[Stepwise reconstruction in mid-hand destruction by crush].

The treatment of very serious crush injuries of the metacarpus is reported in three examples. It is recommended that in such injuries reconstruction of all damaged structures should not be performed in the first operation. The most important step beside the stabilisation of the skeleton is microsurgical revascularisation.. The reconstruction of nerves and tendons should be limited during the primary operation. Secondary reconstruction then has a lower risk and gives a good functional result. In such trauma the use of distant flaps for the reconstruction of large soft tissue defects seems more advantageous than the transplantation of free flaps by microvascular anastomoses.