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