Comprehensive approach to treating a mangled hand injury using innovative wound coverage: A clinical case

Mangled hand injuries caused by entrapment in rotating industrial machinery pose a significant challenge in trauma and reconstructive surgery. This clinical case describes the treatment of a 45-year-old female patient with a mangled injury to the right hand, who presented one month after the initial trauma.Following the injury, the patient underwent primary amputation of the first, fourth, and fifth fingers with surgical wound debridement. Upon admission, signs of a chronic wound with soft tissue necrosis, edema, and inflammation were noted. Within the first 24 hours, radical surgical debridement (necroectomy) was performed to remove necrotic tissues and sanitize the wound. An innovative wound covering based on modified alginate hydrogel with silver ions and the antibiotic cefepime was applied to the wound surface. Three days later, the antibacterial covering was replaced with a wound covering containing fibroblast growth factor (FGF-2) to stimulate tissue regeneration. Two weeks later, after wound preparation, free autografting was performed using skin grafts harvested from the patient’s thigh. The postoperative period was uneventful. Two weeks after the skin grafting, satisfactory wound healing was observed.This case demonstrates the effectiveness of innovative wound coverings with sequential use of antibacterial and regenerative strategies in combination with staged surgical treatment. This approach successfully closed the complex wound defect and improved the functional state of the hand.Keywords: hand injury, chronic wound, necroectomy, autografting, wound covering, silver ions, fibroblast growth factor.