EMERGENCY HAND CASE - STARTERS

This 19 yr old man had sustained injuries in an injection moulding machine at around 1 AM on 13 June 2009. Presented to us at 10.45 AM. Examination findings as below.

Skin loss on the dorsum of the left hand about 5 cm / 4 cm

Laceration on the palm

Extensor tendon loss for the ring finger ( 3 cm loss )

Bone loss _ about 2.5 cm on the IV metacarpal in shaft

No flexor tendon / neurovascular bundle injury

The segment that is missing is totally crushed.

What would be your plan of management?

We shall discuss what we did, in the next post and we can compare notes.

GREETINGS TO ALL

Hi, Everybody!
Greetings from the Institute for Hand and Microsurgery at Govt. Stanley Hospital, Chennai.
Great to meet you all in cyberspace!!
This seems to be a nice place to communicate, interact and make new friends.
We plan to make this blog a meeting forum for us.
As you may already be aware, several patient services and academic activities are being offered at the Institute. And as part of the Institute, we learn volumes from our patients and each one of the members of the Department. We would like to share this experience with all our friends and colleagues, worldwide.
We have Emergency Hand Injury Services 24 × 7. Every single patient treated here is special for us and receives our undivided attention. This sometimes throws up interesting and challenging cases that we shall share with you once a week.
Some hand problems are so challenging that it requires a combination of minds to solve the problem. These meetings are called the Specialised Evaluation And Research Clinics on Hand (SEARCH) signifying the search for the perfect answer for these unfortunate patients. One such case will be presented once a week and your participation will enrich us.
Every morning we have an Internal Audit, where the Consultant and Resident present the cases done on the previous day. The cases and the treatment modality offered are critically evaluated and any changes that need be made are immediately carried out. One such case will be presented for your analysis and evaluation.
We plan to start off with these discussions. We again reiterate that it is your participation that we value most.
Thank you.
Looking forward to meeting you every week.

History of the Institute

This institute was started as the department of Plastic and Reconstructive surgery in 1971 by Prof.R.Venkataswamy with 20beds (Phase I). In 1974,Hand Injury Service was started with a separate Hand Injury ward with 20 beds and a dedicated Hand Injury Operation Theatre (HIOT) exclusively for Hand and a separate database for Hand and Plastic Surgery were also established (Phase II).

This is the only Organised Center for Hand and Microsurgery in the country and renders the following specialized Hand Reconstruction and Rehabilitation services in addition to Plastic Surgery.

1. Surgery on acutely injured Hand.

2. Reconstructive Hand surgery - following trauma, burns, infection, congenital, etc.

3. Reconstructive Microsurgery

4. Anesthesia for Hand and Microsurgery

5. Hand therapy

In order to create human resources and broaden the services, Post Graduate Course in MCh plastic surgery was started in 1978 and the department was re designated as “Department of Plastic and Reconstructive Hand Surgery” in 1979. Exclusive Elective operation theatre complex with five tables (two for plastic surgery, one for microsurgery and two for day emergency hand injury) and a 20 bed ward for women and children and a dedicated physiotherapy section were established in 1982. (Phase III) The concept of early primary skin cover and in continuity management under one roof, unique documentation system and morning conference are the special features of this institute.

The department was upgraded as an Institute for Research and Rehabilitation of Hand and Department of Plastic and Reconstructive Hand Surgery with additional staffs and 20 beds in 1987(Phase IV) and recognized as center of excellence in 1998 with 6 bed ICU and later in 2003 a new building complex with 20 more beds were commissioned (Phase V)

In order to develop human resources and expand the services on this very specialized Hand and Microsurgical services, this Institute is divided into Department of Plastic and Reconstructive Surgery and the Institute for Hand and Reconstructive Microsurgery in 2008. (Phase VI), thus committed to the society to establish a new post graduate higher specialty course in M Ch Hand and Reconstructive Microsurgery and making the service more accountable and opened a new chapter in the management of a very important Regional Anatomical Organ – The Hand.

This institute has been designated as the Nodal Training Center for Hand and Microsurgery and a statewide Training Program for medical officers and paramedical staffs at all levels of healthcare delivery system has been initiated by the Government of TamilNadu with an announcement in the last Assembly Session ,April,2008.