Francisco del Piñal, MD, PhDa, Esteban Urrutia, MD, Maciej Klich, MD

Clinics in Plastic Surgery Vol. 40, Issue 4, April, Pages 233-255 – © 2016 by Elsevier Inc. All rights reserved.

ABSTRACT (full text pdf. below)

Severe Crush Injury to the Forearm and Hand. The Role of Microsurgery 

Summary  Crush injuries rate among the most feared injuries for hand surgeons. Stiffness, deep infection, chronic pain, and late amputation are frequent outcomes. In the authors’ experience, radical debridement of devitalized tissues, rigid fixation, and widespread usage of microsurgery to achieve rapid healing have dramatically altered the outcomes for this type of injury. In this work, the authors illustrate how adipofascial free flaps, along with free bone forming flaps, allow the surgeon to provide the ideal environment for healing. Toe transfers can dramatically
improve function in digital defects.

Key points

• Microsurgery changes the prognosis of crush hand syndrome.
• Radical debridement should be followed by rigid (vascularized) bony restoration.
• Finally, bringing vascularized gliding tissue allows active motion to be restored..

Keywords Crush syndrome, hand, compartimental syndrome, free flap, hand revascularization, microsurgery.

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