Degloving injuries produce tearing and detachment of skin and neurovascular structures away from bone in the finger or hand. Lack of sufficient local circulation and innervation generally require amputation. 4 Crush injuries, seen when hands are crushed between heavy machinery or objects, can cause extensive bleeding. Excessive bleeding into muscle can precipitate compartment syndrome, which is the elevation of tissue pressures within a muscle compartment. To relieve elevated intracompartmental pressures that can cause compartment syndrome, a fasciotomy may be performed.
Amputations demand special considerations.
Cooling is best achieved when amputated parts are wrapped in sterile gauze that has been moistened with sterile normal saline solution. The part is then placed in a sterile container and the container is placed on ice. Amputated parts are never put directly into povodine iodine solution, saline, water, or ice. These fluids will cause lysis of cells with destruction of tissue, which will render the part unusable for replantation or grafting. If an amputated part has not been cooled and managed properly, the tissues release prostaglandins and histamine that further damage tissue.