Management of a mutilated hand: the current trends

Abstract

Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The most important factor in salvage of a mutilated hand is involvement of a senior surgeon at the time of initial assessment and debridement. A regional block given on arrival helps through assessment and investigations in a pain-free state. Infection still remains the important negative determinant to outcome and is prevented by emergent radical debridement and early soft tissue cover. Radical debridement and secure skeletal stabilization must be achieved on day one in all situations. Dermal substitutes and negative pressure wound therapy are increasingly used but have not substituted regular soft tissue cover techniques. Ability to perform secondary procedures and the increased use of the reconstructed hand with time keeps reconstruction a better option than prosthesis fitting. Toe transfers and free functioning muscle transfers are the two major secondary procedures that have influenced outcomes.

Management of conflict injuries to the upper limb. Part 2: reconstruction and managing complications

“…The treating surgical team should have expertise in various reconstructive techniques, including orthopaedic fracture management and microsurgery. The current trends in management of the mutilated hand have been recently described in detail (Sabapathy et al., 2022).…”