AOTrauma Masters CourseCurrent Concepts Module 3 Case 2

AOTrauma Masters Course―Current Concepts Module 3, Case 2: Wide posttraumatic loss of skin coverage of the hand wrist with exposure of arteries, nerves, and bone and associated loss of the fingers and thumb Davos Courses December 2018

Case description • 47 -year-old food industry worker • Sustained severe injury to his dominant hand • Injury while operating a flour mill • Series of surgical debridement were performed in a regional hospital • Patient was seen (follow-up) 1 week after injury

Discuss 1. Describe the injury and patient requirements 2. Plan of reconstruction 3. The question of complex reconstruction versus early amputation and prosthesis

• Free lateral arm flap was used to reconstruct the ulnar aspect of the hand

• Free wrap-around flap combined with dorsalis pedis flap was used to reconstruct the thumb and the volar aspect of the hand; skin graft was used to cover the dorsal aspect

Postoperative • 1 year

Postoperative • 8 years

Learning objectives • Evaluate injury and identify the exposed anatomical structures • Emphasize importance of the functional requirements of the patient • Explain usefulness and benefits of early microsurgical reconstruction (emergency free flaps) in this type of injury based on the published evidence • Select in the reconstructive ladder of soft-tissue coverage the adequate procedure considering the injury presented