By Norman Weinzweig MD FACS

This booklet is a treasure if you happen to search a entire textual content facing the traumatized or mutilated hand. (Doody's evaluate) The Mutilated Hand is a entire reference protecting all elements of the administration and remedy of mutilating accidents of the hand. it's the definitive ebook at the topic - either as a reference textual content in addition to a realistic device. every one finished bankruptcy incorporates a assessment of the literature in addition to old views; background of the approach; evolution of the therapy recommendations through the years; postoperative care; present cutting-edge administration; problems and sequelae with a number of the concepts; and comparability of practical effects utilizing many of the techniques.Stunning full-color illustrationsProvides hugely established layout in all chapters facing secondary administration of mutilating hand accidents together with: algorithms at any time when attainable to simplify the decision-making technique and illustrative situations demonstrating a number of the concepts in step by step style in colorAuthoritative insurance via well known overseas specialists in cosmetic surgery, hand surgical procedure, and orthopedic surgical procedure

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24 proposed that amputations of adjacent digits proximal to the digital webs are suitable for combined second- and third-toe reconstructions. 24 THE MUTILATED HAND FIGURE 2-11. Approach to reconstruction in relation to pattern of digital loss. METACARPAL HAND Central reconstruction Ulnar reconstruction RADIAL OBLIQUE AMPUTATION Ulnar reconstruction ULNAR OBLIQUE AMPUTATION Radial reconstruction Distal to this, combined toe units produce an unnaturally conspicuous, long palm-short finger reconstruction.

Comment Degloving injuries are serious ones that are usually caused by avulsion of soft tissue by a roller-type mechanism. No local innervated skin is available to resurface important tactile areas of the hand. Soft tissue coverage can occasionally be achieved by harvesting a skin graft from the degloved part. Often, a groin flap or emergency free flap is required. 4,5,7 A B Degloving injuries involve circumferential loss of innervated skin and the tactile surface of the hand. They are often associated with nerve, vessel, or tendon avulsion.

For a small defect, a serratus anterior muscle or gracilis muscle flap is recommended. For a medium-sized defect, a rectus abdominis muscle flap is best. For a large defect, including the dorsum of the hand and forearm, a latissimus dorsi muscle flap is most useful. Application of a skin graft over vascularized fascia provides the thinnest coverage and is often desirable over the dorsal surface of the hand. The special needs of a defect that can be C FIGURE 4-1. A, This patient sustained a crushing injury to the dorsum of the hand that resulted in a degloving soft tissue defect.

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