Arch Hand Microsurg.  2022 Sep;27(3):229-233. 10.12790/ahm.22.0022.

Postoperative edema management with external compression for successful treatment of shredder injuries of the hand: a report of two cases

• Ko JG
• Jang U
• Lee JY

• KMID: 2532739
• DOI: http://doi.org/10.12790/ahm.22.0022

Abstract

Shredder injuries have a poor prognosis and are a problematic type of hand trauma. The authors describe the successful management of two cases of shredder injuries, one involving a child and the other involving an adult. In the child, the authors performed loose skin sutures for closure in the initial surgery and adjusted the degree of intensity of the external compression daily. According to the degree of tissue swelling, the skin sutures were gradually tightened. In the adult, the authors used external compression rather than sutures and adjusted the degree of intensity every day. When treating a shredder injury, the most crucial task is balancing perfusion and tissue pressure to reduce edema while preserving viability, thereby healing and restoring the original function and shape of the injured body part. This paper suggests that external compression may be an important postoperative edema management method in patients with hand shredder injuries.

Keyword

Hand injuries; Shredder injury; Edema; Indocyanine green angiography

Figure

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  Fig. 1. (A, B) A 22-month-old female patient injured her left hand, particularly on the index finger to the little finger, in a mushroom shredding machine. (C, D) During the initial reconstructive surgery, the wounds were approximated with loose sutures, and the degree of intensity of external compression was adjusted daily. We controlled severe postoperative swelling by tightening the loose skin sutures daily, starting from the 3rd (E, F) to the 8th (G, H) postoperative day. (I, J) Postoperative 4-year follow-up view after release of the first web space contracture with a full-thickness skin graft in the second postoperative year.

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  Fig. 2. (A, B) A 45-year-old female patient injured her third to fifth fingers in a raw fish shredding machine. Only tissue alignment was performed initially. (C, D) Ten-day postoperative view of the wound. Thin foam dressing was rolled around the finger with gentle tension to increase tissue pressure without circulation compromise. (E, F) Ten months after the injury, the shredded fingers survived and were restored to their original shapes through external compression without suturing.

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  Fig. 3. (A) After 4 days of surgical delay, only the ring finger’s nail bed (yellow arrowheads), tip, and eponychial folds were sutured. (B) Indocyanine green (ICG) angiography imaging after suturing showed that the sutured flap of the shredding injury had lost contrast due to decreased perfusion. This perfusion difference was more evident when compared to the middle finger's nail bed. (C) ICG imaging after suture removal showed restoration of perfusion by contrast enhancement.

Reference

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