Traumatic Hand Injuries
Hand functions include touching, holding, catching, expressing, defense, attack, eating, and expressing our feelings. All these complex functions are performed by harmonic and complete work of blood vessels, nerves, muscles, tendons, and tissues in the hand.
A large portion of traumatic hand injuries occur unfortunately as a result of work accidents. In addition, home and traffic accidents can cause traumatic hand injuries. No matter what causes traumatic hand injuries, the primary goal of the treatment of such injuries must be to restore the complete hand functions of the patients. Hand injuries may be caused by a penetrating object as well as by being crushed or smashed. Electrical shock, acid, or hot burn may lead to a hand injury. Many types of traumas take place in most injuries. Only crush of the hand or skin cut may be seen after an injury as well as various fractures, vascular, nerve or tendon cuts, loss of tissue, or loss of extremities such as ruptured finger may occur.
Our fingers move with ability of muscle extensions, called a tendon, to pull. Tendon injuries lead to loss of move of fingers or wrist depending on the level of cut. There are basically two types of tendons. Flexor tendons provide inward movement of fingers and are located in the palm. Extensor tendons provide upward movement of the fingers and are located on the dorsal of the hand.
Tendon injuries of the hand must be repaired. The injuries of the hand should ideally be repaired by hand surgeons under operating room conditions. After the repair procedure, a fixing instrument such as a splint is often used until the body fully heals the tendon. During this period of time, physical therapy will be helpful to avoid adhesions, one of the major problems that may occur after the operation.
There two major blood vessels, arteries and veins, in our hands and fingers as in the whole body. The arteries carry the oxygenated blood in the lungs to the tissues. A cut of an artery as a result of a hand injury should mostly be repaired by microsurgery. The injuries left unrepaired may lead to insufficient nutrition of tissues eventually to necrosis and loss of extremities. Microsurgery is a surgical procedure performed using specific instruments and stitching materials and a microscope. Not all surgeons are able to perform a microsurgical procedure. It must be performed by specifically trained surgeons. This service is provided by our hand surgeons, who are specifically trained on microsurgery, at Hand Surgery clinics.
Sensation and complex movement of our hands and fingers depend on the health nerve structures. Injury-related nerve cuts result in the loss of ability in movements and/or sensation depending on the nerve characteristics. This is a cause of a severe disablement. Nerve cuts must be surgically repaired. Repair of a nerve is a specific procedure and performed using microsurgical methods. The functions of a repaired nerve are not immediately restored. The body needs a certain period of time to repair the nerve.
Hand – Finger Amputations
Unfortunately, we often encounter amputations of the hand, fingers, and arm at various levels as a result of work accidents in particular. The most common one is cutting of finger tips. The amputated body part can be replanted at this level of injuries or may be treated using a tissue graft. Replantation of the amputated part should be primarily considered when a part of the body is cut at a further level. The form of the injury, if the injured person has any other diseases, his/her age, the time between the injury and intervention, and storage conditions of amputated part play an important role in replantation of amputated parts. Amputations as a result of crush or pull are highly unlikely to be replanted compared to one associated with cut. The success rate of replantation performed within 6 hours after injury is higher. The amputated part is washed by isotonic solution, covered by a wet gauze bandage and put in a waterproofing bag. This bag is placed over the ice and sent to a replantation center. The muscular tissue is not able to survive without blood for a long time and therefore the higher the amputation level is, the shorter the time before the replantattion should be.
Replantation of amputated parts is performed using microsurgical methods and a microscope. Prior to the surgery, bone repair, tendon repair, artery and vein repair, nerve repair, and finally skin repair of the amputated part must be performed individually. The hand and the forearm should remain in a plaster splint for 4 to 6 weeks after the surgery. Sensation of the replanted part will not be returned immediately. Recovery of the nerve varies depending on the type of the injury and age of the patient.