A consideration of the tendons in hand injuries

I have given directions for the diagnosis of tendon injuries and for the exposure and identification of the cut ends, from nerves as well as from other tendons. In addition, I have expressed my personal conclusions regarding the disposal of the tendons in operations involving the loss of part of a digit.     

手部皮肤套脱伤的治疗

目的探讨手部皮肤套脱伤的治疗方法。方法2002年4月-2004年11月，治疗22例手部皮肤套脱伤患者，其中19例分别通过吻合血管、套脱皮肤修薄回植及多切口引流等方法进行修复。另有3例，因无法行套脱皮肤回植而采用腹部带蒂皮瓣修复。结果术后随访3个月-1年。19例套脱皮肤原位回植患者中，13例皮肤完全成活，4例有部分皮缘坏死，经中药换药后愈合，2例行切痂植皮术后治愈。手功能按ATN功能评分评定：优9例，良7例，中3例，优良率为84％，患者对手外形及功能满意。3例腹部皮瓣修复者，皮瓣全部成活。术后随访5个月-1年，手外形及功能明显差于皮肤原位回植者。结论尽可能地回植手部套脱皮肤，对手功能及外形的恢复具有重要意义。     

Treatment of blast injuries of the hand

INTRODUCTION: Blast injuries of the hand result from the manipulation of handmade explosives, the blast causes most damage in the first web. Our purpose is to propose a classification of these injuries so as to lead to a therapeutic strategy. METHOD: We report a series of nine blast injuries of the hand in eight patients of average age 24 years. The aetiologie was handmade explosive manufacture (five cases) and the manipulation of munitions (four cases). Five hands presented an amputation of the thumb together with the index and in three of them, the long finger was involved as well. Only one thumb was revascularised successfully. Four thumbs were reconstructed, two by toe transfer, and two by "index bank". DISCUSSION: We observed four different stages: Stage 1: Isolated musculo-cutaneous injury. An intermetacarpal pin avoids first web contracture. Skin coverage is achieved by a pedicled local flap or a skin graft. Stage 2: Osteo-articular injuries of the thumb and second ray but sparing the trapezo-metacarpal joint. The thumb reconstruction is often based upon rinciple. Stage 3: Characterised by a destructive injury of the trapezo-metacarpal joint. Stage 4: Amputation or devascularization of the thumb. Extensive vascular injuries neccessitate a bypass from a healthy zone. The amputations, which are mostly proximal, require a preliminary osteocutaneous reconstruction of the first metacarpal before any toe transfer. Finger translocations are made difficult because of the high rate of serious injuries of the index and palm.     

What determines the sick leave of repair and rehabilitation of the hand flexor tendons injuries

OBJECTIVES: The purpose of this study is to analyse the relationship between the social and economical consequences, after repair and rehabilitation of the hand flexor tendon injuries, and to prove that it is not related to local factors. METHOD: All the patients who underwent surgery for at least one flexor tendons injury of one or several long fingers, between the years 2003-2004 were included in this study. Information regarding the data was taken from the patient file. Statistical tests were used for analysing these data. RESULTS: Significant first rate factors related to the length of sick leave are the chaotic professional history (P=0.03), the type of occupation (P=0.01) and the age (P=0.0002). A significant second rate factor is represented by the type of mobilization/retraining (P=0.04). Sex, side of injury, finger injured, zone of injury, associated damages, did not significantly influence the results of this study. CONCLUSION: The environmental factors determine the length of sick leave more than the characteristic of injury in hand flexor tendons surgery.