Selected Features of Our Program

Evaluation and Diagnosis

Open wounds on the hand and upper extremity can occur anywhere from clean lacerations to heavily contaminated crushed tissue. In addition to the skin, damage may have occurred to nerves, blood vessels, tendons, muscles or bones. Identifying such damage is usually possible with a simple physical examination combined with x-rays. Sometimes the damage cannot be fully appreciated until the wound is inspected at the time of surgery. All wounds must be taken seriously as severe consequences can result from improper treatment. Wounds should be treated as quickly as possible to minimize complications.

Treatment and Recovery

A clean wound seen soon after injury can be directly sutured in the emergency room. Deeper, non-critical injuries can be repaired later within a short time frame. More extensive or contaminated wounds should go directly to surgery. Surgery for traumatic wounds can be broken down into four steps. The first is to remove any tissue that is not completely healthy and clean the wound's entire surface. Second, the deeper parts of the wound are checked for injury to any important structures such as nerves, blood vessels, or tendons. Third, these structures are repaired along with any fractures. Fourth, the wound is closed or covered. With more complex wounds, direct closure is not possible due to the amount of damage in the surrounding tissues, and special coverage techniques are required. Special coverage strategies include transferring other tissue nearby to cover the open area or skin grafting. Sometimes a very sophisticated technique is required where tissue is completely transplanted from one area of the body to the wound area. This is called a "free flap" and requires very specialized microsurgery expertise. Most patients heal their wounds and are able to return to their previous lives. Of course, some injuries are more extensive and require many months of therapy and additional reconstructive surgery to achieve maximum function.