Open hand injuries refer to any injury that penetrates the skin of the hand whether it's in the palm or the back of the hand, and where the subcutaneous fat is exposed. These injuries can be as minor as a small cut created by trying to remove an avocado pip with a sharp knife, or could be catastrophic like an industrial or farming accident where there is a large injury zone affecting the skin, muscles, and tendons, as well as the bone and joints. Whether the injury is small or big, our approach is generally the same.

The wound is surgically debrided and all excess dirt is removed and washed out. A surgical exploration is done of all the involved anatomical structures. The skin will be open slightly and any structural damage to the nerve, arterial blood supply, tendons, and all the ligaments are repaired at the same time. These injuries are commonly associated with fractures of the hand, and this is usually internally fixated with a plate and screws to ensure a solid fixation and facilitate mobilizing the hand as early as possible. Whenever a wound penetrates the joint, especially around the knuckles, there is a high risk of infection and a washout is imperative.

Treating hand wounds requires the care of a specialist who has the expertise to suture these wounds in a specific way that allows post operative movement. In the acute phase, all fingers are immobilized to facilitate healing for the first few days and then a very purposeful rehabilitation plan is undertaken as soon as possible, to start mobilising the hand.

A sub-section of open injuries pertains to bites, whether it is animal or human bites. These we treat very seriously, as typically animal bites, like cat bites, have very small, but deep penetrations and cause bacterial seeding. It is therefore imperative that these wounds are treated urgently with surgical debridement and intravenous antibiotics.