PubMed · 16377821
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Emil Lesho. 2006. Hand in hand.. https://doi.org/10.1097/00001888-200601000-00015
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In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. This results in many victims and in cases of explosions in closed or semi-closed areas, often results in complex medical problems in many of the victims. An explosion that occurs as the result ofa bomb detonating can result in 4 patterns of injury: the primary explosion injury caused by the pressure of the blast, the secondary injuries caused by flying debris, the tertiary injuries caused by the explosion wind, and the quaternary caused by heat and fire. Common injuries seen following an explosion include: lung damage, neurological damage, abdominal injuries, bone fractures and skeletal damage and crush-syndrome. The triage occurs at the site of the explosion as well as on arrival in hospital. One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.
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We present our experience of two cases in which we carried out pollicisation of the index metacarpal based on the first dorsal metacarpal artery and venae comitans. Both cases were complex severe hand injuries where the initial injury was the result of a firework exploding while held in the hand. In both cases the radial side of the superficial palmar arch was destroyed by the injury. In both cases there was virtually complete loss of the thumb ray and amputation of the index through the base of the proximal phalanx. A useful opposition post has been created from vascularised index metacarpal with free flap soft tissue reconstruction.