Saving Hands in Times of War in Conflict Zones with Limited Resources: A Cohort Study from Sudan

Background: The hand is essential for daily function, yet war-related injuries can cause complex damage leading to disability or amputation. This issue is particularly pronounced in resource-limited settings. In light of these challenges, this article examines the epidemiology, types of injuries, surgical interventions, and complications of combat-related hand injuries in Sudan. Methods: This prospective cohort study was conducted at a single hospital from January 2024 to January 2025. Fifty-three patients with combat-related hand injuries underwent reconstructive surgery, and data were collected on demographics, mechanism of injury, anatomical zones, surgical procedures, and outcomes. To evaluate complications and recovery, patients were followed up for 6 months. Results: Most patients were male (79.2%), with manual laborers and students being the most affected groups (32% each). Gunshots (52.8%) and explosions (47.2%) were the leading causes. Fractures occurred in 92.4% of cases, most of which were treated with K-wires (77.3%). Flap coverage was the main reconstructive method (64.1%), followed by delayed primary closure (32%) and skin grafting (5.6%). A single-stage procedure was performed in 77.4% of cases. Finger amputation occurred in 24.5%, most commonly the index finger. Infection was the leading complication (42%). Conclusions: War-related hand injuries primarily affect young males and often involve fractures and tissue loss. Despite limited resources, functional preservation is achievable using traditional techniques, and single-stage surgery has been proved to be effective. Careful planning and physiotherapy optimize outcomes, even in patients with amputations.