Aesthetics in Hand Surgery
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DHP[MH[F@P FG MDGK PXQIHQV?BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
Ldttmfhu AHXP[HP-P[HBDGHJJF, LKUjdstf` Purihry & Mdgk Purihry
Udrfs, Brdg`h
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F) Dhstmhtf` `ngsfkhrdtfngs fg mdgk surihry
FF) Mdgk dhstmhtf` rh`ngstru`tfng
FFF) Mdgk rhouvhgdtfng
DHP[MH[F@P FG MDGK PXQIHQV?BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
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F) Dhstmhtf` `ngsfkhrdtfngs fg mdgk surihry
FF) Mdgk dhstmhtf` rh`ngstru`tfng
FFF) Mdgk rhouvhgdtfng
DHP[MH[F@P FG MDGK PXQIHQV?BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
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! Dhstmhtf` ugfts nb Lf`mng
! Dkdptdthk Pcfg fg`fsfngs
! Lfgf-fgvdsfvh surihry (hgkns`npy, drtmrns`npy)
! @ngshrvdtfng nb tmh knrsdj dsph`t nb tmh mdgk dgk tmh bnrhdrl
! Gn scfg irdbts ng tmh pdjldr dsph`t nb mdgk dgk pujp
! Pcfg irdbt dgk bjdp kngnr sfths
! ht`…
DHP[MH[F@ @NGPFKHQD[FNGP
FG MDGK PXQIHQV
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! Dhstmhtf` ugfts nb tmh mdgk (Lf`mng)
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Gng-lhsmhk scfg irdbt rhsph`tfgi dhstmhtf` ugfts
nb tmh knrsul nb tmh mdgk dgk tmh bfgihrs
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! Dkdptdthk Pcfg fg`fsfngs
Udjldfrhs +++ Knrsdjhs +
Jdtærdjhs +++
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Qhsph`t tmh scfg thgsfng jfghs nb Jdgihr
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! Lfgf-fgvdsfvh Purihry
" rhku`hs s`drs
hx? Cgfbh jfimt® bnr @[P
hx ? Yrfst tmhrdphutf` drtmrns`npy
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! @ngshrvdtfng nb tmh knrsdj dsph`tnb tmh mdgk dgk tmh bnrhdrl
. Dvnfk knrsdj s`drs
. Gn lhsmhk scfg irdbts
. [mfg bjdps
. Dvnfk FNU bjdp fg `mfjkrhg nr ynugi wnlhg
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Xgdhstmhtf` dsph`tnb d lhsmhk scfg irdbt
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Irnfg bjdp tnn tmf`c
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! Dvnfk scfg irdbts fg pdjl dgk pujp
hx ? Ufilhgthk dgk mhdry Bujj [mf`cghss Pcfg Irdbt
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Kdy 14
1 lngtm
Ld` @dsm prn`hkurh
(nphg pdjl) +++fg Kupuytrhg‖s kfshdsh
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! Ah `drhbuj wftm tmh `mnf`h dgk tmh qudjfty nb mdrvhstfgi nb kngnrsfths
Pcfg irdbt tnn tmf`c
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Bujj tmf`cghss scfg irdbt mdrvhsthk fg tmh irnfg nb d ajd`c pdtfhgt bnr tmh pdjl
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Lhkfdj dsph`t nb tmh drl tn mdrvhst djdrih bujj tmf`cghss scfg irdbt
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F) Dhstmhtf` `ngsfkhrdtfngs fg mdgk surihry
FF) Mdgk dhstmhtf` rh`ngstru`tfng
FFF) Mdgk rhouvhgdtfng
DHP[MH[F@P FG MDGK PXQIHQV?BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
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4 ! Qmuldtfsldj Khbnrldtfngs wftmnut pdfg+++ KFUO drtmrftfs
+ Qmuldtnfk Drtmrftfs+ 4st @L@ Drtmrftfs
1 ! Knrsdj Kupuytrhg‖s kfshdsh
0 ! @ngihgftdj ldjbnrldtfngs
; ! Phquhjdh nb trdulds nb tmh bfgihrtfp
8 ! Dlputdtfngs (dhstmhtf` dlputdtfngs, dhstmhtf` prnstmhshs)
2 ! @utdghnus khbh`ts
9 ! Pua`utdghnus khbh`ts
= ! Pcfg surbd`h kfsnrkhrs
! ht`…
MDGK DHP[MH[F@ QH@NGP[QX@[FNG
D) Mdgk rh`ngstru`tfvh surihry bnr dhstmhtf` fgkf`dtfngsA) Dkouvdgt trhdtlhgts (dhstmhtf` prnstmhshs, khrldtnjnif`djtrhdtlhgts)
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4 ! KFUO Drtmrftfs(lnst `nllng dhstmhtf` fgkf`dtfng fg mdgks)
0 `ngshrvdtfvh th`mgfquhs +++
" `nrtf`nfk fgoh`tfngs
" Qnldgn‖s KFUO drtmrnpjdsty
" KFUO Pwdgsng Urnstmhsfs (sfzh 5)
Fb Drtmrnkhsfs ?
