[The treatment concept in severe hand injuries].

Treatment of complex injuries of the hand aims at best possible reconstruction of function and quick social and professional rehabilitation. This objective is hardly to achieve in most cases due to the severity of injury. Outcome depends on patients' age and injury pattern and essentially on the strategy of surgical treatment. Errors in prehospital emergency treatment can hardly be corrected, no matter how excellent the surgical technique may be. Traumatic multiple finger or thumb amputations are clear indications for replantation. Beginning with osteosynthesis, suture of tendons and ligaments the restoration of blood supply is the most important step. Nerve reconstruction should be performed immediately, but if tension free repair is impossible, secondary nerve grafting is preferred. Primary skin closure should be carried out if possible, in case of defects skin grafts, local or free flaps have to be used.