In hand injury first structure to be repaired should be-
CSDT 13/e p1149 writes -"Bone must first be stabilized with K wires or metal plates before vascular repairs are performed. Arterial and venous repairs are done with microscopic magnification, and the ischemic tissue is reperfused."
Sabiston 18/e p1995 writes-"Although control of active hemorrhage is always a top priority, reconstruction of injured vessels must be carefully orchestrated with the management of bone and soft tissue injuries. It is preferable to achieve bone alignment before vascular reconstruction because orthopedic manipulation and reconstruction takes time and may disrupt the vascular repair. Thus, if the limb is not grossly ischemic, reduction and fixation of fractures is performed first. If the limb is ischemic, a temporary intraluminal shunt is inserted to maintain distal perfusion during the orthopedic procedure."
Skin
Nerve
Muscle
Bone