Management of Traumatic Wounds of Hand and Foot by Various Modalities: A Comparative Analysis

Abstract

Background: Hand and foot have lower blood supply as compared to face and scalp, leading to hindrance in wound healing. Delayed and/or inadequate treatment of these wounds may even lead to permanent disabilities. Despite the importance of this matter, there are no widely accepted protocols for the treatment of traumatic wounds of hand and foot which can provide the most optimal treatment to the patients. Objective: To study the outcome of management of traumatic wounds of hand and foot by various modalities and compare the results of the above modalities of wound management in terms of rate of healing, control of infection, and functional outcome. Methods: A total of 30 patients were enrolled in this study and divided into 3 groups with 3 different treatment modalities: ARegular sterile dressings, BInfiltration of platelet-rich plasma (PRP) at wound edges, and C Split thickness skin grafting. Wounds were assessed serially by Bates Jensen Wound Assessment Tool (BJWAT) and skin grafting wounds were assessed by clinical points of graft acceptance, exudation, infection, contractures, etc. The functional outcome was quantified by the QuickDASH score for hand injuries, and the Foot and Ankle Ability Measure (FAAM) score for foot injuries. Results: Pre-treatment, the majority of the wounds were in the size range of 6-10 cm2. The pre-treatment mean BJWAT scores were 31.2 ±4.26, 33.2 ±4.80, and 32.2 ±4.52, in dressing group, PRP group, and Skin grafting group, respectively and it was not statistically significant. There was a statistically significant decrease in BJWAT scores in groups A and B by 9 weeks of treatment, but the PRP group showed a faster rate of healing. 80% of patients in the skin grafting group showed ‘excellent’ results. Most superior functional outcome scores of QuickDASH and FAAM were observed in the PRP group, followed by dressing and skin grafting groups. Conclusion: Platelet-rich plasma infiltration at wound edges provides a safe and effective treatment modality for the treatment of traumatic wounds of hand and foot.