Initial management of complex hand injuries in military or austere environments: how to defer and prepare for definitive repair?

Choufani, Camille; Barbier, Olivier; Grosset, Antoine; Murison, James Charles; Ollat, D.; Rigal, Sylvain; Laurent, Michel

doi:10.1007/s00264-017-3439-9

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…It is a matter of making a reasoned debridement preserving contused but viable tissues in order to limit the size of the loss of substance to be reconstructed. Fracture stabilisation uses splints or K-wires 6 8. Repair of tendons, vascular and nerve elements is often impossible: none has been possible in this series.…”

Section: Discussionmentioning

confidence: 89%

“…Patients in this series were treated sequentially according to the principles of hand damage control orthopaedics 6. In blast injuries, primary treatment should be limited to wound decontamination, alignment and stabilisation of the digital rays 4.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, most wounds were initially closed, even when secondary debridement was necessary. Alternatives are the use of wet dressings or negative pressure therapy between serial debridement 6…”

Section: Discussionmentioning

confidence: 99%

“…Blast may cause damage to the human body by the direct effect of overpressure, penetration by highly energised fragments and blunt trauma by violent displacements of the body 2 3. Despite the biophysics and the fact that various effects of blast trauma have been well described in the modern medical literature, few papers have focused on combat-related blast injury of the hand 4–8…”

Section: Introductionmentioning

confidence: 99%

“…No military classification has been described because weapons of war often cause heterogenous multidigital amputations combined with life-threating injuries 4 7. Due to the severity and multiplicity of the lesions and the limited resources available in forward surgical units, damage control surgery always apply with three priorities: saving life, saving the limb and preserving function 6 7. However, preservation or restoration of hand function is particularly challenging in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Blast injury of the hand related to warfare explosive devices: experience from the French Military Health Service

et al. 2020

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IntroductionThe objective was to report on the experience of the French Army Health Service in the management of blast injury of the hands related to warfare explosive devices.MethodsA retrospective study was conducted in the Percy Military Hospital (role 4 medical treatment facility) among French soldiers who presented with a combat-related blast injury of the hand between 2002 and 2018. The functional result was assessed by the disabilities of the arm, shoulder and hand (DASH) and the Orthotics and Prosthetics User Survey (OPUS, upper extremity functional status) scores. Proximal amputations (PAs) and distal amputations (DAs) were distinguished for the analysis.ResultsFifteen patients with a mean age of 31±8 years were included. They totalised 20 blasted hands. There were 16 traumatic amputations: 8 in each of the PA and DA groups. Twelve patients had additional injuries, four of which were polytraumatic. Skin closure time and flap use were higher in the DA group. Only one thumb reconstruction was performed. At a mean follow-up of 6.5±4 years, the number of amputees wearing a prosthesis was higher in the PA group. The mean DASH and OPUS scores were 35.5%±24.0% and 64.0%±19.0%, respectively, with no difference between the two groups.ConclusionThe severity of hand blasts related to warfare explosive devices requires the systematic application of damage control surgery. PAs are frequent and secondary reconstruction options are limited. The functional result is poor and similar between proximal and distal amputees.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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