Chirurgie de la main
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Blast injuries of the hand result from the manipulation of handmade explosives, the blast causes most damage in the first web. Our purpose is to propose a classification of these injuries so as to lead to a therapeutic strategy. ⋯ We observed four different stages: Stage 1: Isolated musculo-cutaneous injury. An intermetacarpal pin avoids first web contracture. Skin coverage is achieved by a pedicled local flap or a skin graft. Stage 2: Osteo-articular injuries of the thumb and second ray but sparing the trapezo-metacarpal joint. The thumb reconstruction is often based upon rinciple. Stage 3: Characterised by a destructive injury of the trapezo-metacarpal joint. Stage 4: Amputation or devascularization of the thumb. Extensive vascular injuries neccessitate a bypass from a healthy zone. The amputations, which are mostly proximal, require a preliminary osteocutaneous reconstruction of the first metacarpal before any toe transfer. Finger translocations are made difficult because of the high rate of serious injuries of the index and palm.