The initial surgical treatment is the main link in the treatment of hand injury and the basis for further treatment in the future. The principles of management are: early thorough debridement to prevent wound infection; Try to repair the damaged tissue and maximize the function of the hand. 1. Anesthesia should be performed under perfect anesthesia. Single finger injury can be anesthetized by finger nerve block; Wounds involving palm, back of hand or multiple fingers can be used as wrist nerve block; Larger wounds are best performed under brachial plexus anesthesia. 2. The purpose of debridement is to remove dirt and foreign bodies from the wound, remove inactive tissues, and turn the contaminated wound into a clean wound (not a sterile wound) to prevent infection. But emphasize: (1) Do a good job of wound cleaning? Although the method is simple, it is actually an important step to prevent wound infection and should be carried out very seriously. (2) What principles should be followed in debridement? From the outside to the inside, from shallow to deep, according to the level of planned debridement. The structure of the hand is complex, fine and rich in circulation. During debridement, the tissue with blood supply should be preserved as much as possible and the skin margin should be cut less. (3) Examine the damaged tissue and estimate the extent and scope of the damage? While planning debridement, comprehensively and systematically examine the injured tissue, estimate the degree and scope of injury, loosen the tourniquet when necessary, and observe the circulation of tissue (such as muscle and skin). 3. Usually handle the injured tissue with hand trauma and repair the injured tissue as soon as possible. If there is metacarpal and phalangeal fracture, fine kirschner wire can be used for percutaneous fixation, or the tail of kirschner wire can be buried under the skin. In case of fracture or poor local skin condition, it can be fixed with miniature external fixator. For the broken tendons, nerves and blood vessels, if there is no obvious pollution, the skin and subcutaneous tissue covering them are in good condition and can be sutured at one stage. Otherwise, it will be left to the second phase. 4. Closing the wound is an important measure to prevent wound infection. Only by closing the wound on the basis of thorough debridement can we protect the exposed deep tissue, prevent bacterial invasion and prevent infection. Rich hand circulation and strong anti-infection ability. The time limit for hand wound closure can generally be extended to 12 hours after injury, but it is not fixed and can be increased or decreased according to the nature of injury, pollution degree and temperature. The methods of closing the wound are: ① direct suture; ② Free skin grafting; ③ Skin flap coverage. 5. The bandaging and fixation of hand trauma is very important. Bone and joint injuries should be bandaged and fixed in functional position after operation. Tendon nerve injury should be fixed in a tension-free position after repair.