MAJOR TRAUMA AND DEGLOVING UPPER LIMB INJURIES
Major trauma to the hand and upper limb can be devastating injuries that change the course of life for the injured person. These injuries usually involve a high energy mechanism like industrial machines, heavy weights or high speed car and motorbike accidents.
These injuries are commonly associated with other injuries of the chest, spine or lower limbs. It is therefore essential that these injuries are evaluated and treated in a tertiary dedicated specialist unit.
Major trauma injuries usually involve fractures of the skeletal bone structure associated with soft tissue injury, invariably involving the skin, muscle-tendon units and arteries and nerves. It is imperative that a hand specialist manages these injuries. Priority is always given to save the limb, which requires resuscitation of the patient to ensure good vascular perfusion of the limb. Sometimes urgent revascularization is required. The bone framework is fixed to create stability to allow initiation of early movement. Tendons and nerves are meticulously repaired to ensure the best outcome. Soft tissue cover is important and soft tissue reconstruction might be required. Soft tissue coverage can be obtained with full thickness flaps or skin grafts. These injuries always require prolonged rehabilitation.