INJURIES OF THE UPPER EXTREMITY. THE ROLE OF THE RECONSTRUCTIVE SURGEON

Proper primary care of the injured hand minimizes both temporary and permanent disability. It is essential that the physician undertaking the primary management and treatment of an injured hand appreciate the problem and understand the available procedures and techniques. Thoughtful examination of the injured part, noting loss of voluntary motion or any absence of sensation, and adequate x-ray studies will assist in outlining the appropriate immediate care. By carefully and thoroughly debriding the wound, restoring bony anatomical alignment and obtaining satisfactory skin cover, the stage is set for maximum salvage of the injured hand. By evaluating the time interval (minutes to 12 hours since injury), as well as the type of injury (laceration, crush, or avulsion trauma) and the structures involved (fractures, cut nerves and tendons, skin loss), one can properly undertake the primary repair of the damaged tissues. The choice between primary or delayed tendon and nerve repair should be carefully weighed, dressing applied judiciously and correct splinting carried out so as to minimize ultimate deformity and disability. Rehabilitative measures including voluntary exercise by the patient should be begun early.