Crush, degloving, and burns of the upper extremity: a case report

Abstract

Excessive hand injuries are not uncommon in hand surgeon’s practice. They are usually caused by various devices such as circular saws, grinders, millers, presses, conveyers, and agricultural machines.
This article reports a case of mutilating injury to the entire upper extremity as a result of crush and burn of IV degree. The right upper extremity of a farmer who attempted to unblock the mechanism of a straw-press was pulled inside the machine. Despite resistance against the pulling force, the extremity was drawn inside the machine up to the elbow, where the cog-wheels started to glide on the exposed bones of the forearm and arm. The farmer first attempted to cut off the extremity with the pocket knife, following by firing the straw inside the press to draw somebody’s attention to his dramatic situation. Eventually, a person who passed by on the road nearby noticed the smoke flying out of the machine, came to the victim, and called for help. Despite the excessive injury of the entire upper limb and bleeding, the condition of the patient on admission was good. The extremity from the level of mid-arm was crushed, whittled, and burned, and the only option was the amputation at the proximal arm level. The post-operative course was uneventful.