Vascular injury of the hand

　　1, incisions occur when the skin, subcutaneous tissue, or deep tissue is cut or torn by sharp objects such as glass fragments or blade edges. The characteristics of the wound are relatively neat, small in area, but due to the injury of blood vessels, there is a lot of bleeding.

　　2, the common sharp objects in sharp instrument injuries are knife wounds, with smooth damaged walls, regular base, and no interstitial bridge. The hair at the damaged site is cut off, and the segment is neat.

　　3, bullet injuries, etc.

　　Severe hand vascular injury can be complicated with complete ischemic necrosis.

　　The characteristic pathological changes of ischemic necrosis are the death of bone cells due to the obstruction of blood supply. The severity of ischemic necrosis depends on the extent of damage to the circulatory system. The femoral head (hip) is the most common damaged site; followed by the distal femur and the humeral head (shoulder). The ankle bone, navicular bone of the wrist, and navicular bone of the foot are less frequently involved. Ischemic necrosis of the femoral head is a disease in which the blood supply of the femoral head is destroyed by different causes, causing bone necrosis of the femoral head, leading to a series of clinical manifestations such as hip pain and limited activity. It can occur in people of all ages and is a very common disease in clinical practice.

　　The blood circulation in the hand is very rich. Generally speaking, the rupture of the ulnar artery or radial artery alone will not affect the blood circulation of the hand. However, due to the possible variation of the superficial palmar arch formed by the ulnar and radial arteries, sometimes the injury of the ulnar artery or radial artery may threaten the blood supply of some fingers, which should still be taken seriously and carefully examined. Sometimes, both the ulnar artery and radial artery are completely ruptured at the same time. As long as the soft tissues on the dorsal side of the wrist are intact, and the interosseous dorsal artery and its collateral circulation can compensate, the blood supply of the hand will not be affected. In this case, even if the injured radial and ulnar arteries are not repaired, ischemic necrosis is generally not caused. Nevertheless, the injury of the main arteries in the hand, although it may not cause ischemic necrosis of the hand, will ultimately lead to insufficient blood supply to the hand, which will have a certain impact on the function of the hand.

　　There are currently no effective preventive measures for hand vascular injuries. Early detection and early diagnosis are the key to the prevention and treatment of the disease. Attention should be paid to concentration at work to prevent hand vascular injuries caused by machines, and for hand vascular bleeding, it is necessary to determine the amount of blood loss. If the blood loss exceeds 30% of the total blood volume of the body and continues to bleed, immediate fluid infusion and supplementation of blood loss should be performed. Treatment should be sought for the disease in a timely manner.

　　The diagnosis of hand vascular injuries mainly relies on clinical manifestations. In addition, related auxiliary examinations are also indispensable. X-ray examination shows no positive findings. Vascular ultrasound and CT can clearly show the injured site.

　　In addition to conventional treatment, attention should also be paid to some aspects of diet for patients with hand vascular injuries. Diet should be light and balanced. Foods that are刺激性 such as cigarettes, alcohol, coffee, strong tea, and various spicy seasonings such as scallions, ginger, garlic, chili, pepper, curry, etc., should be avoided.

　　1. Treatment

　　The treatment principle for the main vascular injuries of the hand, that is, the injury of the ulnar artery or radial artery, whether it is a single injury of the ulnar artery or radial artery, or simultaneous injury of both, regardless of whether the injury affects the blood supply of the hand after the injury, as long as the necessary conditions for vascular repair are met, vascular repair should be performed in the first stage. If necessary, vascular transplantation should also be performed to ensure sufficient blood supply to the hand, which is conducive to the recovery of various functions of the hand.

　　After vascular repair surgery, the injured limb should be kept in a flexed position at the wrist joint, and the forearm dorsal plaster splint should be used for fixation. Appropriate anticoagulant, antispasmodic, and antibacterial drugs should be used to prevent vascular spasm, thrombosis, and wound infection. Generally, the plaster splint is removed after 2 weeks of surgery, and the sutures are also removed at the same time, and functional exercise begins.

　　2. Prognosis

　　The general prognosis is good.