This document outlines principles for hand trauma management. It discusses initial survey and resuscitation, washing and dressing wounds, and splinting the hand. A secondary survey involves assessing history, vascularity, muscles/tendons, soft tissue defects, fractures, and imaging. Informed consent is required. Reconstruction may use early or delayed approaches. Early approaches reconstruct skeletal stabilization, vascularity, nerves, tendons, and soft tissue within 72 hours. Wound excision is classified as tidy or untidy wounds. Skeletal stabilization uses plates or external fixation. Revascularization uses end-to-end anastomoses or grafts. Nerves are repaired or transferred. Tendon reconstruction is early for simple fractures but staged for

1. PRINCIPLES
HAND TRAUMA
MANAGEMENT
Mansoor Khan (M.B.B.S)

3. initial survey &
Resuscitation…..?

5. wash THE WOUND...

6. dress THE WOUND…

7. splint hand in POSITION OF
SAFE IMMOBALIZATION (POSI)

8. AMPUTATED PARTS
1
2
4
3

9. Secondary
survey..?

10. SECONDARY SURVEY
HISTORY
Occupation, hobbies, hand
dominance, mechanism of
injury, position of hand
during the insult, duration,
treatments already offered,
protocol of amputated part
transportation,
Past history: Co-morbidities,
any past surgery of on the
injured part.

11. vascularity: PERIPHERAL PULSES, CAPILLARY REFILL

13. muscle/tendons: LOSS OF MOVEMENT,
DECREASED POWER OR PAINFUL MOVEMENT

14. soft tissue defect:SIZE, LOCATION, CONTAMINATION
LEVEL, DONOR SITE ASSESSMENT

15. fractures: PAIN, TENDERNESS,
DEFORMITIES (SCISSORING OF FINGERS)

16. x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE
VIEWS

17. CT scan: BONE S & JOINTS DEFORMITIES

19. INFORMED CONSENT

20. Reconstruction….?

22. SENSIBILITY,
FLEXIBLE DIGITS (ATLEAST TWO..)
POWER & ACTIVE MOVEMENT
ACCEPTIBLE ASTHETICS
functional hand…..?

23. UPPER LIMB
RECONSTRUCTION
Delayed
approach
Skeletal
stabalization/
vascularity/ skin
cover -- early
Nerve/tendon/skel
etal reconstruction
is delayed
Early
All the
components are
reconstructed
within 72hrs

25. 1
CAREFUL WOUND EXCISION

26. 1
tidy wounds: sharp, fresh (<24h)

27. 1
untidy wounds: CRUSHED, CONTAMINATED, INFECTED,
DEVITALIZED, DELAYED….. Delayed primary closure

28. 2
SKELETAL STABALIZATION
Simple fractures: ORIF
Bone gaps: EX-FIX OR
EARLY BONE GRAFTING
AND PLATING

29. 3
revascularization; END TO END, REVERSED VEIN GRAFTS

30. 4
nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS

31. Tendons
reconstruction
early: WHEN EARLY
MOBILIZATION IS
POSSIBLE (SIMPLE
FRACTURES)
staged:
MULTIPLE/COMPLEX
FRACTURES,
PULLEYS/SYNOVIAL
SHEATHS DESTRUCTION,
CONTAMINATION
5

32. 6
Soft tissue
reconstruction
TYPE, SIZE,
LOCATION,
MISSING
STRUCTURES,
CONTAMINATION
LEVEL, FUTURE
SURGERIES

33. 6
Soft tissue reconstruction
OCCUPATION OF THE PATIENT,
MENTAL STATUS,

34. 6
primary healing: TENSION FREE CLOSURE

35. 5
primary healing: SKIN GRAFTING
AVOID: exposed vital structures, plan of
re-exploration)

36. 5
primary healing: LOCAL FLAPS

37. 6
primary healing: REGIONAL FLAPS

38. 6
primary healing: DISTANT FLAPS

39. EARLY MOBILIZATION
7

40. REPLANTATION

41. INDICATIONS..