This chapter, the first of two; deals with the basics of crush injuries of the hand as opposed to crush syndrome. The definition is explained and the differences are outlined. A journey through the historical review of the causative mechanisms gives the reader an insight into the machines inflicting a spectrum of injuries and their sequelae. We see how the tools either remain the same or change with time, exacting similar types of injuries but in a different manner and timescale due to mechanisation. Thus it is vital to grasp the mechanics to get a basic understanding of the pathomechanics, enabling one to address the injury by reversing the inflictive force while maintaining respect for the machine. These are humbling injuries that require experience, expertise and enterprise by a dedicated and cohesive team always open to learning.
Part of the book: Essentials of Hand Surgery
This chapter details crush injuries of the hand as opposed to crush syndrome. The definition along with the spectrum of injury is described including a historical review of the causative mechanisms to help in the understanding of basic pathomechanics. The main menu comprises Clinical Assessment, Management and Outcomes, where the reader is taken through the steps one by one on how to approach such an injury, from the history, examination and investigations pointing out important aspects. Basic facts and figures to know and memorize have been placed in an easy-to-absorb format of tables and highlighted boxes. Key points are emphasized, and important aspects of management as well as those simple tips to improve outcome are given to ease the novice as well as the tempered surgeon’s encounter. A special section on management of specialized tissue is given toward the end after the basic management is dealt with so that a deeper understanding is gained and applied. Possible outcomes would alert the surgeon on both adverse events to avoid and excellent results to aim for. As always, good functional outcome is sought after but a good cosmetic appearance should be constantly filed away in mind’s eye to enhance the final result.
Part of the book: Essentials of Hand Surgery
Microvascular anastomosis is a highly skilled surgical technique that requires the assistance of optical magnification via an operating microscope or loupes to be fully visualised and thus accomplished reasonably well. It demands the full attention of the surgeon throughout the procedure. Even the smallest of inadvertencies may result in disastrous results. Practice has no shortcut and the more experienced a skilled surgeon is, the better his results. The chapter begins with a detailed account of preparedness in the operating room, for preparation is the path to success. There are however tips to reduce the incline of the learning curve and points to remember when things are not quite going right. This chapter attempts to deal with those moments.
Part of the book: The Current Perspectives on Coronary Artery Bypass Grafting