It's quite common to see injuries occurring to young children in rural settings of Rajasthan. We have come across patients injured with manual hand operated fodder cutting machines of the age group of 7 to 8 months to 10 to 12 years.
A common pattern noted in very young who are so small in height that there hand cannot reach the cutting spokes of the machine, is that they were in lap of somebody close to the machine and suddenly, the child started exploring the machine and was injured. Also it has been observed in rural areas, young school going kids like to play with these machines, and usually one child puts his hand on machine while the other accidentally moves it.
Since these injuries are by manual machines, so usually sharp cut wounds with cut structures are seen mainly dorsum, either cutting the extensor tendons, or metacarpals along with it , and in few cutting all flexors along with the above structures, and ocassionally amputations .
Now a days more severe injuries are seen by these machines if timely it has not been stopped. with multiple crushing and wounds, at primary inspection it seems like ending in an amputation.
As a Hand Surgeon, I have seen many of these cases, and all attempts at prevention of digits, which ever is possible and thumb the most, should be attempted. Surprisingly the results are very good with these injuries and many fingers which initially appeared hopeless, will survive. All it requires is stabilization with good debridement and followed by constant dressings.
Many times the parts that are amputed can be used to reconstruct the remaining injured hand, The viable skin can be used for filitization, or FTG. Spare bone can be used as graft.
To illustrate what is said above a childs hand with preoperative and post operative pictures is presented. It can be very well seen that the Index finger that was non salvagable was used as flap cover and small portions of FTG.
The underlying message is that a lot can be preserved in these hands if they are timely seen and handled by any competent Hand Surgeon.