Principles of hand surgery
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Principles of hand surgery

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Principles of Hand surgery

Principles of Hand surgery

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    Principles of hand surgery Principles of hand surgery Presentation Transcript

    • PRINCIPLES HAND TRAUMA MANAGEMENT Mansoor Khan (M.B.B.S)
    • initial survey & Resuscitation…..?
    • wash THE WOUND...
    • dress THE WOUND…
    • splint hand in POSITION OF SAFE IMMOBALIZATION (POSI)
    • AMPUTATED PARTS 1 2 4 3
    • Secondary survey..?
    • SECONDARY SURVEY HISTORY Occupation, hobbies, hand dominance, mechanism of injury, position of hand during the insult, duration, treatments already offered, protocol of amputated part transportation, Past history: Co-morbidities, any past surgery of on the injured part.
    • vascularity: PERIPHERAL PULSES, CAPILLARY REFILL
    • muscle/tendons: LOSS OF MOVEMENT, DECREASED POWER OR PAINFUL MOVEMENT
    • soft tissue defect:SIZE, LOCATION, CONTAMINATION LEVEL, DONOR SITE ASSESSMENT
    • fractures: PAIN, TENDERNESS, DEFORMITIES (SCISSORING OF FINGERS)
    • x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE VIEWS
    • CT scan: BONE S & JOINTS DEFORMITIES
    • INFORMED CONSENT
    • Reconstruction….?
    • SENSIBILITY, FLEXIBLE DIGITS (ATLEAST TWO..) POWER & ACTIVE MOVEMENT ACCEPTIBLE ASTHETICS functional hand…..?
    • UPPER LIMB RECONSTRUCTION Delayed approach Skeletal stabalization/ vascularity/ skin cover -- early Nerve/tendon/skel etal reconstruction is delayed Early All the components are reconstructed within 72hrs
    • 1 CAREFUL WOUND EXCISION
    • 1 tidy wounds: sharp, fresh (<24h)
    • 1 untidy wounds: CRUSHED, CONTAMINATED, INFECTED, DEVITALIZED, DELAYED….. Delayed primary closure
    • 2 SKELETAL STABALIZATION Simple fractures: ORIF Bone gaps: EX-FIX OR EARLY BONE GRAFTING AND PLATING
    • 3 revascularization; END TO END, REVERSED VEIN GRAFTS
    • 4 nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS
    • Tendons reconstruction early: WHEN EARLY MOBILIZATION IS POSSIBLE (SIMPLE FRACTURES) staged: MULTIPLE/COMPLEX FRACTURES, PULLEYS/SYNOVIAL SHEATHS DESTRUCTION, CONTAMINATION 5
    • 6 Soft tissue reconstruction TYPE, SIZE, LOCATION, MISSING STRUCTURES, CONTAMINATION LEVEL, FUTURE SURGERIES
    • 6 Soft tissue reconstruction OCCUPATION OF THE PATIENT, MENTAL STATUS,
    • 6 primary healing: TENSION FREE CLOSURE
    • 5 primary healing: SKIN GRAFTING AVOID: exposed vital structures, plan of re-exploration)
    • 5 primary healing: LOCAL FLAPS
    • 6 primary healing: REGIONAL FLAPS
    • 6 primary healing: DISTANT FLAPS
    • EARLY MOBILIZATION 7
    • REPLANTATION
    • INDICATIONS..