Vacuum assisted closure as adjuvant therapy for a mangled upper extremity injury

Injuries to the hand are frequent, with an incidence of 15 per 1,000 individuals per year. They occur in one third of industrial accidents, in one in five traffic accidents, and they are the cause of one in every 3 cases of disability. The term “catastrophic or mangled hand” has traditionally been used to define lesions that affect all or almost all of the tissues and functional systems of the hand (the skin, bones and joints, the arteries and veins, sensory and motor nerves and the muscles and ligaments) usually accompanied by the amputation of fingers. The first surgery is crucial to ensure good vascularity to the salvaged tissue, prevent infection and achieve bony stabilization. Re-look surgery and definitive reconstruction can then follow. The complexity of these injuries has led to the development of various surgical treatments and vacuum assisted closure. In this case, the initial surgery was performed at another institution. Therefore, upon accepting the patient at our institution, we carried out initial surgical management, followed by the placement of a vacuum-assisted closure, considering the possibility of performing a definitive surgical procedure aimed at restoring the functional capacity of the hand.