Using an algorithm for reconstruction of low-energy blast injuries of the hand

Abstract

Background: Low-energy blast injuries caused by fireworks and other small explosives are a significant source of hand trauma resulting in fractures, amputations, and soft-tissue defects. In this study, we aimed to present a comprehensive clinical algorithm for managing these injuries and to share our experience in treating hand trauma resulting from low-energy blasts. Materials and Methods: A retrospective study was conducted on 37 patients who presented to the emergency services at two university hospitals between 2015 and 2018 with isolated hand trauma due to low-energy blasts. Upon arrival, the patients underwent tetanus prophylaxis and were stabilized before evaluation. All patients underwent surgery on the same day as the injury. Demographics, type of explosives, and reason for the explosion were noted, and treatment modalities were meticulously documented. Results: Of the 37 patients, 29 were injured by firecrackers and 8 by fireworks. Among the patients, 7 presented with total amputations, 3 had circulation problems before the operation, and 24 required bone fixation. Soft-tissue reconstruction was necessary in 30 patients, and vacuum-assisted closure therapy, skin grafting, or flap reconstruction was performed in seven patients. Delayed complications were observed in 12 patients during the postoperative period. Conclusion: Low-energy blast injuries of the hand require a multidisciplinary treatment approach. Our clinical algorithm provides an efficient treatment modality that emphasizes early exploration and aggressive debridement. We recommend managing soft-tissue defects by approximating existing tissues without tension. Furthermore, our findings suggest that legal and sales regulations are effective in reducing firework-related hand injuries, highlighting the importance of their consideration.