Mutilating or “mangling” injuries of the hand pose a formidable challenge for both the patient and the hand surgeon. These are devastating injuries resulting from industrial, agricultural or power tool accidents. Often, these accidents present as incomplete or complete amputations of the thumb, fingers, hand or even the entire arm. These injuries involve multiple structures including bones, joints, tendons, ligaments, arteries, veins, nerves and soft tissues. The mechanism of injury can be range from guillotine sharp clean-cut injuries with a limited zone of injury to crush-avulsion degloving injuries with an extensive zone of injury. The key concerns in these patients are salvageability of the mutilated hand followed by repair, reconstruction and rehabilitation. This is a life-changing event requiring a comprehensive team approach providing highly individualized treatment, often over 1-2 years, requiring multiple staged surgical procedures and a prolonged rehabilitation process, to optimize function and pain management. This will entail a multidisciplinary team approach including the hand surgeon, occupational therapist, employer, nurse case manager, psychologist and patient.
Following a thorough physical examination, including the ABC’s of establishing an adequate Airway, Breathing and Circulation, detailed documentation and systematic classification of the traumatic hand injury is performed. Tetanus prophylaxis, antibiotics, good quality x-rays are obtained prior to the operating room. It is crucial that there is appropriate preservation of the amputated part.
From the time the patient presents to the Emergency Department, it is crucial that the patient be treated by an experienced Hand Surgeon thoroughly familiar in dealing with these most devastating injuries. Dr. Norman Weinzweig, co-editor of the comprehensive text THE MUTILATED HAND, is one of the most respected and talented hand surgeons having tremendous experience at several major Level I Trauma Centers in dealing with these patients over the past 25 years. He has written extensively about this specific area of hand surgery including his text, chapters, articles, presentations and educational videotapes.
There is much to lose with having an inexperienced or casual hand surgeon attempt to manage these complex hand problems. Proper reconstruction of a mutilated hand is a highly individualized process. Numerous well thought out decisions have to be made by the hand surgeon and by the patient affecting the future personal and employment status of the patient. The Chicago Institute for Hand Surgery & Rehabilitation is a major referral center in the Midwest for patients with acute traumatic injuries of the hand as well as for those patients who will require secondary reconstruction of their hands.
