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The COVID-19 pandemic has impacted many medical specialties throughout the world, including hand surgery. Emergency hand surgery deals with a wide spectrum of injuries, including bone fractures, nerve, tendon and vessel cuts, complex injuries and amputations. These traumas occur independently to the phase of the pandemic. The objective of this study was presentation of changes in organization of activity of hand surgery department during the COVID-19 pandemic. Modifications of the activity were described in details. Over a period of the pandemic (from April 2020 to March 2022), a total of 4150 patients were treated, in this number 2327 (56%) with acute injuries and 1823 (44%) with common hand diseases. Forty-one (1%) patients were diagnosed COVID-19 positive, 19 (46%) with hand injuries and 32 (54%) with hand disorders. One case of work-related COVID-19 infection was registered in the 6-people clinic team in analysed period. Results of this study show effectiveness of measures undertaken in the authors institution to prevent the coronavirus infection and viral transmission in hand surgery staff.

Hand and forearm injuries are relatively rare in polytrauma patients; their incidence is estimated at 2-5%. Hand and forearm injuries are usually not life threatening, and, therefore are considered of secondary importance, replaced by serious injuries of other body parts. However, they should be treated immediately after stabilization of the general condition of patients, as their delayed management may result in serious dysfunction of the hand. The aim of this study was to determine the incidence, distribution and methods of treatment of hand and forearm injuries in patients treated at the Polytrauma Centre of the SPSK 1 in Szczecin over the period of 4 years. Medical records of 16 patients, 11 men (65%) and 5 women (35%) with a mean age of 34 years (range 19-62) who were treated at the Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analyzed. Medical records of 16 patients, 11 men (65%) and 5 women (35%) at the mean age of 34 years (range 19-62) who were treated in Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analysed. The most common component of polytrauma with associated hand injury was major bone fractures (spine, pelvis and extremities) - 12 cases (70%), followed by chest - 11 (65%), maxillofacial - 9 (53%), brain - 8 (47%) and abdominal injuries - 5 (29%). The most common injury of the distal upper limb was fracture of the distal radius - 9 patients (53%). Two patients sustained excessive crush-degloving injuries which were the primary cause of their admission to the Polytrauma Centre. Nine patients required surgery, predominantly fixation of the distal radius with a plate. All patients survived. The importance of the correct management of hand injuries performed promptly after stabilization of the general condition of polytraumatized patients was emphasized.

This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Among these accepted, there were 165 total (50%) and 131 subtotal (40%) amputations; 34 patients (10%) had other severe hand injuries. Vast majority of the patients constituted young and middle-age males. The most common was amputation of several digits and thumbs - a total of 251 cases (76%), followed by transmetacarpal - 30 (9%), forearm - 23 (7%) and wrist - 20 (6%) amputations. Replantation of amputated extremity was performed in 138 patients (42%), revascularization in 98 (30%) and in 45 (14%) primary repair of the complex injuries. In 26 cases (8%), coverage of tissue defects was performed, and in 23 (7%) primary terminalization. Survival rate was of a mean of 65% for replantations and 85% for revascularizations. Comparing to the previously reported period 2013-2017, the number of treated patients was similar, but structure of injuries differed: number of digital amputations increased (of 22 cases), whereas number of proximal amputations (hand, forearm and arm) significantly dropped (of 50 cases). The importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients was emphasised.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

Introduction: Total or partial upper limb amputation significantly reduces ability of normal functioning in the society. Development of microsurgical skills enabled to replantation of the amputated limb (or part) and to regain its partial or sometimes full function., Material and Methods: The study analyses the causes of refusal of admission to 55 of 141 patients referred to the replantation service of the Department of General and Hand Surgery PUM, over the period 2012-2013., Results: The causes of denied admission included: injury without compromise of blood supply to the limb (35%), distal amputations (27%), crush injuries (11%), single finger amputation (9%), severe damage of the amputated part (9%) and lower limb amputations (5%). The age of the patient had no significant influence on the decision to refuse admission. The distance between the referring hospital and the replantation centre was statistically significantly shorter in accepted cases (252 km vs 496 km, p < 0.05)., Conclusion: Our outcomes show a variety of causes of refusal. of admission to patients with severe trauma and amputation of the hand. The main factors influencing decision making regarding admission or denial were associated with the actual danger to the survival of the involved limb, and estimation/calculation of the chance for limb saving.

Introduction: The objective of the study was the analysis of the indications for, and assessment of the outcomes of secondary interventions after primary repair of injuries within the upper limb in the authors' institution--Department of General and Hand Surgery of the Pomeranian Medical University in Szczecin (a tertiary care unit)., Material and Methods: Answers on questionnaires (including DASH) mailed to 33 patients were the subject of the analysis. The group consisted of 27 men and 6 women, mean age 36 years, in whom secondary interventions were performed at a mean of 8 months after primary surgery., Results: Injuries were grouped in five categories: tendon lacerations, hand or finger amputations, nerve sections, complex tissue injuries, and isolated finger fractures. The most common cause of secondary intervention was incomplete finger movement and lack of opposition of the thumb. The most common operations included tenolysis, arthrolysis and opponensplasty. The outcomes of secondary surgery from patients' perspective were overall good: 13 (39%) patients reported significant improvement, 16 (48%) moderate, and only 4 (13%) patients had no benefit. Twenty-five patients regained full, or almost full hand function (DASH scores 2-39), and 8 (24%) had moderately to severely impaired function (DASH 40-80). Twenty-eight patients returned to work., Conclusions: Primary repair of upper limb injuries (even severe) in the tertiary institution was adequate, and secondary interventions rarely necessary. The most common indication was incomplete finger movement caused by ineffective postoperative mobilization. The important role of rehabilitation for the final outcome of the treatment of hand injuries was emphasized.

