Mutilating Hand Injuries - Challenging Frontier Our Experience

Authors: KHALID ALAWADI, GOWRISHANKAR SARAVANAMURTHY, CHAITANYA GANGADHAR DODAKUNDI, NEBOJSA JOVANOVIC, BASEM SARAJ, MOHAMED FATHI SEIDAM, ABDELHAKIM MAREI, HAMED BADAWI

DOI: 10.18231/j.ijos.12883.1760085363

Keywords: Mutilating Hand injuries, Amputation, Reconstructive surgery, Severe hand injury, Debridement

Abstract: Background: Severe hand trauma can lead to extensive soft tissue and skeletal defects, necessitating advanced plastic surgical reconstruction to optimize both functional and aesthetic outcomes. Aim: This study aims to present our approach to the management of mutilating hand injuries at Rashid Hospital, Dubai, United Arab Emirates. Materials and Methods: This retrospective study analyzed patients with severe hand injuries treated between 2017 and 2020, who underwent either surgical or non-surgical management. Data collected included the extent of tissue damage, the number of surgical procedures performed, treatment strategies, and the mean hospital stay, which was recorded from the initial presentation to the last documented inpatient or outpatient visit. Documented complications occurring during the hospital stay were also evaluated. Results: A total of 34 patients were included in the analysis, of whom presented with severe degloving injuries. The mean age of the patients was 35.21 ± 10.11 years, with the majority aged between 21 and 50 years. The most common injury types were crush injuries (47.1%), degloving injuries (20.6%), and multiple traumatic amputations (26.5%), with grinder machine accidents accounting for 67.6% of cases. Patients underwent an average of 2.62 ± 1.18 surgical procedures, including skin grafting (29.4%), replantation (26.5%), and pedicled flap reconstruction (17.6%). Complications were observed in 41.2% of patients, including infections (35.3%), non-viable fingers (5.9%), poor functional outcomes (23.5%), and joint stiffness (14.7%). However, 58.8% of patients had an uncomplicated postoperative course. Conclusion: This study underscores the complexity of managing mutilating hand injuries, where the need for multiple surgical interventions often results in suboptimal outcomes due to complications such as infection and joint stiffness. The findings emphasize the importance of early intervention, individualized treatment planning, and optimized postoperative care protocols to enhance recovery and improve functional outcomes. Keywords: Mutilating Hand injuries, Amputation, Reconstructive surgery, Severe hand injury, Debridement Level of Evidence – IV