Interestingly, classification of mutilating injuries of the hand can be as simple as Tic-Tac-Toe. In fact, more than a decade ago, Drs. Norman and Jeffrey Weinzweig designed a classification scheme to simplify the description of these complex injuries, allowing a more direct approach to communicating the nature of these injuries from one surgeon to another. This classification is based upon the pattern of involvement of the bones, involvement of soft tissue, bones or both, and vascular integrity.
However, while this classification scheme facilitates the description of the injury, management is far more complex, both in acute and chronic settings. Initially, the goal is to maximize the survivability of the digits. These can be tedious and lengthy operative procedures requiring microsurgical expertise. Often, 6 or 8 sutures are placed around the circumference of a vessel no larger than the tip of a pencil or less than 1mm in diameter. Surgical precision and flawless technique is mandatory to maximize the probability of survival of the digit. Frequently, intraoperative decisions have to be made to optimally utilize the viable tissues. Fractures are reduced and fixed, tendons and nerves are repaired and hopefully, blood perfusion is restored. This is the “opening game”, as in chess. Dr. Norman Weinzweig has extensive experience in the management of these injuries throughout his career.
Following successful replantation or revascularization, the “middle game” begins. This consists of careful monitoring of the digit, various procedures to restore early function and satisfactory appearance and occupational therapy to optimize function of the surviving digit. A normal appearing digit without useful function fails to achieve the maximal benefit of the surgery. Often, there are setbacks in the “middle game” and while there may be a normal appearing digit, it may be stiff, painful and unable to function appropriately.
This brings us to the “end game”, where the hand surgeon’s experience is often limited. At The Chicago Institute for Hand Surgery, Dr. Weinzweig has patients referred to him from all over the country, These patients have limited function and require surgery, intense occupational therapy, the Continuous Passive Motion Machine and gentle intraoperative manipulations of the joints under anesthesia to optimize the long-term functional outcome. The occupational therapists at The Chicago Institute for Hand Surgery are uniquely trained to care for these patients. Furthermore, close supervision under Dr. Norman Weinzweig optimizes the eventual functional outcome.
