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 insult of heat and pressure results in an injury that apparently is more severe than the simple additive effect, as the heat is transmitted deeper through the crushed tissues. The full extent of tissue destruction cannot always be fully recognized initially. Treatment in stages is the preferred approach, rather than attempted immediate reconstruction procedures. Failure of immediate skin grafting procedures in some of the cases presented herein was the result of underestimation of the severity of trauma. Early debridement should be done soon after admission. Definitive treatment as dictated by the magnitude of injury needs to be delayed until the extent of injury is delineated. Our conclusions from the presented experience with this type of injury were successfully applied in the treatment of the last presented patient.