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Mangled Upper Extremities: Our Experience
Francesco Gargano, MD, PhD; Karen Szymanski, DO; Silvio Podda, MD
St. Joseph's Medical Center, Paterson, NJ

Introduction: Severe blast injuries represent a surgical challenge for the concomitant poorly vascularized soft tissues and multiple hand fractures. Controversies of treatment exist regarding the need of multiple surgical attempts to save the severely amputated limb
Materials & Methods: Two cases of severe blast and avulsion injuries are presented. Clinical examination in both cases showed severe right mangled hands with devascularization of the thumb, index, middle fingers. Multiple metacarpals, phalangeal fractures were present. Soft tissues were devascularized. Surgical priorities in order of importance consisted of: 1)debridement of devitalized tissues, 2)thumb reimplantation , 3)open carpal tunnel release and forearm fasciotomies, 4) reconstruction of the soft tissues with fillet flaps, groin flap and integra placement, 5) open reduction and internal fixation of multiple fractures
Results: Postoperative, one patient required further debridement and soft tissue coverage with groin flap. Hand therapy was initiated and good progresses were achieved. Sensation of the right thumb was present in both cases and assessed with light touch and two point discrimination test. Pinch and grasping was achieved in both cases.
Conclusions: Severe blast injuries represent a challenge and should be address with the following algorithm: debridement, reimplantation and revascularization, stable soft tissue coverage and bone fixation.


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