BLAST INJURY OF THE FIRST COMMISSURE: CLASSIFICATIONS AND THERAPEUTIC STRATEGY

Purpose: Blast injury of the hand generally occurs during manipulations of unstable explosives. The explosion greatly damages the first commissure. The aim of this study was to define a classification system useful for establishing therapeutic strategy.Material and methods: From 1988 to 2002, we treated eight patients (nine hands, five dominant) with blast injury of the hand. Mean age was 24 years. Five hands were injured during manipulation of firecrackers and four during manipulation of munitions. The thumb was amputated on five hands, including three cases of index or medius amputation. Thumb revascularisation was successful in only one case. Two proximal thumb amputations were treated by twisted toe transfer. For one of these patients, the transfer was prepared by translocation of M2 on M1 using an inguinal flap. Two patients required a composite osteocutaneous reconstruction of M1 using the index as the bone source. In one final patient, lesions were limited to soft tissues.Discussion: Blast injured ...