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The potential for acute injuries is
ever present in our work and leisure
activities. These injuries often take the
form of puncture wounds, cuts and burns,
and frequently lead to infection. The
gourmet cook, week-end woodworker, auto
mechanic or sailor can sustain injuries
resulting in skin loss, tendon or nerve
lacerations, or even fractures in the more
violent crushing injuries. Regardless of
the nature of the injuries, accurate
diagnosis, early treatment, and careful
planning for future possible surgery is
necessary to achieve maximum recovery.
 Skin
Loss
Slicing injuries, crushing injuries or
burns can result in loss of skin. When
minimal, such as in minor finger tip
injuries, effective treatment requires
nothing more than soaking, dressing
changes and the encouraging of motion in
both the injured and uninjured fingers.
With more complex lacerations, crushing
injuries and burns, careful consideration
as to wound care and protective splinting
methods is essential.
Surgical reconstruction by skin grafts
and skin flaps harvested from other areas
of the body, combined with timely hand
therapy methods, can avoid disabling
scarring and stiffness.
Tendon and Nerve
Injury
Tendon and nerve injury demands an
even higher level of judgment. The
decision to repair such injuries
immediately, delay repair for several
days, or even abandon initial repair in
favor of later reconstruction can make the
critical difference between an expedient
or a protracted recovery.
Further considerations impact the
complexity of these decisions. For
example, an appropriate course of action
for a musician may be inappropriate for a
self-employed mechanic. Where an attempt
at aggressive reconstruction of a finger
with tendon or nerve injury might be
necessary for a musician , amputation, as
radical as it may seem, may be the most
appropriate course of action for the
self-employed mechanic.
Bone
Injury
When bone injury accompanies skin,
nerve and tendon injury, the priorities
and complexities increase dramatically. In
general, surgically stabilizing fractures
and achieving skin coverage takes
precedence over tendon and nerve repair.
The principle behind this approach is to
avoid the development of infection before
considering any surgical
reconstruction.
Infections
Infection of the hand is a double
edged sword. When diagnosis and treatment
are delayed or inadequate, irreversible
scarring and stiffness is almost
guaranteed.
In contrast, prompt recognition and
aggressive treatment of the hand and upper
extremity infection almost always ensures
complete functional recovery. This
requires an understanding that most hand
infections will not respond to antibiotic
treatment alone and must be surgically
treated.
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