Soft tissue injuries can be as disabling as bony fractures in the hand. Apart from bones hand has various nerves, blood vessels, ligaments, and tendons which are essential for proper functioning.

Tendons: Tendons are rope-like structures connecting muscles to bones of fingers. These tendons help in transmitting the pull of muscles to the terminal bones of the hand. The opening and closing of a fist are enabled by these tendons. In case they are cut, or crushed the person is not able to move his fingers/ wrist properly.

Mostly I receive patients whose tendons are cut due to glass cut or grinder cut either at home or work. This accounts for up to 80% of my patients with tendon injuries. Rest 20% are crush injuries while working in heavy industries. These tendons may be injured in the hand itself or the forearm. Mostly forearm is injured in sharp injuries and the hand in crush injuries.

These injuries should be repaired early for best results, preferably within 24 hours. As time passes by the process of repair becomes complicated and results worsen. If not repaired for a few weeks most cases will need a 2-stage tendon reconstruction. This process is I use a 4-strand repair technique with 2.5-4 X magnification in my repairs as opposed to 2 strand repairs. A 4-strand repair is more durable, and the patient can be mobilized early with physiotherapy. It leads to less incidence of contractures and scar adherence to tendons.

We mostly use Duran's physiotherapy protocol for the rehabilitation of patients. It takes 3-6 weeks for patients to get normal and back to work.

Nerves: Ulnar and median nerve are the two principal nerves of the hand. The ulnar nerve controls fine movements of the hand and the median nerve controls the coarse movements of the hand. Permanent Injury of either of them can have a disabled hand in form of a claw hand. It also leads to sensation loss.

Like tendon injuries, I receive patients whose nerves are cut due to glass cut, or grinder cut either at home or work. Simple cut injuries should be repaired on the same day if possible. Repairs within 24 hours give the best results. If a part of the nerve is damaged beyond repair, then a nerve is borrowed from the leg to replace the damaged segment.

Unlike tendons, nerves require higher magnification for repair. I routinely use an operating microscope to repair such injuries instead of surgical loupes. This ensures my patients get best results.

Like Tendons these injuries also need prolonged physiotherapy and rehabilitation for many weeks. Nerves take time for regeneration sometimes months before movements are appreciated. I follow such patients on regular intervals to see the progress of recovery.

Vascular Repairs: Arteries bring oxygen rich blood from the heart to hand while Veins take that blood back to lungs for oxygenation. Venous injuries usually do-not cause many problems and are easily treated.

Arterial injuries on other hand are surgical emergencies which need immediate repair. Golden period is 6 hours beyond which permanent damage is ensured. Prolonged absence of blood flow can even lead to gangrene of hand. In case a part of artery is permanently damaged then I replace that segment with a graft from leg.

Entire finger/hand can be lost if the vessels are not repaired properly. I use operating microscope instead of surgical loupes to repair such injuries. Operating microscopes improve the outcomes of repair because higher magnifications are possible with microscopes.

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