Guidelines for management of crush injuries of the hand

Crush injuries of the hand involve damage to multiple structures within the hand, loss of tissue, devascularisation and possibly amputation of digits. They are complex and difficult to classify. Each injury has a unique pattern and requires a unique plan of management. There are no set procedures that can be described, however fundamental principles can be laid down to guide surgical management. Optimum management requires a planned and decisive approach. The surgeon or the team must be well versed with techniques necessary for management of all the structures within the hand, microsurgery and free tissue transfer. The essential components of management are, accurate assessment of the injury and creating a reconstructive plan by structures. The essential components for primary surgery are precise and complete debridement, skeletal stabiliation, vascular repair and if vessels are exposed, soft tissue cover. Secondary surgery should include procedures to enhance the function of the hand or to improve the aesthetics of the hand. These include bone grafting, fusion, tendon and nerve reconstruction, flap de-bulking and toe to hand transfers. The following article is a concise synthesis of the fundamental principles which a hand surgeon must understand while undertaking these challenging procedures.