MEMORANDUM TO: Colonel Elliott C. Cutler, MC,Senior Consultant in Surgery, European Theater of Operations.
SUBJECT: Recommendation for Care of HandInjuries in the Zone of Interior.
1. Many severe hand injuries are being seen onthe plastic surgery services of the general hospitals in the United Kingdom. Anattempt is being made to accumulate these cases from other hospitals intohospitals for plastic surgery, where they can be cared for jointly by plasticand orthopedic or general surgeons. The experience with these cases has giventhe distinct impression that most surgeons do not realize the possibilities ofplastic surgery in obtaining early and adequate closure or covering of thewounds with massive soft tissue and skin loss. Many wounds are left open toolong, with the result that prolonged splinting, infection of the open wound,sloughing of exposed bone and tendon, will result in crippling that is out ofproportion to the severity of the original injury.
2. Of all cases that deserve specialconsideration, none are more deserving than hand injuries. It is theresponsibility of surgery in this theater to see that the soft tissue loss isreplaced early in order to limit progress of the disabling pathologicalprocesses that result from an open wound. This procedure should be done early,before evacuation to the Zone of Interior. An Article has been submitted tothe Medical Bulletin, European Theater of Operations, pointing out thathands and other injuries of the extremities that require extensive soft-tissueand skin replacement should be referred to hospitals in which plastic surgery isbeing done. The number so far subjected to early plastic surgery procedures isonly a small percentage of the total that must be in hospitals of the Theater.
3. An increasing number of hand injuries arebeing sent to the Zone of Interior, following pedicle grafting here. Theseinjuries are of all degrees of severity and many of them will require latereconstructive surgery. The pedicle grafts, in addition to halting theincreasing incapacity that results from an open wound, will make it possible forthe early institution of physiotherapy and reconstructive operations. The caseswill present problems of bone, tendon, and nerve grafting that are completelybeyond the scope of the ordinary surgeon. It is very strongly felt that thesecases should not be operated upon by any but surgeons who have had somebackground in this type of work, and in hospitals where the work can becontrolled.
4. It is the opinion of this Office that suchcases should be accumulated, for their later care, in special hospitals, underthe joint care of specialists qualified in this type of work.
RETURN TO TABLE OF CONTENTSEugene M. Bricker
EUGENE M. BRICKER
Lieutenant Colonel, MC
Senior Consultant in Plastic Surgery
