The superficial location of tendon, nerve, and vessel in
the volar wrist puts these structures in jeopardy with any
penetrating injury. The more extensive of these injuries
have been referred to commonly as spaghetti wrist
injury1,2 (Fig. 1). One tendon laceration or even two may
have little disabling importance. However, complete
transaction of either median or ulnar nerve is crippling,
and when three or more tendons are injured, functional
disability becomes quite marked. Spaghetti wrist can be
devastating in nature, involving as many as 16 different
structures, including 12 tendons, 2 nerves, and 2 arteries.3
Although the three-structure minimal limit was selected
by Puckett and Meyer,1 spaghetti wrist injuries were
defined as lacerations occurring between the distal wrist
crease and the flexor musculotendinous junctions involving
at least three completely transected structures, including
at least one nerve and often a vessel. Furthermore,
there is no standard definition in the current literature as
to what constitutes a spaghetti wrist, ranging from a minimum
of three completely transected structures (nerve,
artery, and tendon)1 to at least 10 divided structures inclusive
of both median and ulnar nerves.4–6 Despite their
relatively frequent occurrence, few data are available in
the literature to categorize these injuries and even less is
known about functional outcome.1,3–6 The goals of present
study are to 1) present common patterns of spaghetti
wrist injuries, 2) describe different operative approaches
according to site and shape of the wound, 3) present new
functional outcome score able to evaluate the results of
both tendon and nerve repair, and 4) compare and contrast
our findings with those in the literature.