Highlights
- •Hand wounds are very common and represent a major public health issue
- •The digits represent 71% of wounds with the Index finger accounting for 1/5th of all injuries
- •Palmar zones are the most affected but dorsal wounds have a higher association with injury to underlying structures
- •Areas with more than 50% of lesions are palmar zone 5 and dorsal zones 1, 3, 5, 6, and 7.
- •Dorsal wounds overlying joints had more lesions with zone 3 presenting a rate of 68%
Abstract
Introduction
Hand wounds account for 35 to 51% of hand traumas. Damage to underlying anatomical
structures depends on the location of the wound. The objective of this study is to
describe the topographic distribution of hand wounds allowing for subsequent evaluation
of the link between affected surface area and underlying lesion.
Methods
We retrospectively reviewed the medical records of 1058 patients with a total of 1319
wounds over a period of 2 years. Wound location was described according to the cutaneous
projection of IFSSH zones for flexors and extensors. Any associated deep lesions were
evaluated. Topographical distribution was modeled graphically using a heat-map. We
compared the proportion of underlying lesions between each cutaneous zone. Sub-group
analysis for lesions’ rate regarding zone groups were performed.
Results
58.9% of wounds were located on the palmar surface and 41.1% on the dorsal surface.
71% of wounds affected only the digits. The index finger was the most affected. The
most damaged region was zone 2 for palmar wounds and zone 3 for dorsal wounds. 45.5%
of wounds resulted in injury to a significant underlying anatomical structure. This
frequency was 36.4% and 58.5% for palmar and dorsal wounds respectively. More than
50% of wounds in palmar zone 5 and dorsal zones 1, 3, 5, 6 and 7 presented at least
one lesion.
A lesion of major structure was more frequently found in palmar zone 5 (p <0.001).
Dorsally, no zone predominated. Subgroup analysis for dorsal wounds revealed that
wounds overlying joints had more major lesions including more tendons injuries and
more articular violations with zone 3 presenting a rate of 68%.
Conclusion
We provided the first graphical representation for the topographical distribution
of hand wounds. Dorsal wounds have a higher association with injury to underlying
structures. These results generally support surgical exploration of all hand wounds
regardless of their location.
Level of evidence: IV Study type: Epidemiological study.
Keywords
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Article info
Publication history
Published online: October 20, 2022
Accepted:
October 18,
2022
Footnotes
Copyright: This work has not been published previously, is not under consideration for publication elsewhere, and if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.
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