" dt 5µ nb hxthgsfng
" angh irdbt fb lfkkjh bfgihr
Lu`nfk `yst Mhahrkhg‖s gnkuj
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Qnldgn‖s KFUO Drtmrnpjdsty
# Lf`rnjfbt nb tmh scfg ? « Autthrbjy ³ khsfig
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! Khbdttfgi nb tmh ; bjdps
! Qhsh`tfng nb snbt tfssuh
# Qhsh`tfng nb tmh jdthrdj nsthnpmytfs
# Qhsh`tfng nb tmh knrsdj nsthnpmytfsugkhr tmh hxthgsnr thgkng vhryprh`dutfnusjy
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! Pcfg `jnsurh fg RV
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; lngtms
`nlprhssfng
RV
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KFUK Pwdgsng Urnstmhsfs(sfzh 5)
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KFUO Drtmrnkhsfs nb lfkkjh bfgihr?
- dt 5µ nb hxthgsfng
- wftm angh irdbt tn chhp tmh jhgitm
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4 ! Qmuldtnfk drtmrftfs
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4 ! 4st @L@ drtmrftfs
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1 ! Knrsdj Kupuytrhg‖s kfshdsh
Cgu`cjh pdks
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0 ! @ngihgftdj ldjbnrldtfngs
" dhstmhtf` fgkf`dtfng fg 68% nb `dshs
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; ! Phquhjdh nb bfgihrtfp trdulds
hx ? Gdfj `nlpjhxvds`ujdrfzhk trdgsbhr
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@urvhk gdfj
hx ? gdfj strfdtfng dgk bfxdtfng + fsjdgk bjdp +/-angh irdbt
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8 ! Dlputdtfngs
hx ? lfkkjh bfgihr dhstmhtf` dlputdtfngay fgtrd-`drpdj nsthntnly nb Jh Rfht
¤ Dhstmhtf` surif`dj dlputdtfngs
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Ufjjht Mdgk Urnstmhsfs (UMU), Udrfs - Brdg`h
[mula
¤ Dhstmhtf` mdgk prnstmhshs
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Jngi bfgihrs
trduld
`ngihgftdj
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Udrtfdj Mdgks
trduld
`ngihgftdj
t
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[ntdj mdgk
trduld
`ngihgftdj
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Bnrhdrl
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Drl
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Urnstmhsfs dbthr rh`ngstru`tfvh surihry
Gng dhstmhtf` pmdjdgifsdtfng nb ;
lhtd`drpdjs
Udrtfdj mdgk prnstmhsfs
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[nh trdgsbhr bnr tmh bug`tfng Jngi tmula prnstmhsfs tn flprnvhdhstmhtf` dsph`t
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Irnfg bjdp? tnn aujcy
2 " @utdghnus khbh`ts
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Pcfg suastftuths nr bds`fdj bjdps lnrh dkdpthk
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hx? ujgdr pdjsy wftm dlyntrnpmy nb fgthrnsshnus lus`jhs
9 " Pua`utdghnus khbh`ts
bdt irdbtfgi +++
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. Ldjdkfh kh Kupuytrhg å ug stdkh præ`n`h (F nu FF)hx? Kupuytrhg‖s kfshdsh (hdrjy stdihs)
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!!! #$ %&&'(#%)#'$ *#)+ ,-.(/)%$-'/& %,'$-5.')'41 01 $--;8- 29= 6'5#/&?
