Emergency repair and reconstruction in the severely crushed hand

Crushing injuries of the hand are a common clinical problem which require judgement and assessment by an experienced hand surgeon for an optimum result. The crushed hand has to be viewed in the perspective of injury to an essential organ with its skin and contents, namely muscles, vessels, nerves, tendons, bone and joints. A poor result is often due to inadequate wound debridement, failure to identify the extent of crushing of the devitalized tissue, closure of the skin under tension in the presence of wound contamination, and complex repairs in an avascular bed. In an emergency situation, the simplest suitable procedure is preferred. Open degloving injuries, grease and paint gun injuries, and especially closed crushing, degloving injuries can be very misleading and need special attention.