Management of mutilating injuries of the hand

In the devastating destruction of parts associated with mutilating injuries of the hand, it is often not possible to salvage the elements essential to normal function of the hand. The objective of primary treatment is re-establishment of circulation to the devitalized part, realignment of the remaining skeletal structures, and skin cover of the denuded portions. Definitive reconstruction has to be delayed until survival of the salvaged parts is assured. Occasionally, complex procedures have to be carried out to convert a marginal remnant of the hand into a useful functional unit. These may comprise rearrangement of bony elements to provide a radial digit with intervening space to permit pinch and grasp. Lack of sensibility can be corrected by shifting neurovascular pedicle or by immediate transfer of free neurovascular flap from a distance. Challenge met by skill, tempered by knowledge and sound judgment, comprise the elements of reconstructive hand surgery in the face of mutilating trauma. It is a field in which the surgeon is continually reminded of humility and yet it is filled with rewards for both patient and plastic surgeon.