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Myphrpfilhgthk scfg irdbt T swft`mhk Jdshr
= " Pcfg surbd`h kfsnrkhrs
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[nh trdgsbhr wftm mdfr" Hpfjdtnry Jdshr
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[dttnn ng tmh mdgk knrsul " Jdshr Vdi T swft`mhk
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F) Dhstmhtf` `ngsfkhrdtfngs fg mdgk surihry
FF) Mdgk dhstmhtf` rh`ngstru`tfng
FFF) Mdgk rhouvhgdtfng
DHP[MH[F@P FG MDGK PXQIHQV?BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
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Yftm tmh khvhjnplhgtnb bd`fdj rhouvhgdtfng,
dpphdr snlh pdrdknxdjsftudtfngs wmhrh bd`hdifgi dgk mdgks difgi
kn gnt `nrrhspngk…
‚Ldknggd sygkrnl‚
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YH @DG @MDGIH HRHQV[MFGI FG D YNLDG,
MHQ MDGKP YFJJ DJYDVP PMNY MHQ DIH…>
MDGK QHOXRHGD[FNG
Mdgk dhstmhtf`s fg lhkf`dj lhhtfgis
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Mdgk dhstmhtf`s fg lhkf`dj lhhtfgis
¤ Ahbnrh 1559? ngjy bhw fsnjdthk brhh pdphrs
¤ 4st LHID MDGK Pylpnsful (Bharudry 155=, Udrfs, 4 kdy)
¤ DLY@ @ngirhss (Dprfj 155=, Udrfs, d shssfng nb 1 mnurs)
¤ BHPPM @ngirhss (Ough 155=, Jdusdggh, d shssfng nb 1 mnurs)
¤ FL@DP @ngirhss (Odgudry 1556, Udrfs, d shssfng nb 4 mnur)¤ 1gk LHID MDGK Pylpnsful (Bharudry 1556, Udrfs, 1 kdys)
¤ DLY@ @ngirhss (Ldr`m 1556, Lngd`n, d shssfng nb 1 mnurs)
¤ PNB@HU @ngirhss (Dprfj 1556, @dgghs, d shssfng nb ;8 lfguths)
¤ 0rk
LHID MDGK Pylpnsful (Ldr`m 1545, Udrfs)
¤ ;tm LHID MDGK Pylpnsful (N`tnahr 1544, Udrfs)
¤ 8tm LHID MDGK Pylpnsful (N`tnahr 1541, Udrfs)
¤ 2tm LHID MDGK Pylpnsful (Phpt 1540, Gf`h)? 4st f@jdss Mdgk
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Mdgk rhouvhgdtfng
Ymy sn jdth>
. wh kng‖t jnnc nur mdgks fg tmh lfrrnr
. wh kng‖t tdch pf`turhs nb nur mdgks
. mdgk difgi fs jdthr tmdg bd`h difgi
. dgk djsn ah`dush nb tmh sph`fbf` dgdtnly nb tmh mdgk wmf`mfgku`hs bhdr fg ldgy pmysf`fdgs dgk sjnwhk knwg tmh
khvhjnplhgt nb mdgk rhouvhgdtfng th`mgfquhs…
P f j b m k f
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Phlfnjniy nb mdgk difgi (+++ knrsdj, ++ jdthrdj, + pdjldr)
FG[QFGPF@ DIFGI (dih)
¤ Pcfg < khrldtnpnrnsfs
- hpfkhrldj dtrnpmy
- khrldj dtrnpmy
¤ Bdt dtrnpmy
¤ Lus`jhs < dlyntrnpmy
¤ Rhsshjs brdifjfty # spngtdghnus mhldtnlds
¤ Gdfjs (difgi gdfjs)
¤ Onfgts < khbnrldtfng (KFUO dgk 4st @L@ drtmrnsfs +++)
H][QFGPF@ PCFG DIFGI (sug +++, slncfgi +)
< khrldtnmhjfnsfs? kdrc spnts +++ / bfgh wrfgcjhs +
# kryghss
# schjhtngfzdtfng (vhfgs, thgkngs dgk schjhtng tnn lu`m vfsfajh)
# ihghrdj dsph`t tmfgghr dgk jngihr
# scfg trdgspdrhg`h dgk brdifjfty (`fidrhtth pdphr scfg)
# scfg sdiifgi (khhp wrfgcjhs)
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Mdgk rhouvhgdtfng trhdtlhgts
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d k hou h dt n t hdt h tsPXQIF@DJ [QHD[LHG[P?
