Viability and Functional Prognosis in Mangled Hand Casualties Depending on Their Etiological Factors. A Study of 31 Cases.

Purpose: Mangled hands refer to disfiguring severe injuries that affect many anatomical components. These injuries are evaluated using various scoring systems. In addition to these ratings, we need to include critical aspects relating to the patient, such as the trauma origin, prognosis, and procedure. We examined the significance of accident etiology in assessing trauma and predicting outcomes, as well as their value in guiding decisions for trauma treatment. Methods: Thirty-one patients, from 6 to 73 years, have been treated for upper limb compound injuries at our hospital between 2004 and 2009. We registered 10 blast injuries, 10 work accidents, six motor vehicle accidents, and five gunshot injuries. The severity, anatomy, topography, and type assessment method was used to evaluate the prognosis on viability and functionality. Additionally, we studied the influence of the etiological factor on injury prognosis. The functional results have been assessed by the manual muscle testing grading system, whereas the results of the limb usefulness have been evaluated by Disabilities of Arm, Shoulder and Hand (DASH) score test (patients' self-questionnaire). Results: Seventeen cases involved major vascular lesions that required emergency reconstruction or amputation. Our findings indicate that cases with blast injuries managed by partial or total amputations or using flaps to close stumps had poor prognoses. For cases with work-related injuries, we performed revascularization or flaps where the likelihood of saving the limbs was deemed higher than the potential risks of postoperative complications. In cases with gunshot injuries, despite the low overall functioning seen, our primary approach was to repair rather than amputating because of the potential feasibility of achieving viability. Conclusions: Further investigation is needed to determine if the cause of trauma has an important impact on trauma evaluation scores and predicting trauma outcomes, furthermore, helping decision making in emergencies. Type of study/level of evidence: Prognosis IIa.