Abstract :
Background: Mutilating hand injuries are severe multi-structural traumas that commonly result from high-energy mechanisms such as industrial accidents, kitchen equipment entrapment, road traffic collisions, gunshot wounds, and agricultural machinery injuries. These injuries involve extensive tissue trauma and simultaneous damage to multiple structures, posing significant challenges in restoring hand function and aesthetics.Aim: This study aimed to present our approach to managing mutilating hand injuries at Rashid Hospital, Dubai, United Arab Emirates.Materials and Methods: We conducted a retrospective cohort study of 214 patients (including 34 severe cases) who sustained mutilating hand injuries between January 2017 and January 2020. The inclusion criteria encompassed severe soft tissue defects, extensive damage to the digits, metacarpus, or carpus, and amputations. Surgical management followed a structured protocol, including debridement, selective replantation, and soft tissue coverage with split-thickness skin grafts or pedicled/free flaps. Postoperative care included multidisciplinary monitoring, antibiotic therapy, and early rehabilitation. The key parameters assessed were injury extent, number of surgeries, treatment patterns, hospital stay, and complications.Results: The most common injury was single-finger amputation (48 cases), followed by multiple-finger amputations (21 cases). Severe cases underwent 2–4 surgeries per patient, with hospital stays of 5–19 days. Wound coverage varied and included secondary closure, skin grafts, pedicled and free flaps, and replantation. Complications included infections (35% in severe cases), replantation failure, and joint stiffness. Tailored interventions, early debridement, and structured reconstruction optimized early functional outcomes.Conclusion: A multistage, individualized surgical approach facilitates functional restoration in patients with mutilating hand injuries. Despite the descriptive nature of this single-center study, our findings highlight the importance of early debridement, revascularization, and soft tissue coverage. Further prospective studies with standardized functional outcome measures are required to validate these results.
Keyword :
Mutilating hand injuries, Amputation, Reconstructive surgery, Severe hand injury, Debridement