Case of the Month – UXO Hand – Part 2 Now Live

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Aeromedical evacuation to a higher echelon care facility was not approved for this patient.  The surgical team’s first task was to clean and revise her amputations. They removed her index finger metacarpal because it was already fractured near its base and removed about half of her middle finger metacarpal to debulk the closure/flap area.

“We needed to pin her metacarpal fracture but didn’t have a C-arm, so we did the best we could in this deployed austere environment” the surgeon recounted.

Doing what they could without subspecialty availability or modern fluoroscopic imaging, the surgical team then performed a closure with a drain.  They made sure the closure wasn’t under tension and Muna Z. could reach the tips of her ring and small fingers with her thumb.

  

“We tried to do as much as we could for her, seeing how she’ll only have access to very limited care at an Afghan hospital, which is where she’ll be transferred next.  We also gave her father a bag of food and some military blankets.  The entire surgical team was near tears as the appreciative father spoke to us in translated statements of thanks when his daughter was ready to be discharged from care.”

If Muna Z.’s fracture and soft tissue wounds heal, she should have a functional hand for gripping.

Question: 

What other options could be considered for soft tissue coverage of a hand if local coverage is needed?

2 thoughts on “Case of the Month – UXO Hand – Part 2 Now Live”

  1. In this area a full thickness flap (primary closure donor site) from the antecubital fossa or groin is excellent durable resurfacing — pie crust and with a bolus to hold in place is an excellent method for thumb-finger web space and will contour and heal to periosteum. What you did is excellent.

  2. Thanks for your comments Dr. Koman! Agree with your suggestions for areas of possible full thickness graft harvest from the skin in the groin or ac fossa. Might even be able to utilize a tube graft from the groin as well. Fortunately after the ray resections it appears the surgeon had enough local tissue to primarily close the wounds in this girl’s case. The family was quite worried about losing the entire hand and what that would mean for this girl’s future life.

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