[Treatment of soft tissue injuries of the child's hand].

There are three major facts which differentiate injuries in children and adults: 1. The size of the hand and its anatomical structures which require finer instruments and a meticulous -- almost microsurgical -- operative technique. 2. The better healing and better regeneration following injuries which lead usually to a better functional result. 3. The relationship between scars and growth: a scar will not grow in the same way as normal skin, so that contractures may occur some years after the injury even in areas of the hand where in adults scar contractures may never occur. In this lecture, presented at the 17th Annual Meeting of The German Speaking Society for Surgery of the Hand in Tübingen, several cases demonstrate the general principles and special details in the operative treatment of soft tissue injuries in children. For the skin the correct placement of incisions in reconstructive surgery and the conversion of wounds into suture lines which will not lead to scar contractures are mentioned. Some cases with correction of existing scar contractures and prevention of new ones are shown (fig. 1 to 12). For flexor tendon injuries some of the satisfactory results after primary repair and secondary reconstruction are demonstrated. Also in nerve injuries the better regeneration in children will lead to good functional results following nerve grafting. In irreversible nerve damage tendon transfers are employed by the same technique as in adults (fig. 13 to 15). For the operative treatment of ischemic contractures of the forearm and the hand the different procedures are mentioned. The importance of the intrinsic test (PARKES) for the diagnosis of the contracture of the interossei is stressed (fig. 16 and 17). A case of thumb reconstruction in a four year old girl by transposition of the index finger on a neurovascular pedicle shows that in smaller children complicated reconstructive procedures can give excellent results (fig. 18).