Reconstruction of the distal part of the thumb after traumatic amputation. Restoration of function and sensation using nerve, tendon, and bone from the amputated portion.
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Biomedical subjects
Publications and source records attributed to C E NEMETHI.
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Crushing injury of the hand usually causes "explosive" damage. Subsequent swelling of the palmar structures further impairs venous outflow, and hemorrhage into structural spaces increases the pressure. The arterial system and the large dorsal veins, however, are seldom obstructed and provide adequate circulation unless hampered by improper bandaging. A bandage that compresses the dorsal veins causes back-pressure, which increases the swelling further and brings about ischemia. Swelling and pain cause the patient to restrict exercise of the injured hand, which permits contractures to develop. The author has averted this sequence in more than 100 cases by preserving integrity of veins during debridement, arresting hemorrhage, bandaging the hand with compression dressings in functional flexion, and reducing swelling with hyaluronidase. In these cases, on removal of bandages in 24 hours, swelling was reduced and continued to diminish. All patients exercised the hand at this time without discomfort and only a few required aspirin for pain.
Loss of sensation in a finger due to industrial injury is of rather high incidence as a cause of disability. In many cases "finger blindness" can be prevented by nerve repair immediately after injury. Over a period of three years at a clinic for treatment of industrial injuries, primary nerve repair resulted in 95 per cent of cases in usefully functioning digits.
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