[Hand lacerations in initial clinical treatment : Small cut-Major injury]

Hand lacerations carry a significant risk of overlooked involvement of deep-lying functional structures. Flexor and extensor tendons, digital nerves and blood vessels run immediately subcutaneously and can be completely or partially injured even with minor skin lesions. Inadequate medical history, incomplete clinical examination or failure to perform a systematic wound exploration are among the most common causes of a delayed diagnosis. This results in poorer functional outcomes, more complex secondary reconstructions and increased medico-legal risks. This CME article provides a practice-oriented overview of the structured diagnostics and management of lacerations of the hand. A particular focus is placed on wound exploration as a central diagnostic step for the reliable identification of tendon, nerve and vascular injuries. In addition, evidence-based principles of acute care, surgical treatment and early functional follow-up treatment are summarized.