Spaghetti Wrist Injury: Repair Strategy, Microsurgery and Rehabilitation

“Spaghetti wrist” is one of those injuries where anatomy, microsurgery, trauma strategy and rehabilitation meet in a single wound. This lecture walks through the management of extensive soft-tissue injuries of the distal and middle forearm, where flexor tendons, median and ulnar nerves, and radial or ulnar arteries may be injured simultaneously.

The discussion focuses on decisions that change the entire treatment plan: how the mechanism of injury predicts tissue loss, when ischemia should alter the sequence of repair, why tendon repair may technically come first but circulation sometimes cannot wait, and when temporary restoration of blood flow becomes useful. The speaker also reviews surgical exposure, identification of multiple divided structures, tendon and nerve suturing, arterial anastomosis under magnification, wound closure and drainage.

A major part of the lecture is devoted to what happens after the operating room. Complex hand trauma creates competing priorities: vessels and nerves benefit from protection, while repaired tendons need movement to avoid adhesions. The session explores this compromise, immobilization, monitoring of vascular patency, rehabilitation timelines, secondary surgery for adhesions and contractures, and realistic assessment of function over many months.

The extended Q&A adds practical scenarios rarely covered by textbook algorithms: major nerve defects, staged reconstruction, temporary vascular shunting, gunshot wounds, tendon graft options, muscle stimulation, scar management and what to do when specialist resources are limited. It is a clinically grounded discussion for surgeons learning to think beyond the repair itself and plan the entire pathway toward a functional hand.