Objective To summarize the clinical experiences in microsurgical treatment of severe children hand injuries caused by firecrackers. Methods 26 cases of children hand injuries caused by a firecracker blast were treated with microsurgical procedures. An emergency operation was done for 23 cases, and a delayed repair was done for 3 cases. Operative procedures differed from case to case, according to the injury type. Results All flaps and reconstructed thumbs survived completely by first intention. Of the 9 cases with 11 fingers replanted, 7cases with 9 fingers survived. The follow up for over two years showed that satisfactory restoration of hand function and shape was achieved and the replanted fingers also showed satisfactory restoration of holding and finger to palm and finger to finger functions. Conclusion Severe children hand injuries caused by a firecracker blast must be treated as soon as possible with microsurgical procedures. Preoperative planning of a proper repair or reconstruction approach is also of great importance.

Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist.Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.