Hand TraumaHand Trauma

Muhammad SaaiqDepartment of Plastic & Reconstructive Department of Plastic & Reconstructive

Surgery. July 25, 2008Surgery. July 25, 2008

HAND TRAUMA: MANAGEMENT EXPERIENCE AT PIMS, ISLAMABAD, PAKISTAN.

By: Muhammad Saaiq

International Bhurban Conference on AppliedSciences and Technology (IBCAST 2009)

At: Centres of Excellence in Sciences

and Applied Technologies ( CESAT ), Islamabad.

Jan 19, 2009.

The Hand

Skeletal Injury aloneSoft tissue ± Skeletal injury

Loss of Digits / Hand

Various FracturesVarious Fractures

Carpal InjuriesCarpal Injuries

INITIAL ASSESSMENT AND

MANAGEMENT

RECONSTRUCTIVE PRORITIESRECONSTRUCTIVE PRORITIES1) TO PRESEVE VIABILITY / RESTORE CIRCULATION1) TO PRESEVE VIABILITY / RESTORE CIRCULATION

2) GOOD SOFT TISUE COVERAGE2) GOOD SOFT TISUE COVERAGE

33) SKELETAL ALIGNMENT AND STABILIZATION) SKELETAL ALIGNMENT AND STABILIZATION

4) RESTORATION OF NERVE FUNCTION4) RESTORATION OF NERVE FUNCTION

5) RESTORATION OF JOINTS MOBILITY5) RESTORATION OF JOINTS MOBILITY

6) 6) RESTORATION OF TENDON FUNCTIONRESTORATION OF TENDON FUNCTION

RECONSTRUCTIVE LADDERRECONSTRUCTIVE LADDER

Split Thickness Skin Grafts / Full Thickness Skin GraftSplit Thickness Skin Grafts / Full Thickness Skin Graft

TurnTurn--over Flapover Flap

Atasoy Kleinert FlapAtasoy Kleinert Flap

CrossCross--finger Flapfinger Flap

Abdominal FlapAbdominal Flap

Groin FlapGroin Flap

Posterior Interosseous Artery FlapPosterior Interosseous Artery Flap

Toe Transfer ?Toe Transfer ?

Preparation for Definitive SurgeryPreparation for Definitive Surgery

SoaksSoaks

VAC DressingVAC Dressing

Storage of Amputated PartsStorage of Amputated Parts

Physical RehabilitationPhysical Rehabilitation

Psychological RehabilitationPsychological Rehabilitation

KK--Wire DriversWire Drivers

Modified Gustilo Classification/ GradingModified Gustilo Classification/ GradingI - Tidy laceration <1cm length,

No soiling, crush or tissue loss.

II - Tidy laceration <2cm in length, Inside out, No soiling or tissue loss,

Partial muscle laceration.

III a - Laceration >2cm, Penetrating or puncturing projectile,

Frankly soiled.Adequate bone coverage.

III b - 3a plus Periosteal elevation and stripping.

III c - 3b + Neurovascular injury.

Our PIMSOur PIMS’’

(( Jan 2008 to May 2008 )Jan 2008 to May 2008 )

Male82%

Female18%

Gender Distribution (n=403)Gender Distribution (n=403)

Age Distribution (n=403)Age Distribution (n=403)

7

33

103 109

80

47

24

0

20

40

60

80

100

120

0-10 11 20 21-30 31-40 41-50 51-60 61-70

AGE ( YEARS)

NU

MB

ER

OF

PA

TIE

NT

S

221

101

25

23

15

7

6

3

2

0 50 100 150 200 250

Machines

RTAs

Household

Fircrakers

Electrical

Burns

Assaults

Sports

FAIs

Distribution of the Causes (n=403)Distribution of the Causes (n=403)

Distribution of Hand Injuries Overall Distribution of Hand Injuries Overall (n=403)(n=403)

INJURY NUMBERS1 Skeletal injury alone 892 Soft tissue ± Skeletal injury 3143 Loss of fingertips 13

4 Loss of digits 245 Loss of Hand(s) 27

Associated Injuries (n=21)Associated Injuries (n=21)

ASSOCIATED INJURY NUMBERS1 Long bone Fracture 72 Head Injury 43 Abdominal/ Thoracic Injury 84 Pelvic Fracture 2

Surgical Procedures Undertaken among Hand Surgical Procedures Undertaken among Hand trauma Victims trauma Victims (n=403)(n=403)

Procedure Numbers1 K-wire Fixations 1512 Flaps 533 STSGs 614 Fasciotomy/ Compartment

Release12

5 Replants 026 Miscellaneous 33

COMPLICATIONSCOMPLICATIONS

COMPLICATIONS NUMBERS

1 Wound Infection 232 Flap tip Necrosis 43 Hand Stiffness 34 Failed Digital Replant 1

Rate of Hospitalization : Rate of Hospitalization : 10.91%10.91%

Average Hospital stay: Average Hospital stay: 11 days ( Range 511 days ( Range 5--33 days) 33 days)

Inhospital Mortality: Inhospital Mortality: NilNil

CONCLUSIONCONCLUSION

&&

MESSAGEMESSAGE

Muhammad SaaiqMuhammad SaaiqDepartment of Plastic & Reconstructive Surgery.Department of Plastic & Reconstructive Surgery.