Principles of hand surgery

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Principles of Hand surgery

Published in: Health & Medicine

Principles of hand surgery

  1. 1. PRINCIPLES HAND TRAUMA MANAGEMENT Mansoor Khan (M.B.B.S)
  2. 2. initial survey & Resuscitation…..?
  3. 3. wash THE WOUND...
  4. 4. dress THE WOUND…
  5. 5. splint hand in POSITION OF SAFE IMMOBALIZATION (POSI)
  6. 6. AMPUTATED PARTS 1 2 4 3
  7. 7. Secondary survey..?
  8. 8. 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.
  9. 9. vascularity: PERIPHERAL PULSES, CAPILLARY REFILL
  10. 10. muscle/tendons: LOSS OF MOVEMENT, DECREASED POWER OR PAINFUL MOVEMENT
  11. 11. soft tissue defect:SIZE, LOCATION, CONTAMINATION LEVEL, DONOR SITE ASSESSMENT
  12. 12. fractures: PAIN, TENDERNESS, DEFORMITIES (SCISSORING OF FINGERS)
  13. 13. x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE VIEWS
  14. 14. CT scan: BONE S & JOINTS DEFORMITIES
  15. 15. INFORMED CONSENT
  16. 16. Reconstruction….?
  17. 17. SENSIBILITY, FLEXIBLE DIGITS (ATLEAST TWO..) POWER & ACTIVE MOVEMENT ACCEPTIBLE ASTHETICS functional hand…..?
  18. 18. 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
  19. 19. 1 CAREFUL WOUND EXCISION
  20. 20. 1 tidy wounds: sharp, fresh (<24h)
  21. 21. 1 untidy wounds: CRUSHED, CONTAMINATED, INFECTED, DEVITALIZED, DELAYED….. Delayed primary closure
  22. 22. 2 SKELETAL STABALIZATION Simple fractures: ORIF Bone gaps: EX-FIX OR EARLY BONE GRAFTING AND PLATING
  23. 23. 3 revascularization; END TO END, REVERSED VEIN GRAFTS
  24. 24. 4 nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS
  25. 25. Tendons reconstruction early: WHEN EARLY MOBILIZATION IS POSSIBLE (SIMPLE FRACTURES) staged: MULTIPLE/COMPLEX FRACTURES, PULLEYS/SYNOVIAL SHEATHS DESTRUCTION, CONTAMINATION 5
  26. 26. 6 Soft tissue reconstruction TYPE, SIZE, LOCATION, MISSING STRUCTURES, CONTAMINATION LEVEL, FUTURE SURGERIES
  27. 27. 6 Soft tissue reconstruction OCCUPATION OF THE PATIENT, MENTAL STATUS,
  28. 28. 6 primary healing: TENSION FREE CLOSURE
  29. 29. 5 primary healing: SKIN GRAFTING AVOID: exposed vital structures, plan of re-exploration)
  30. 30. 5 primary healing: LOCAL FLAPS
  31. 31. 6 primary healing: REGIONAL FLAPS
  32. 32. 6 primary healing: DISTANT FLAPS
  33. 33. EARLY MOBILIZATION 7
  34. 34. REPLANTATION
  35. 35. INDICATIONS..

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