Mutilating corn-picker injuries of the hand.

Our experience with 15 patients who had acute mutilating hand injuries from corn-picker machines is reviewed. Three injury patterns were defined. Type I involved severe injury to all digits of the hand, including the thumb; type II injuries involved amputation of all fingers, in whole or in part, but with sparing of the thumb; and type III injuries involved amputation of multiple fingers with sparing of the thumb and at least one other digit. Attempts at revascularization or at complex reconstruction of the injured digits in the period immediately after injury failed in all 15 patients. The most satisfactory results in patients with type I injuries were obtained by complex reconstructive procedures such as toe-to-hand transfer. Patients with type II injuries were best treated with construction of a mitten-type hand by various methods. Patients with type III injuries were best treated by amputation of the devascularized digits.