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Complex Combined Thermal-crush Hand Trauma. Our 10 years Experience.
Dinu Iuliu Dumitrascu, MD PhD1; Alexandru Georgescu, Prof, MD; PhD2
1UMF Cluj, Cluj-Napoca, Romania; 2Plastic Surgery and Reconstructive Microsurgery Clinic, UMF Iuliu Hatieganu, Cluj Napoca, Romania

Introduction
Even rare, the combined thermal and crush injury is present in our service. The etiology of the trauma is especially due to misuse of industrial equipment. The cumulative insult results in a complex trauma that usually not only affects the skin but also nerves, muscles, tendons, vessels and even bone.

Materials and Methods
A total of 24 patients (mean age 46) were included in the study. 16 patients were female and 8 men. The etiology was a combined crush and burn injury sustained with heat press (flat or rotary). The patients were admitted from 2006 to 2016. All patients had skin defects that needed coverage with skin grafts or flaps. 15 patients had dorsal or palmar tendon injury, 8 had interosseous muscle injury and 3 had fractures in the hand. Defect coverage was obtained using skin grafts, pedicled flaps, perforator pedicled flaps or free flaps.

Results
In 8 cases free flaps were used to cover the defects. In 10 cases the coverage was achieved with the use of perforator pedicled flaps. In 2 cases, skin grafting and fascial pedicled flaps were used. In 4 cases, only skin grafting was necessary to achieve a good coverage. If needed, osteosynthesis and tendon grafting were performed.

Conclusions
Due to the complex injury mechanism, the tissue destruction is difficult to estimate. Usually a treatment in successive stages is mandatory. A good debridement is paramount in order to obtain a good result. If possible, we prefer the coverage with perforator flaps instead of free flaps due to early postoperative mobilization and shorter operative time.


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