Open hand wounds

　　Open hand wounds are caused by traumatic factors, with a variety of wound-inducing factors, such as object striking, knife wounds, glass cuts, machine striking, and artillery explosion, etc., which can all cause open hand wounds.

　　Patients with hand wounds may experience hand bleeding, and severe cases can manifest as massive bleeding affecting blood circulation, leading to limb swelling. Patients who do not pay attention to early exercise after surgery may develop tendinous and joint adhesions, resulting in dysfunction. Severe cases can cause joint stiffness and traumatic arthritis. In addition, the most common complication of open hand wounds is infection, and its main causes include: severe tissue destruction due to mechanical entanglement, crush injuries, unclear distinction of necrotic tissues, incomplete debridement, and so on.

　　Open hand wounds are mainly manifested as bleeding at the wound site. When combined with skeletal and nerve injuries, it can result in limb dysfunction. Another most important issue is the infection caused by trauma. Directly violent open wounds are divided into three regions according to their pathological changes:

　　The most superficial central part is the 1st region, which contacts with the wound-inducing object and air and is the main contaminated area.

　　The surrounding area is the 2nd region, which is torn, compressed, extinguished, and causes necrosis of tissues and loss of vitality of cells due to violence. Debridement also requires the removal of tissues.

　　The third peripheral area is the third zone, which is the tissue concussive reaction zone. Due to the compression and shock of violence, tissue edema, increased exudation, vascular spasm, and reduced cell vitality, if infection does not occur, vitality can be restored, debridement can be thorough, that is, remove the tissue of 'Zone 2', but only when it is clear whether the tissue is viable, can a decisive choice be made.

　　Open hand trauma is caused by traumatic factors, so paying attention to safety in production and life is the key to preventing this disease. In social production activities, through the harmonious operation of people, machines, materials, environment, and methods, various potential accident risks and injury factors in the production process are always kept under effective control, effectively protecting the lives and health of laborers. In addition, it is necessary to strictly implement preoperative and postoperative nursing measures, pay attention to psychological care, closely observe changes in the condition, and do a good job of pain relief and functional exercise, guide patients in recuperation, and prevent the occurrence of joint stiffness.

　　Open hand trauma can be diagnosed according to the symptoms of the affected area, and it is not necessary to use other auxiliary examination methods. Only when there is a suspicion of other injuries in the patient, such as fractures and nerve damage, other examination methods need to be used to assist in diagnosis, such as X-ray examination and limb function examination.

　　The diet of patients with open hand trauma should include high-protein, high-sugar, collagen-rich, trace elements (copper, zinc, iron, calcium), and vitamin A, C-rich foods such as lean meat, pork skin, liver, egg yolks, dairy products, carrots, fresh vegetables, and fruits to provide sufficient nutrition, which can promote wound healing and body recovery.

　　A considerable amount of blood is lost during the process of injury and wound suture, so iron-rich and blood-building foods such as peanuts (shell removed, best eaten raw), spinach (both iron-rich and rich in dietary fiber), animal liver (not overcooked to avoid nutrient loss), and Eucheuma are indispensable in the patient's diet; in addition, during the process of wound healing, the body needs to supplement an adequate amount of protein and vitamins.

　　The initial surgical management of open hand trauma is the main link in the treatment of hand trauma and also the basis for future treatment. The principles of treatment are: early and thorough debridement to prevent wound infection; try to repair the damaged tissue and maximize the retention of hand function. The specific steps are: debridement, tissue repair, wound closure, and bandaging. Wounds should be promptly relieved of pain, and tetanus antitoxin and anti-infection drugs should be administered. Detailed content is as follows:

　　1. Anesthesia

　　Surgery should be performed under complete anesthesia. For simple外伤, finger nerve block anesthesia can be used; for wounds involving the palm, back of the hand, or multiple finger injuries, wrist nerve block can be performed; for larger wounds, it is best to perform under brachial plexus anesthesia.

　　2. Debridement

　　The purpose of debridement is to remove dirt and foreign objects from the wound, remove tissue that has lost vitality, and convert a contaminated wound into a clean wound (not sterile) to prevent infection, with specific methods as described in the general trauma chapter. However, it is emphasized that:

　　1. Pay careful attention to wound cleaning, although the method is simple, it is an important step in preventing wound infection and should be carried out very seriously.

　　2. The principles of debridement should be followed, debriding from the outside to the inside, from the superficial to the deep, and planned debridement should be performed layer by layer. The hand structure is complex, delicate, and rich in circulation, and it is necessary to try to retain tissues with blood supply during debridement and minimize the excision of skin edges.

　　3. During planned debridement, a comprehensive and systematic examination of the damaged tissues should be conducted to estimate the extent and range of the injury. If necessary, the tourniquet should be released to observe the circulation of tissues (such as muscles, skin, etc.) in order to formulate a comprehensive surgical plan.

　　III. Treating Damaged Tissues

　　In daily hand injuries, as long as the conditions permit, the damaged tissues should be repaired as early as possible. Because at this time, the anatomical relationship is clear, secondary changes are slight, and not only is the surgical operation easy, but also the effect is good, and the functional recovery is fast.

　　IV. Closing the Wound

　　Closing the wound is an important measure to prevent wound infection. Only by thoroughly debriding and closing the wound can the exposed deep tissues be protected, bacteria invasion be prevented, and infection be prevented. The hand has abundant circulation and strong anti-infection ability, and the time limit for closing the hand wound can generally be extended to 12 hours after injury, but it is not fixed and unchangeable. It can be increased or decreased according to the nature of the injury, the degree of contamination, and the temperature, etc. There are the following methods to close wounds:

　　1. Direct suture is used when there is no defect or only a small defect in the skin, which can be directly sutured, but it is strictly forbidden to force tension suturing. For straight incisions that cross joints, are perpendicular to the palm creases, and parallel to the web of the fingers, local 'Z' shaped skin flap transfer should be performed to avoid scar contracture.

　　2. In free skin grafting, the base of the skin defect wound still retains a well-vascularized tissue bed, and there is no exposure of bone and tendons, which allows for free skin grafting. Small exposed bone and tendons can be covered with nearby soft tissue (muscle, fascia) or soft tissue flaps, and then skin grafting is performed. Generally, medium-thick skin grafts are preferred, and the palmar surface and fingers can also be grafted with full-thickness skin.

　　V. Bandaging and Immobilization

　　It is very important to bandage and immobilize hand injuries. After surgical treatment for bone and joint injuries, the injured part should be bandaged and immobilized in the functional position. After repair of tendons and nerve injuries, the injured part should be bandaged and immobilized in a tension-free position.