[Complex hand injuries].

Most problems in the treatment of complex hand injuries result from not clearly recognizing which structures are destroyed or preserved preoperatively. The plan for treatment depends on priorities. Beginning with reduction and osteosynthesis and after suture of tendons, restoring blood supply is most important. Nerve reconstruction is best done soon. But if suture without tension is impossible, secondary nerve grafting is to be preferred. Skin closure is to be done soon if possible. Otherwise we need skin grafts, local or free flaps.