Hand is a very special organ. A trivial looking injury may hide far more damage than can be seen by the untrained eye. Improper treatment may lead to lifelong stiffness, disability or even deformity. On the other hand skilled surgery can salvage even very bad hand injuries with good functional outcome.
Care of hand injury falls in orthopedic and plastic surgery areas. Traditionally in many places, it is the ortho surgeon who looks after hand trauma. In any country there are more orthopedic surgeons than are plastic surgeons and so traditionally hand trauma goes to orthopedic specialists. Again not all plastic surgeons get adequate training in hand. However, if a hand trained plastic surgeon is available, then it is worthwhile getting the plastic surgeon involved, especially so where there are open skin/soft tissue injuries in addition to bony. There have been great advances in hand surgery with the result that there are very elegant plastic surgical solutions for soft tissue loss in the hand. Such losses need to be addressed primarily along with bone fixation and not later on. Hence ortho and plastic specialists must see the injured hand in its early days.
At the Welcare hospital Dr. Mohan started an acute hand service in 2002 where almost all hand injuries with tissue loss or soft tissue injuries combined with bony injury are seen and treated by him. Closed hand injuries are still treated effectively by orthopedic surgeons. In fact an easy cooperation between the two departments works to the best interest of the patient. Cases range from fingertip injuries due to crushing in a door to full scale amputations. Great care is taken in such cases to give the most optimum tissue salvage and functional outcome. The department is proud of its hand service and has several successful re-implants to its credit. Tendon, vessel, nerve injuries may also require plastic surgeon’s expertise.
What to do if the digit is amputated? If a part has been amputated, the part should be washed with clean water or sterile saline if available and then kept in a clean zipper plastic bag [like the kitchen zip bag or equivalent] and cooled in ice or using cold packs. The part should not lie in direct contact with ice. Do not put salt in the ice!! DO NOT PUT ANY CHEMICALS OR ANTISEPTICS. Preserved this way, it can sometimes be replanted or at least parts of the amputated digit can be used as grafts to cover the stump. The injured finger should be cleaned with sterile saline and covered in sterile dressing. The hand is to be elevated. Direct compression will stop most bleeding. The victim must then reach the hospital along with the part.
Surgical repair of crush injuries may often be delayed by 2-5 days to allow time for swelling to subside, however it is important to do thorough professional cleaning within 6 hours and to start effective antibiotics and anti-inflammatory medications [medication to reduce swelling]. This care is usually rendered by emergency room physicians, a plastic surgeon should be consulted early, preferably by the emergency physician so that a priority out of turn appointment may be arranged. Most cases can be well repaired on the third day.