Francisco del Piñal, MD, Dr. Med.
Clinics in Plastic Surgery Vol. 47, Issue 4, October, Pages 461-489 – © 2020 by Elsevier Inc. All rights reserved.
ABSTRACT (full text pdf. below)
An Update on the Management of Severe Crush Injury to the Forearm and Hand
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.
- Microsurgery changes the prognosis of crush hand syndrome.
- Radical debridement should be followed by rigid (vascularized) bony restoration.
- Bringing vascularized gliding tissue allows active motion to be restored.
- Finally, the management of the chronic injury is discussed.
Keywords Crush syndrome, hand, compartimental syndrome, free flap, hand revascularization, microsurgery, frozen hand