MANGLE AND SEVERE WRINGER INJURIES OF THE HAND IN CHILDREN

¹ Department of Surgery, Children's Hospital of Michigan, and Wayne University College of Medicine, Detroit

The importance and seriousness of wringer and mangle injuries have been emphasized. In most wringer injuries the trauma to the hand is comparatively slight, the most serious

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injury occurring about the elbow and axilla. With mangle injuries of the hand, the mechanism of injury is the same, but in addition to the effect of rolling, there is a thermal burn.

The treatment of both injuries is basically the same. Attempts are made to clean the wound as early as possible and this is done at the end of five to seven days, by mechanical debridement. Split-thickness skin grafts should be applied early to prevent secondary infection and to minimize scar formation. The wound should be closed by the fourteenth to the twenty-first day.

Later, in the case of palmar defects, the contracted skin graft is excised and full-thicknsess skin grafts are applied. A tube pedicle graft may be necessary if tendons and nerves have been destroyed. Postoperative splinting and physical therapy are necessary to prevent recurrence of contractures and to restore function.

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