[Modern aspects of aftecare of hand injuries].
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Due to favourable survival rates in replantation surgery and a high standard of free tissue transplantation, the interval between injury and microsurgical reconstruction has continuously decreased in the past. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to "urgence différée" procedures within 72 hours. Bearing in mind the infection rates of 1.5% and 17.5% respectively as it has been reported in the literature, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1991, 674 free tissue transplantation have been performed in our unit, 61% of the cases of free tissue transplantations to the upper extremity were done in the acute phase, the majority within 72 hours (urgence différée). No significant differences in rates of infections were evident comparing acute phase and urgence différée procedures. Because of this, we still support the concept of urgence différée. In our opinion the following advantages have to be considered: urgence différée allows a second loop operation, the vitality of the extremity can be ascertained, and the reconstructive procedure can be planned more precisely. Last not least, a procedure performed during the day-time assures better operating conditions. This concept is demonstrated with clinical cases.
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A review of all cases of operative hand surgery at The Adelaide Children's Hospital during the period January 1-June 30, 1988 yielded 38 cases that resulted from trauma (burns and fractures excluded). Lacerations from uncapped galvanized-iron fences occurred in 10 patients. Of these patients, two patients required skin grafts, seven patients had flexor-tendon injuries and three patients suffered digital-nerve lacerations. Twenty-five fingers were damaged. The pattern of injury involves multiple digits at different levels, with distally-based skin flaps, frequent divisions of flexor tendons and less-frequent nerve damage. This serious injury is common in South Australia but could be prevented easily by capping all iron fences.
This is a review of six patients presenting with severe injuries of the dorsum of the hand following motor vehicle accidents. In each case the injury was sustained by the hand being trapped between the road and the overturning vehicle. The injured hands were either outside the window or passed through the open window at the time of the accident. These injuries were all sustained during the summer months.
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There is a disturbingly high incidence of heavy machinery, industrial hand mutilation, involving recent Pacific Island immigrants many of whom have a poor comprehension of English. A survey of cases admitted to the Hutt Hospital during eight monts of 1973, showed a proportionately greater incidence of severe injuries amongst these immigrants, and indicates that one causative factor is unsuitable selection of works for this dangerous machinery, coupled with inadequate instruction in its use and safety precautions.
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