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Complex, serious injuries of hands in children are rare.

Between 2009 and 2015, 3 girls in age 2-3.5 years were admitted to our Department with serious injuries to hand caused by electrical meat grinder. Two had injuries to dominant right hand, one to the non dominant hand. The injuries happened at home. Two of the patients arrived at the hospital with the hand still crushed in the grinder. The hand and the forearm were drawn into the grinder, causing the fingertips to partly be left in the grinder, partly they wre visible at the exit of the grinder.

In 2 of the patients, 2., 3. and 4. digit had no vascularization, the thumb and 5.digit had intact vascularization. The digits with no vascularization underwent replantation followed by routine postoperative replantation regime. The other digits were treated for lacerations and fractures in multipel levels.

One of the patient suffered vascular compromise in 3. and 4. digit after 3 days, the digits were amputated 10 days after initial surgery. The 2.digit survived. This girl has since undergone 6 surgeries including revisions,skin transplants and corrections of scars. The last surgery was performed 1 year after the injury. The patient returned after last surgery back to Irak.

The second patient suffered vascular compromise in 2. and 3.digit day 1 postoperative and underwent resurgery for both arteries and veins. Revaskularization failed and digits amputated day 4 after initial surgery. 4.digit survived. During the first year after trauma, the patient underwent 9 operations. She is still under our care for hand therapy.

The third patient suffered amputation of the thumb and separate amputation of digit 2-5 in one block. The level of the amputations were proximal to the MCP-joints. After thorough trauma evaluation, replantation was not found indicated. Revision and split skin transplant were performed. The patient has since undergone 4 surgeries including revisions and correction of webspacescaring. The last surgery took place 14 months after trauma. The family has received information about possibilities of grip reconstruction with toetransfer and prosthesis. She has routine follow up visits in our outpatient department and by the children hand therapist.

Injuries in children hands caused by meat grinder are complex. The outcome of the replantation is challenging due to injuries at more levels. Regardless will these injuries require multiple surgical intevention and long term follow up.