary healing of the soft tissues with healthy vascularized tissue. This enables early movement—ideally, supervised by hand therapists—and generally results in a good outcome. In particular, delayed healing and immobility can lead to long-term morbidity. We provide a general overview of the principles of surgical incisions in the hand, wound care, and suturing, and discuss the use of skin grafts and flaps in the upper limb. We describe reconstruction of the different areas of the upper limb, along with detailed sections on digital and thumb reconstruction.
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