Department of Plastic, Hand and Microsurgery and Burns, Ganga Hospital, Coimbatore, India.
Private Practice, Madrid and Santander, Spain.
J Hand Surg Eur Vol. 2022 Jan;47(1):98-104. doi: 10.1177/17531934211047760. Epub 2021 Oct 9.
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.
残缺的上肢会造成各种组织物质的损失，丧失握持能力。在最初评估和清创时，由资深外科医生参与是挽救残缺手的最重要因素。到达时进行区域阻滞有助于在无痛状态下进行评估和检查。感染仍然是影响结果的重要负面因素，通过紧急彻底清创和早期软组织覆盖来预防。在所有情况下，都必须在第一天实现彻底清创和骨骼稳定。真皮替代品和负压伤口治疗的应用越来越多，但尚未替代常规的软组织覆盖技术。随着时间的推移，进行二次手术的能力以及对手的重建使用增加，使得重建成为比假肢适配更好的选择。足趾转移和游离功能肌肉转移是影响结果的两个主要的二次手术。
