COMBINED THERMAL AND CRUSH INJURY TO THE HAND AND FINGERS

Combined thermal and crush injury is a relatively rare type of injury, although it may be more common in industrial settings. The combined i nsult of heat and pressure results in an injury that apparently is mor e severe than the simple additive effect, as the heat is transmitted d eeper through the crushed tissues. The full extent of tissue destructi on cannot always be fully recognized initially. Treatment in stages is the preferred approach, rather than attempted immediate reconstructio n procedures. Failure of immediate skin grafting procedures in some of the cases presented herein was the result of underestimation of the s everity of trauma. Early debridement should be done soon after admissi on. Definitive treatment as dictated by the magnitude of injury needs to be delayed until the extent of injury is delineated. Our conclusion s from the presented experience with this type of injury were successf ully applied in the treatment of the last presented patient. (C) 1997 Elsevier Science Ltd for ISBI.