In accordance with preventive medicine programs in industrial surgery, early management of the injured hand starts before the trauma is sustained. No greater dividends may be accumulated than those gained by the industrial surgeon who tours his plant to eliminate hazards. He must be a safety engineer. The responsible surgeon should be capable of managing all phases of the therapy of hand injuries and should, with the first inspection of the traumatized hand, envision the entire subsequent course, from first aid to rehabilitation. Step-by-step treatment and reconstruction follow. Certain procedures that in times past were considered urgent may now safely and advantageously be deferred.
The injured hand is inspected at the first aid station for serious bleeding and obvious nerve, tendon, and bone injury as well as for contaminants and irritants. The essential facts are recorded, and sterile, wrapped pressure dressings are applied for control of bleeding. Ligation may be