Hand Wounds

About Hand Wounds

Hand wounds occur in many ways: road traffic accidents, machinery and industrial injuries, household incidents and severe infections. Whatever the cause, the principles of management are the same. Bleeding is controlled, the wound is examined carefully for hidden tendon, nerve and bone injury, and a structured plan is made for cleaning, repair and durable soft tissue cover.

When a patient arrives at our Lucknow clinic, our team follows a systematic approach: assess airway and circulation if it is a major trauma, document the level and pattern of injury, photograph wounds, X-ray the hand to rule out fractures and start tetanus and antibiotic cover. Only then is detailed planning of repair carried out under appropriate anaesthesia.

Treatment options are matched to the size and depth of the defect. Small superficial wounds may be allowed to heal by re-epithelialisation, although this can take four to six weeks and may leave contour or sensation issues. Skin grafting, usually thin sheets harvested from the thigh, suits clean wounds without exposed bone, tendon or nerve, with regular dressings every other day.

Local flaps, including the reverse radial artery flap from the front of the forearm and the posterior interosseous artery flap from the back, are versatile workhorses for hand resurfacing. They follow the principle of like-for-like cover, replacing missing skin with skin of similar texture, colour and thickness, while keeping donor-site morbidity to a minimum.

Pedicled flaps from the groin, abdomen or chest are useful for larger defects and need a second-stage division three weeks later. For deeper wounds with exposed tendons, nerves or joints, microvascular free flaps from distant donor sites give the best cover. Dr. Agarwal, FRCS Edinburgh, selects the right option to balance form, function and recovery time.

What to expect

• Systematic clinical and imaging assessment
• Photographic documentation of injury
• Tetanus prophylaxis and antibiotic cover
• Choice between secondary healing and grafting
• Local, regional or free flap reconstruction
• Coordinated tendon, nerve and bone repair
• Structured hand therapy after wound healing

Recovery

• Hospital stay of one to ten days based on technique
• Frequent dressings during early wound care
• Splinting in a functional position
• Hand therapy starting once wounds are stable
• Avoid heavy gripping until cleared by surgeon
• Final softening of scars over several months