Blast/Cracker Injury Hand
Blast accidentsand cracker blast injurieslead to mutilated hand.
Blast accidents and cracker blast injurieslead to mutilated hand.
Few of the cracker burn injuries are flame burns which are managed with regular dressings, antibiotics and analgesics.
Other type of cracker burn injuries are blast injuries which happen when the cracker is burnt while kept in hand. These injuries are surgical emergencyand need to be managed on a priority basis.
Blast injuries due to explosives are injuries of grave concernand patient is usually a case of polytrauma where management of other injuries take a priority over mutilated hand. In such situation, patient is managed as a whole, and the upper extremity is splinted if there is no active bleed. If active bleed is present, then the hemostasis is maintained a long side management of other injuries.
Management of mutilated hand due to blast injuries (explosives or cracker) is complex, demands special skills and expertise.
If limb ischemia is present or the part of limb is amputated the extremity should be transported carefully covered in ice with no direct contact with ice at an ideal temperature of 4 degree Celsius.
Once the patient is stable and other serious injuries tackled, hand is addressed
Pre-operative management of blast injuries of hand
- Splintage of upper limb
- Wound is washed and cleaned
- Vascularity of hands and fingers is assessed
- Missing structures of the hand are noted and informed to the attendants.
- Sensation of hand is assessed
- Range of motion of various movementsis assessed
- Tetanus toxoid is administered
- Analgesics and antibiotics administered
- Structures to be repaired are assessed and tagged
- Bone injury assessed using radiographs
A detailed counselling is done explaining the whole situation and setting the record straight that management of such injuries is not possible with a single stage surgery. It requires a lot of effort, dedication and expertise on the part of the surgeon and a lot of patience, understanding and support on the part of the attendance.
Management in OT
Management of blast injuries is multi dimensional. It starts from taking note of missing structures of the handlike fingers or thumb in toto or in parts. Then Fractures are ruled out with the help of X-rays. After initial management, the patient is planned for surgery for initial debridementto be done under suitable anesthesia.
Reimplantation is not possible or feasible in most of the casesof hand blast injuries even if the part is brought well preservedas there is injury to the vital structures at multiple levels within the part or the part is damaged beyond recognition or is in shreds. In few isolated cases, where the part is well preserved relatively, reimplantation can be attempted with guarded consent.
Initial surgical treatment
- Debridement of all necrotic and dead tissues + wound irrigation + wound culture
- Antibiotics coverage with skeletal stabilization with K wires
- Management of hand fractures it's done as per protocol. kindly visit the page on hand fractures page for information of the management
- The vital structures are assesed and tagged. These structures are repaired during definitive soft tissue cover surgery
This initial management removes foreign body if present
During initial management if vascularity is compromised, it can be established using microvascular technique.
In few cases, a second relook surgery is required to debride any remaining deadtissue
Post operative management
- Immobilization for 4 weeks
- Flap monitoring
- Limb elevation
- Dressing review every 2nd to 3rd day
- Antisepsis
- Vitals monitoring
- Physiotherapy after 4 weeks
Results of blast injuries or mutilated hand depends upon the extent, type and the level of injury. The road to rehabilitation in such injuries is very long and frustrating for most people. Even after multiple surgeries, the result is different from what you have expected. The main idea after blast injuries is to rehabilitate the patient back in the societywith a functioning and productive hand which is not possible every time and in each case.
Skin and soft tissue reconstruction
- Once the infection load and edema decreases, patient is planned for skin and soft tissue coverage
- Tendon, nerveand muscles are repaired.
- Appropriate soft tissue coverage is important for coverage of bone, joint, tendon, neurovascular structures.
- Closure is done as per protocol of the reconstruction of soft tissue defects of hand. Kindly visit the soft tissue defects of hand page for information of the reconstruction.
- Skin only defect is covered using split thickness skin graft
- Soft tissue defect is covered using local flaps, regional flaps or distant flaps
posterior interosseous artery/radial artery reverse flapgroin flap (local flaps)
pectoral flap, 2 staged
abdomen flap, 2 staged
Groin flap, 2 staged
Distant flapsare harvested and hand is reconstructed using microvascular technique
- ALT free flap
- MSAP free flap
- free groin flap
- medial plantar artery free flap
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Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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