Soft tissue anatomy for hand flaps

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Vaikunthan Rajaratnam

Skin flaps in the hand their anatomy and the use in upper limb reconstruction.

Soft tissue
anatomy
Flaps in the hand
Vaikunthan Rajaratnam
@handsurgeryinternational

Evolution of flap

Perforator Flaps
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg.
1989;42:645–8.
Septocutaneous perforators:
Musculocutaneous perforators

Types of perforator flaps

Elevation of perforator flap

Flap advancement
• Preoperative Doppler
• Outline flap
• Cover the defect
• Donor site closed
directly

Reversed flow
radial artery flap

Ulnar Artery Perforator Flap

Posterior
Interosseous
Artery
Perforator Flap

Posterolateral Mid-Forearm Perforator
Flap

Dorsal
Metacarpal Artery
Perforator Flaps

Digital Artery
Perforator Flap

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Catheterization of the bladder involves introducing a latex or plastic tube through the urethra and into the bladder. The catheter provides a continuous flow of urine in patients unable to control micturition or those with obstructions. It also provides a means of assessing urine output in hemodynamically unstable patients. Because bladder catheterization carries the risk of UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for either specimen collection or management of incontinence. Types of Catheterization. Intermittent and indwelling retention catheterizations are the two forms of catheter insertion INTERMITTENT CATHETERIZATION introduce a straight single-use catheter long enough to drain the bladder (5 to 10 minutes When the bladder is empty, you immediately withdraw the catheter. COMPLICATION- increases risk of trauma and infection. INDICATION- It is common for people with spinal cord injury or other neurological problems such as multiple sclerosis to perform self– intermittent catheterization up to every 4 hours daily for months or years. UTI rate is lower than for patients with long-term indwelling catheters. INDWELLING CATHETERIZATION- remains in place for a longer period, until a patient is able to void voluntarily or continuous accurate urine measurements are no longer needed The straight single-use catheter has a single lumen with a small opening about 1.3 cm ( 1 2 inch) from the tip. . Urine drains from the tip, through the lumen, and to a receptacle. An indwelling Foley catheter has a small inflatable balloon that encircles the catheter just above the tip. When inflated the balloon rests against the bladder outlet to anchor the catheter in place. The indwelling retention catheter often has two or three lumens within the body of the catheter . One lumen drains urine through the catheter to a collecting tube. A second lumen carries sterile water to and from the balloon when it is inflated or deflated. A third (optional) lumen is sometimes used to instill fluids or medications into the bladder. It is easy to determine the number of lumens by the number of drainage and injection ports at the end of the catheter A second type of intermittent catheter has a curved tip A Coudé catheter is used on male patients who may have enlarged prostates that partly obstruct the urethra. It is less traumatic during insertion because it is stiffer and easier to control than the straight-tip catheter Plastic catheters are suitable only for intermittent use because of their inflexibility Latex catheters are recommended for use up to 3 weeks. Be aware of allergies. Pure silicon or Teflon catheters are best suited for long-term use (2 to 3 months) because of less encrustation at the urethral meatus Balloon sizes range from 3 mL (pediatric) to large postoperative volumes (75 mL). In adults the 5-mL and 30-mL sizes are the most common: The 5-mL size allows for optimal drainage, whereas the 30-mL size is used after pros

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Delivered on May 15, 2024 by the public and patient engagement team from the George & Fay Yee Centre for Healthcare Innovation, this presentation discusses the nuances of navigating conflict in patient engagement. Learning objectives include: -Understand the importance of using a trauma-informed approach in patient and public engagement -Develop a strategy to work with patient and public partners in addressing conflict as it arises -Employ strengths-based approaches to plan for conflict in your own work

Navigating Conflict in PE Using Strengths-Based Approaches

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