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[Postoperative treatment in the surgery of acute hand injuries].

Errors happen most often in emergency cases because of insufficient theoretical and practical knowledge and disrespect of the basic principles for the hand management. It is neglected in many surgical wards because of overworking of surgeons with other emergency cases. The hand is usually managed by a junior physician, quickly and inadequately because he is insufficiently trained for such a complicated job. To prevent the consequences of such work which more or less leads to disability, in each medical institution one surgeon should be educated in the modern care of the injured hand. Nowadays, the centres for hand surgery are being established where the hand is reconstructed in team work. It includes the plastic surgeon, orthopedic surgeon and physiatrist and the microsurgical methods are applied for ideal suturing of the nerve or the blood vessel. After hemostasis, immobilization, elevation, pain relieving, protection against infection have been performed the general surgeon should refer complicated cases to the institution where the hand is managed by the team.

Hand Injuries↗

[Management of open, potentially infected hand injuries with bone defect by delayed early bone substitution].

Authors make an analogy between the principles of treatment of the fresh, potentially infected injuries with bone and soft tissue defects and of the already developed manifest infection of the hand. The principles of treatment are essentially the same. First of all the fixateur externe and the antibiotics containing globules are suggested for the sanation and prevention of the disease equally. Attention is called to the fact, that better results can be expected from the prophylaxis than from the attempts to make the process reversible. The beneficial synergism of the extrafocal fixation and the intrafocally acting antibiotics will help. One of the secrets of the good late functional results is the early restitution of the architecture of the bones of the hand. For this, the authors suggest the most modern replacement of bone in the form of primary delayed cancellous bone plasty, performed within two weeks.

Anti-Bacterial Agents↗

Skin cover in extensive hand injuries.

The concept of 'axial-based' flaps has revolutionised the replacement of full-thickness defects of the skin and subcutaneous tissue of the hand. The groin flap provides extensive skin replacement, and has the advantage of allowing considerable mobility of the hand, elbow and should during the period of attachment.

Abdomen↗