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Roberts DC, Jose RM, Duraku LS, Wordsworth M, Foster M, Mortiboy D, Sellon E, Stapley SA, Power DM. Management of conflict injuries to the upper limb. Part 2: reconstruction and managing complications. J Hand Surg Eur Vol 2022; 47:787-797. [PMID: 35701990 DOI: 10.1177/17531934221105225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This is the second of a two-part review article on the management of conflict injuries, focused on the reconstructive strategies for bone, nerve and soft tissue and to provide guidance on assessing and managing common complications associated with complex upper limb injuries. Following assessment and early surgical management, the conflict casualty will require further wound evaluation and planning prior to definitive reconstruction of limb injuries. Surgical management of the upper limb injury should aim, where possible, to preserve the limb and allow functional reconstruction. The principles of the second look procedure are to assess wound progression, further reduce the risk of infection and plan definitive reconstruction with adequate soft tissue cover. The prerequisites for successful surgical reconstruction are a stable patient, combined orthoplastic surgery expertise supported by physiotherapists and hand therapists.
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Affiliation(s)
- Darren C Roberts
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Rajive M Jose
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liron S Duraku
- The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Wordsworth
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Foster
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Deborah Mortiboy
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edward Sellon
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah A Stapley
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic M Power
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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