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Appendix H

APPENDIX H

4 SEPTEMBER 1944

MEMORANDUM TO: Colonel Elliott C. Cutler, MC, Senior Consultant in Surgery, European Theater of Operations.

SUBJECT: Recommendation for Care of Hand Injuries in the Zone of Interior.

1. Many severe hand injuries are being seen on the plastic surgery services of the general hospitals in the United Kingdom. An attempt is being made to accumulate these cases from other hospitals into hospitals for plastic surgery, where they can be cared for jointly by plastic and orthopedic or general surgeons. The experience with these cases has given the distinct impression that most surgeons do not realize the possibilities of plastic surgery in obtaining early and adequate closure or covering of the wounds with massive soft tissue and skin loss. Many wounds are left open too long, with the result that prolonged splinting, infection of the open wound, sloughing of exposed bone and tendon, will result in crippling that is out of proportion to the severity of the original injury.

2. Of all cases that deserve special consideration, none are more deserving than hand injuries. It is the responsibility of surgery in this theater to see that the soft tissue loss is replaced early in order to limit progress of the disabling pathological processes that result from an open wound. This procedure should be done early, before evacuation to the Zone of Interior. An Article has been submitted to the Medical Bulletin, European Theater of Operations, pointing out that hands and other injuries of the extremities that require extensive soft-tissue and skin replacement should be referred to hospitals in which plastic surgery is being done. The number so far subjected to early plastic surgery procedures is only a small percentage of the total that must be in hospitals of the Theater.

3. An increasing number of hand injuries are being sent to the Zone of Interior, following pedicle grafting here. These injuries are of all degrees of severity and many of them will require late reconstructive surgery. The pedicle grafts, in addition to halting the increasing incapacity that results from an open wound, will make it possible for the early institution of physiotherapy and reconstructive operations. The cases will present problems of bone, tendon, and nerve grafting that are completely beyond the scope of the ordinary surgeon. It is very strongly felt that these cases should not be operated upon by any but surgeons who have had some background in this type of work, and in hospitals where the work can be controlled.

4. It is the opinion of this Office that such cases should be accumulated, for their later care, in special hospitals, under the joint care of specialists qualified in this type of work.

Eugene M. Bricker
EUGENE M. BRICKER
Lieutenant Colonel, MC
Senior Consultant in Plastic Surgery

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