The hand can be trapped in many different types of machinery, with the type of injuries dependent on the type of forces applied. The author is from the Institute of Reconstructive Surgery in Sofia, Bulgaria.
Forces Applied to Hand
Type of Machine
Injuries to Hand
Type
tangential shearing forces
moving rollers with narrow gap (< 1 cm); belt pulleys
avulsion of distal phalanges, partial or total denudation of skin from hand (degloving)
Type I
crushing, compressing
rollers with wider gap (1 - 3 cm)
crushing with fracture, lacerated wounds with wide flaying of surrounding skin
Type II
multiple cutting surfaces, rapidly moving planes with sharp cutting edges
carding machine
numerous cuts, skin avulsion, often severe mutilation
Type III
Complications:
(1) loss of blood supply - especially to digits, with mummification
(2) persistent edema
(3) large skin defects
(4) crush injury to bone and soft tissue
(5) amputation
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