[Abstract] Objective : To investigate the surgical modalities for the treatment of crush and soft tissue avulsion injuries of the hand and to further improve the clinical efficacy, using hand trauma caused by a pasta press as an example. METHODS : Seventy-eight patients with hand trauma caused by a pasta press were treated with a one-stage debridement, or/and selected with different implants, to observe the postoperative clinical efficacy. Results : Among 78 patients, 38 were excellent, 26 were good, 10 were acceptable, and 4 were poor, with an excellent rate of 82%. CONCLUSION: Localized and individualized composite tissue transfer repair surgery for extrusion and avulsion injuries of the hand was completed in the same phase as debridement, which accelerated healing and supported early functional exercise, shortened the whole course of the disease, and improved the efficacy. [Keywords] Hand trauma, extrusion, avulsion, blood transport, skin graft, skin flap, extrusion and avulsion of hand skin caused by trauma to noodle press and similar machines is a common hand surgery disease in the emergency department. How to better manage soft tissue trauma in a timely manner and maximize the functional level is the focus of our discussion. A few points are discussed regarding the mechanism of injury and the key points of surgical treatment. 1. Clinical data 1.1 General data: 32 male cases, 46 female cases, age 20~45 years old, average 35 years old. There were 28 cases of left hand and 50 cases of right hand. All were fresh injuries. Among them, 16 cases were with open fracture, 11 cases were with tendon injury, and 6 cases were with vascular nerve injury. 1.2 Injury information: 17 cases of simple skin laceration, 61 cases of skin avulsion of the palm of the hand. There were 19 cases of avulsion of the skin edge of the palm far from the transverse wrist line to the middle palm line, 14 cases of avulsion to the metacarpophalangeal joint, and 28 cases of avulsion to the proximal phalangeal joint. There were 7 cases with combined dorsal avulsion injuries. 1.3 The operation time was 1-5 h after injury, with an average of 2 h. 1.4 Surgical methods 1.4.1 In situ suture: For simple skin lacerations, after debridement, there is no skin defect or only a small amount of defect, with good blood flow and little wound tension, the skin can be directly sutured in situ without skin grafting. There are 9 cases in total. 1.4.2 In situ reimplantation after skin trimming: After wound debridement, no bones and tendons are exposed, which can provide a granulation tissue bed, but the blood flow of the excised skin piece is poor. If the defect of skin and its supporting structures is too large after removal, and there is no hope of survival after in situ suturing, but the skin piece is intact enough to provide grafts, it is feasible to trim into full-thickness or medium-thickness skin pieces for reimplantation after packing and pressure bandaging. There were 33 cases. 1.4.3 Free skin grafting: If the above-mentioned wound is cleared, but the torn skin is lifeless and heavily damaged, it cannot be returned to implantation, it is feasible to free the medium-thickness or full-thickness skin pieces for transplantation. Total 18 cases. 1.4.4 Iliac inguinal flap transplantation: If the trauma surface was exposed with bones and tendons, which could not provide a granulation tissue bed, and the avulsed skin was lifeless and heavily damaged and could not be replanted, the possibility of free skin graft survival was small, and iliac inguinal flap transplantation was feasible. There were 12 cases. 1.4.5 Reversal flap graft with vascular tip: Patients with high requirements for skin texture and color can undergo forearm radial artery reversal flap grafting. A total of 4 cases. 1.4.6 Free flap grafting with anastomosis of blood vessels: for not only soft tissue destruction such as skin after debridement, but also trauma combined with severe tendon or metacarpal bone large severe damage, flap grafting with tendon bone on the back of the foot is performed, and the surgery requires anastomosis of the dorsal artery and vein of the foot. A total of 2 cases 1.5 Postoperative results 1.5.1 Efficacy and evaluation criteria: In order to clarify the efficacy, our department has roughly classified the surgical results as excellent, good, acceptable and poor as follows Functional activities are not restricted, the hand has good tactile and thermal sensation, the two points of discrimination are less than 4 mm, there is no skin necrosis, the appearance is relatively beautiful, there is no contracture scar of the fingers, and there is no web-shaped scar formation between the fingers is excellent, a total of 38 cases. Those with slightly limited functional activity, slightly dulled sensation in the hand compared to the opposite side, 4-5 mm of discrimination between the two points, no skin or a small amount of skin edge necrosis, scar replacement, no serious deformity in appearance, minor finger scar contracture, slight webbing scar formation between the fingers, but no contracture of the tiger skin, and no need for secondary surgery were considered good, in a total of 26 cases. Those who were able to perform basic hand movements, had dull sensation in the hand compared with the opposite side, had small and medium-sized necrosis of the skin, and had scar replacement after healing, with certain deformity in appearance, contracture of the finger scar, webbed scar formation between the fingers, especially contracture of the skin of the tiger’s mouth, and needed secondary surgery were considered good, 10 cases. Those who were unable to perform basic hand movements, palm contracture, severely restricted finger flexion and extension, tiger mouth contracture, extensive skin necrosis, unable to replace the scar, severe deformity in appearance, and had to undergo secondary surgery were considered poor, 4 cases in total.