Wound Care (Hands)

A Wound Management Program includes: 

• assessment,
• treatment,
• protection from further injury and
• patient education.

Unattended wounds invite infection that can damage or destroy the small joints and tendons of the hand.   In hands with insensitivity, what often begins as a series of small injuries or an insidious infection can result in a gradual loss of soft tissue and bone reabsorption.  The infection process is believed to be primarily responsible for the loss of finger length in insensitive hands.  Abnormally high pressures, when holding or manipulating objects and muscle imbalances from nerve loss, also are responsible for loss of finger length and fingertip absorption.  Studies at the National Hansen's Disease Programs have documented x-ray changes over a period of years showing finger shortening and circumferential reabsorption to be frequently associated with episodes of infection.

Patient education and early treatment is essential to minimize deformity. Patients are taught to examine insensitive extremities routinely for redness or swelling and to identify objects and equipment they use which may cause injury.  Hot water from a faucet or a hot cup from a microwave may be enough to cause injury to patients with insensitive hands.  Patients are taught to use areas where they do have "protective sensation" to test potentially damaging hot objects and to wear gloves when manipulating hot or sharp objects.

Splinting of wounds is often necessary for patients with insensitive hands in order to protect the affective area during healing.  Only the minimum that needs to be immobilized is included in a dressing or splint, in order to keep the patient using the hand and increase their compliance with immobilization for the necessary period of healing.

Many wound management programs have been established to educate patients and healthcare workers in prevention of injuries and the need for aggressive treatment of all injuries in order to decrease the incidence of deformities.