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Murthy et al. Plast Aesthet Res 2020;7:64 Plastic and
DOI: 10.20517/2347-9264.2020.72 Aesthetic Research

Review Open Access

Microsurgical salvage of complex dorsal shearing
injuries of the hand and wrist

Praveen G. Murthy *, Adam B. Strohl 1,2,3, *
1,2,
1 Philadelphia Hand to Shoulder Center, Philadelphia, PA 19107, USA.
2 Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
3 Department of General Surgery - Plastic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
*Both authors contributed equally to the article.

Correspondence to: Dr. Adam B. Strohl, Philadelphia Hand to Shoulder Center, 834 Chestnut Street Suite G-114, Philadelphia, PA
19107, USA. E-mail: abstrohl@handcenters.com

How to cite this article: Murthy PG, Strohl AB. Microsurgical salvage of complex dorsal shearing injuries of the hand and wrist.
Plast Aesthet Res 2020;7:64. http://dx.doi.org/10.20517/2347-9264.2020.72

Received: 12 Apr 2020 First Decision: 9 Sep 2020 Revised: 24 Sep 2020 Accepted: 23 Oct 2020 Published: 13 Nov 2020
Academic Editor: Alessandro Thione Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Dorsal shearing injuries of the hand and wrist can be seen with high-energy motor vehicle accidents and present
challenging problems to the reconstructive surgeon. At the time of initial injury, care must be taken to adequately
debride the mangled extremity and extensive wounds. Following debridement, a series of decisions must be made
regarding bony stabilization, extensor tendon reconstruction, and soft tissue coverage. These reconstructions
often require staged procedures, and appropriate planning is warranted from the start. Reasonable function of the
hand can be expected from the patient following such injuries.

Keywords: Dorsal shear, hand, wrist, trauma, extensor, free flap, mangling

INTRODUCTION
Mangling injuries of the upper extremity are devastating injuries involving a combination of multiple tissue
layers and structures that are critical for hand function. Among these, traumatic dorsal shearing injuries of
[1,2]
the hand and wrist pose unique challenges with regards to soft tissue and bony reconstruction .

Dorsal shearing injuries generally involve the skin and soft tissue envelope covering the dorsal hand and
wrist, the extensor tendons, and often the bony structures that comprise the many complex articulations of

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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