Delayed Reconstructive Surgery for Severe Hand Injuries

Abstract

Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries. Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2). Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery. Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life. Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.