La main catastrophique (III): possibilités de microchirurgie pour les patients gravement blessés

26 avril, 2016

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Ci-dessous vous pouvez lire une traduction de traducteur humain en anglais. Vous avez également accès à l’original espagnol en cliquant sur le drapeau dans le coin supérieur droit. Ce lien vous donne accès à une version de traduction automatique de Google en français: http://bit.ly/2NbfHGp

There is no narrow definition of catastrophic hand, but with these couple of terms we describe an upper limb with limited functionality, bone malunions and aesthetical damages (mutilations and amputations, for example) after severe trauma.

A fourth factor is to be added to the forementioned three, a key one also: the contextual perception of the patient, depending on such variables as their pre-injury occupation, the psychological resilience in order to face it, etc.

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Patient operated by Dr. Del Pinal after suffering serious injuries to his fingers with a circular saw. The second and fourth finger lost vascularization. The third finger, amputee, was not reimplantable, but became the source of 1) bone graft for the thumb, 2) vascularized osteochondral graft for the fourth PIP joint 3) non vascularized nerve graft for thumb and forefinger. The patient returned to his job as a carpenter five months after the accident.

In this clinical scenario of great complexity, the surgeon Francisco del Pinal is an international benchmark both on research and development of new surgical techniques, and on  their implementation in the operating room.

His article  ‘Severe mutilating injuries to the hand: guidelines for organizing the chaos’ is still the guiding line in the microsurgical approach to such cases; almost a decade after its publication in 2007 by the Journal of Plastic, Reconstructive & Aesthetic Surgery, official journal of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the European Association of Plastic Surgeons (EURAPS).

According to Del Piñal, in contexts of catastrophic hand the starting point before surgery must be saving the salvageable, giving priority to basic structures such as joints or flexor tendons, without losing view of the aesthetic factor, the final appearance of the limb, which is inseparable from the functional outcomes.

From their perspective, the work of early intervention teams is key, so afterwards this first contact the case is referred to physicians and teams capable to perform the microsurgical techniques that nowadays offer hope to patients with extremely limiting departure situations

Dr. Del Piñal offers the general fundamentals of this profile of trauma in this new blog post (OV).

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