ABSTRACT
This chapter on hand trauma will focus on infectious, traumatic, and posttraumatic conditions that one may encounter in underserved populations. Although patients in high-income countries (HICs) often present acutely, it is not uncommon for patients in low- and middle-income countries to present late and, most often, with other complicating factors. Thus, it is critical for the clinician to consider advanced cases of common scenarios as an explanation for a condition that he or she has never seen. Furthermore, follow-up care of traumatic or infectious conditions can be problematic as distance, education, and financial hardship often prevent return visits. Therefore, it is also important that the clinician consider the likelihood of continued care. For example, in certain circumstances, it may be more prudent to perform an amputation and immediate closure of a fingertip injury as opposed to several weeks of dressing changes to allow secondary healing. Although the latter approach would preserve length, the need for frequent dressing changes and follow-up, and the possibility of infection due to poor sanitation, may increase the risk of complications. Similar reasoning should apply to placement of drains, which may end up staying in place for months.
