Surgical Firework Injury of the Thumb: Injury Pattern and Treatment Algorithm

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.04.012

David Cardenas BS , Muhammad Harirah MD , Anca Dogaroiu MS , Brandon Bruce BS , Andrei Odobescu MD, PhD , Douglas Sammer MD , Andrew Y. Zhang MD

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引用次数: 0

Abstract

Purpose

Firework blast trauma most commonly affects the hands and occurs along a spectrum of severity ranging from minor burns to mangling injuries. This study presents a retrospective chart review of patients surgically treated for upper-extremity firework injuries at a major metropolitan level-l trauma center with a focus on injuries involving the thumb. A detailed treatment algorithm is proposed based on patterns of injuries with an additional two illustrative cases.

Methods

Patients who underwent surgical management for firework-related hand injuries at a level-1 trauma center between January 2009 and December 2023 were retrospectively reviewed for demography, injury pattern, and treatment. Two cases involving the thumb and first web space injuries were selected for the case series. General descriptive statistics were performed.

Results

Seventy-four patients who sustained severe firework blast injuries to the hand were reviewed. Thumb injuries were treated in 59 patients (80%). A majority of these, 52 patients involved both the thumb and the first web space (88%). A wide range of surgical treatments were employed, and often, several different techniques were used for the case. Amputation (60%, n = 45) was performed most frequently, followed by skin grafting (36%, n = 27) and primary closure (32%, n = 24). Local and free flaps were performed in 35% (n = 26) of the cases.

Conclusions

A majority of surgical firework injuries to the hand involve the thumb and first web space. It is paramount to preserve or restore length, sensation, mobility of the thumb, and a supple first web space. Proximal thumb injuries tend to require more aggressive treatment of the first web space. In case of devastating proximal injuries involving the carpometacarpal joint, creating a stable and well-positioned sensate post is acceptable. We propose a treatment algorithm for the management of thumb and first web space blast injuries.

Type of study/level of evidence

Therapeutic IIIB.

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拇指手术烟花伤：损伤模式和治疗算法

目的：烟花爆炸创伤最常影响手部，其严重程度从轻微烧伤到撕裂伤不等。本研究回顾了在一个主要的大都会一级创伤中心手术治疗上肢烟花损伤的患者，重点是涉及拇指的损伤。提出了一种基于损伤模式的详细治疗算法，并附加了两个说明性案例。方法回顾性分析2009年1月至2023年12月在某一级外伤中心接受手术治疗的手部火灾工伤患者的人口学、损伤类型和治疗情况。两例涉及拇指和第一指蹼空间损伤的病例被选为病例系列。进行一般描述性统计。结果回顾性分析74例手部严重烟花爆炸伤。59例（80%）患者接受拇指损伤治疗。其中大多数，52例患者同时涉及拇指和第一个网络空间（88%）。手术治疗的范围很广，通常情况下，几种不同的技术被用于这种情况。截肢（60%,n = 45）最为常见，其次是植皮（36%,n = 27）和初级缝合（32%,n = 24）。35% （n = 26）的病例行局部皮瓣和自由皮瓣。结论手部的外科烟花伤主要累及拇指和第一指间隙。最重要的是保持或恢复长度，感觉，拇指的机动性，和柔软的第一个网络空间。拇指近端损伤往往需要更积极的治疗第一指蹼空间。对于严重的近端损伤涉及腕掌关节的情况，可以创建一个稳定且位置良好的感觉桩。我们提出了一个治疗算法的管理拇指和第一网络空间爆炸伤害。研究类型/证据水平：治疗性IIIB。

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