Understanding Hand Surgery 2
Date, time and type of injury
It can potentially have medico-legal implications. The time of injury should be noted as certain injuries requireurgent management and should be treated as soon as they arerecognized; in order of urgency:1.
Uncontrolled haemorrhage secondary to vascular injury 2.
Complicated fracture or dislocation compromising major vascular injury or producing doubtful viability 3.
Macro-replantation, that is when the amputated partcontains significant muscle bulk 5.
Hydrofluoric acid burns6.
Pressure gas injuriesIf left untreated, the hand will undergo certain changes, which willinfluence its eventual recovery of function:
Necrosis and contractures may result from vessel occlusionsecondary to unstable fractures. (Due to irreversiblepermanent intimal changes or irreversible ischemia in the areaof blood supply)
Contamination of the tissue causing infection.
Progressive edema, leading to:a)
Friability of tissues, which may complicate tendon, nerve,and vessel repairsd)
Difficulty in skin closure, to the point of compromising skin circulation
Place of injury