Subclinical injuries in lacerations to the forearm and hand.

This report describes the incidence and severity of subclinical injuries to underlying structures in lacerations to the hand and forearm. One hundred consecutive hand and forearm lacerations that penetrated the full thickness of subcutaneous tissue were studied prospectively. Lacerations were explored under either biceps or forearm tourniquets. Injuries, treatment, tourniquet time, causative agent and complications were recorded. In all, 97 patients sustained 100 lacerations. A total of 49 deep injuries were discovered, none of which was detected clinically before exploration. Of these, 33 were tendon lacerations; 21 tendons, including three flexor tendons, were repaired. Nineteen patients required treatment in a volar slab for at least 3 weeks. Five patients of 49 returning for review developed wound infection. No patient developed significant problems related to the tourniquet, which was inflated for a mean time of 4.9 min. There is a high incidence of subclinical injury in full-thickness lacerations of the forearm and hand. These should be explored under tourniquet, which should minimize complications such as wound infection and delayed tendon rupture.