Unlabelled: A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service., Material and Methods: Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues., Results: Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations., Conclusion: Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.

A case of severe streptococcal phlegmon of the right upper extremity with subsequent necrosis of both hands and feet in a young, homeless alcoholic man is reported. The disease developed after a minor injury to the hand, and it progressed rapidly, resulting in the involvement of the whole hand and sepsis over 2 days. After admission, antibiotic and anticoagulant therapy was immediately administered, followed by wide surgical incisions on the hand and forearm. Nonetheless, over the course of 3 days, ischemia of the affected hand developed, followed by ischemia of the contralateral hand and both feet the next day. The treatment employed was not effective, and the patient eventually died on the fifth day after admission. [ABSTRACT FROM AUTHOR]

Excessive hand injuries are not uncommon in hand surgeon’s practice. They are usually caused by various devices such as circular saws, grinders, millers, presses, conveyers, and agricultural machines. This article reports a case of mutilating injury to the entire upper extremity as a result of crush and burn of IV degree. The right upper extremity of a farmer who attempted to unblock the mechanism of a straw-press was pulled inside the machine. Despite resistance against the pulling force, the extremity was drawn inside the machine up to the elbow, where the cog-wheels started to glide on the exposed bones of the forearm and arm. The farmer first attempted to cut off the extremity with the pocket knife, following by firing the straw inside the press to draw somebody’s attention to his dramatic situation. Eventually, a person who passed by on the road nearby noticed the smoke flying out of the machine, came to the victim, and called for help. Despite the excessive injury of the entire upper limb and bleeding, the condition of the patient on admission was good. The extremity from the level of mid-arm was crushed, whittled, and burned, and the only option was the amputation at the proximal arm level. The post-operative course was uneventful. [ABSTRACT FROM AUTHOR]

Introduction: Hand and forearm injuries are relatively rare in polytrauma patients; their incidence is estimated at 2-5%. Hand and forearm injuries are usually not life threatening, and, therefore are considered of secondary importance, replaced by serious injuries of other body parts. However, they should be treated immediately after stabilization of the general condition of patients, as their delayed management may result in serious dysfunction of the hand. Aim: The aim of this study was to determine the incidence, distribution and methods of treatment of hand and forearm injuries in patients treated at the Polytrauma Centre of the SPSK 1 in Szczecin over the period of 4 years. Medical records of 16 patients, 11 men (65%) and 5 women (35%) with a mean age of 34 years (range 19-62) who were treated at the Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analyzed. Material and methods: Medical records of 16 patients, 11 men (65%) and 5 women (35%) at the mean age of 34 years (range 19-62) who were treated in Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analysed. Results: The most common component of polytrauma with associated hand injury was major bone fractures (spine, pelvis and extremities) - 12 cases (70%), followed by chest - 11 (65%), maxillofacial - 9 (53%), brain - 8 (47%) and abdominal injuries - 5 (29%). The most common injury of the distal upper limb was fracture of the distal radius - 9 patients (53%). Two patients sustained excessive crush-degloving injuries which were the primary cause of their admission to the Polytrauma Centre. Nine patients required surgery, predominantly fixation of the distal radius with a plate. All patients survived. Conclusion: The importance of the correct management of hand injuries performed promptly after stabilization of the general condition of polytraumatized patients was emphasized. [ABSTRACT FROM AUTHOR]

This article summarizes the activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period, a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centers. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Among these accepted, there were 165 total (50%) and 131 subtotal (40%) amputations; 34 patients (10%) had other severe hand injuries. The vast majority of the patients constituted young and middle-age males. The most common was amputation of several digits and thumbs - a total of 251 cases (76%), followed by transmetacarpal - 30 (9%), forearm - 23 (7%) and wrist - 20 (6%) amputations. Replantation of the amputated extremity was performed in 138 patients (42%), revascularization in 98 (30%) and in 45 (14%) primary repair of complex injuries. In 26 cases (8%), coverage of tissue defects was performed, and in 23 (7%) primary terminalization. The survival rate was on average 65% for replantations and 85% for revascularizations. Comparing to the previously reported period 2013-2017, the number of treated patients was similar, but the structure of injuries differed: the number of digital amputations increased (by 22 cases), whereas the number of proximal amputations (hand, forearm and arm) dropped significantly (by 50 cases). The importance of the Replantation Service, an informal structure, in saving limbs of severely mutilated patients was emphasized. [ABSTRACT FROM AUTHOR]