RESUMEN
INTRODUCTION: The mangled hand is a complex and uncommon injury of the upper extremity. It involves injury to multiple structures i.e., bone, soft tissue, and neurovascular bundles of the hand leading to loss of function and viability. These injuries are usually caused due to trauma from high-energy equipment. PRESENTATION OF CASE: A 32-year female presented with a crush injury to her right hand by a grass-cutting machine. The right hand was de-vascularised with injury to both radial and ulnar arteries. She had multiple lacerations, fractures of the distal radius and ulna, and multiple fractures of the metacarpals and phalanges. An initial revascularization procedure with a vein graft was done in the ulnar artery, joints were stabilized, and planned for reconstructive surgery at a later date. DISCUSSION: Initial evaluation includes a decision to salvage or amputate the limb. Early intervention to restore vascularity is key to salvaging a mangled hand. This should be followed by a multidisciplinary team approach. Preference is given to reconstruction procedures rather than amputation and prosthesis procedures. CONCLUSION: Early intervention, a multispecialty approach, and staged procedures are required for the successful management of a mangled hand. Eventually, physiotherapy has a key role in the restoration of function.
RESUMEN
Microsurgical transfer of the superficial and deep temporal fascia based on the superficial temporal vessels has been documented. This article analyzes the functional recovery when each layer of this facial flap is placed on either side of reconstructed or repaired tendons, to recreate a gliding environment. This fascial flap also provided a thin, pliable vascular cover in selected defects of the extremities. Six patients (four male and two female) with tendon loss and skin scarring of the hand (three dorsum, one palmar, and one distal forearm) and posttraumatic scarring of the ankle with tendoachilles shortening (one patient) underwent this procedure. No flap loss was witnessed. Good overall functional recovery and tendon excursion were observed. Complication of partial graft loss was observed in two patients.
