Polydigital crush avulsion injuries with complete loss of soft tissue, including nerves and vessels, where only bone and tendon structures are preserved need sophisticated treatment. Due to the complexity of the injury amputation should be avoided and the major aim is maintenance of maximum finger length by emergency soft tissue coverage, when replantation is impossible. Later reconstruction of sensation with good mechanical properties must be the ultimate aim. Two cases with a four finger crush avulsion injury are reported from the emergency situation through the subsequent secondary reconstruction to the final result. Soft tissue coverage required the full spectrum of hand surgical procedures ranging from local tissue transfer, to temporary pedicled flaps and microsurgical procedures. Possible treatment options are discussed at each step of the reconstruction. Finally, a treatment concept is presented both to ease the surgical approach for the inexperienced and to provide discussion for the experienced hand surgeon.
European Journal of Plastic Surgery – Springer Journals
Published: May 17, 1999
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