ANY WOUND OF THE HAND LOCATED OPPOSITE A NERVE, VASCULAR OR TENDON PATHWAY MUST BE SURGICALLY EXPLORED.
This exploration will be carried out by a hand surgeon, under loco-regional anaesthesia within the framework of an ambulatory hospitalization. While waiting for this exploration, the wound must be ideally washed (with clear water or Marseille soap), wrapped in a sterile dressing (or failing that in a clean cloth). Do not hesitate to position this dressing in a slightly compressive way in case of important hemorrhage.
Wounds of the hand are potentially serious and are likely to leave more or less significant after-effects if they are not properly managed. On the other hand, in the majority of cases, a cure may be possible when the diagnostic and treatment steps have been correctly followed.
The steps of this surgical exploration are as follows:
- trimming (of the cutaneous edges, articular washing, excision of the entry doors).
- exploration of the wound.
- repair of damaged noble elements, often using microsurgical techniques.
- skin suture, which must sometimes be associated with a skin covering procedure in case of loss of substance (graft, flap). In wounds with a major risk of sepsis (bites), a simple debridement may be performed without skin closure.
- Post-operative immobilization is not systematic. It depends on the extent and type of injury to the noble elements. When it is necessary, it must be as short as possible in order to avoid the formation of adhesions that can stiffen the digital chains. Rehabilitation should be carried out as early as possible, preferably by a physiotherapist specialized in this type of pathology.