Massive Hand Crush: The Role of a Free Muscle Flap to Obliterate the Dead Space and to Clear Deep Infection

Abstract

Death of tissue and/or deep infection leading to amputation is not an uncommon course of events after massive crush injuries of the central part of the hand. Management of this injury faces the dual problem of having to carry out debridement in the central part of the hand which is radical enough to remove all dead tissue but which, in itself, creates a huge dead space in the depths of the wound. Inadequate debridement and/or leaving a dead space which fills with fluid and detritus behind the flexor tendons leads on to infection, devascularisation of the fingers and amputation. This paper presents the results of very radical debridement of the hand dorsal to the flexor tendons, including the intermetacarpal spaces, and filling the dead space with a well-vascularised free muscle flap in two hands which were referred in a pre-amputation stage, with one already being infected. Both hands were salvaged.

The Reconstruction of the Mutilated Hand

“…26,27 Muscle Flaps Several different muscles can be easily transferred on their dominant pedicle. [28][29][30][31][32] A few of these muscles appear recurrently in the literature because of the ease of the dissection and reliability. Each of these muscles can be taken with the cutaneous paddle as well.…”

Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction

“…When reconstructing three‐dimensional lower extremity defects, filling the dead space is necessary to prevent secondary complications, such as infection and abscess formation . Unfortunately, the size and shape of the dead space are ambiguous in many cases, which makes the choice of a donor flap difficult.…”

“…Lower extremity defects due to trauma can present in various forms, ranging from simple soft tissue defects to complicated defects with dead space and loss of multiple tissues. In cases of three‐dimensional defects, the dead space should be filled and the surface defect should be covered after surgery to prevent complications, such as infection and abscess formation . In cases of complex three‐dimensional defects, various muscle flaps have traditionally been used, and these flaps have several advantages that are related to filling the dead space and matching the shape of the defect .…”

Vascularised Corticoperiosteal Grafts from the Medial Femoral Condyle for Difficult Non-Unions of the Upper Limb

“…A sixth patient had a massive crush to his hand. This was initially treated elsewhere then referred to the first author for probable amputation but was salvaged with a free gracilis flap (Piñal et al, 2006b). Bone fixation had been achieved primarily with K-wires, and, although reduction was far from anatomical, it was left untouched in the early stages for fear of compromising the viability of the whole hand.…”