¤ Jfbtfgis
¤ Bdt irdbtfgi
¤ Khrldj irdbts? dutnjninus (smhht nr `rusmhk+fgoh`thk ) nr djjnihgf` (hx? Djjnkhrl® )
¤ Khrldj-bdt irdbtfgi (hg ajn` nr fgoh`thk shpdrdthjy)
¤ Bds`fdj irdbts (thlpnrdjfs bds`fd, bds`fd jdtd, juladr bds`fd)
¤ Khrldj Puastftuths wftm 4 sthp prn`hkurh (Fgthird® KQ[ Pfgijh Jdyhr, Ldtrfkhrl® 4ll)
¤ Ujfdajh afnldthrfdj smhhts (Pfjf`ngh, Inrh-thx ® )
¤ Ujdsld fgoh`tfngs (UQU, UQIB)
¤ Umjhah`tnlfhs
¤ @nrrh`tfng nb onfgt drtmrnsf` khbnrldtfngs (KFUO, 4st @L@, …)
LHKF@DJ [QHD[LHG[P?
¤ Pygtmhtf` Bfjjhrs (MD, NMdpdtfth, UJD, @njjdihgh, Pfjf`ngh) / Lhsntmhrdpy
¤ Qdkfdtfngs? Jdshrs, Jfimts ( FUJ , JHK), Umntntmhrdpy (UK[), Qdkfnbrhquhg`y
¤ @mhlf`dj phhjs
¤ Khrldardsfng dgk lf`rnkhrldardsfng / Pcfg ghhkjfgi
¤ @dranxytmhrdpy
¤ Rhfg s`jhrntmhrdpfhs
¤ Gdfj rhouvhgdtfng
DKOXRDG[ [QHD[LHG[P?
¤ @nslh`hutf`s (lnfsturfzfgi, dgtf-nxykdgts, ̀ nnjfgi, snjdr s`rhhg, khpfilhgtdgts, …)
¤ Dgtf-Difgi Lhkf`fgh (kfhtdry dkvf`hs, bnnk suppjhlhgts, vftdlfgs, mnrlnghs, slncfgi stnp…)
Mdgk rhouvhgdtfng trhdtlhgts
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PXQIF@DJ [QHD[LHG[P?
¤ Jfbtfgis
¤ Bdt irdbtfgi
¤ Khrldj irdbts? dutnjninus (smhht nr `rusmhk+fgoh`thk ) nr djjnihgf` (hx? Djjnkhrl® )
¤ Khrldj-bdt irdbtfgi (hg ajn` nr fgoh`thk shpdrdthjy)
¤ Bds`fdj irdbts (thlpnrdjfs bds`fd, bds`fd jdtd, juladr bds`fd)
¤ Khrldj Puastftuths wftm 4 sthp prn`hkurh (Fgthird® KQ[ Pfgijh Jdyhr, Ldtrfkhrl® 4ll)
¤ Ujfdajh afnldthrfdj smhhts (Pfjf`ngh, Inrh-thx ® )
¤ Ujdsld fgoh`tfngs (UQU, UQIB)
¤ Umjhah`tnlfhs
¤ @nrrh`tfng nb onfgt drtmrnsf` khbnrldtfngs (KFUO, 4st @L@, …)
LHKF@DJ [QHD[LHG[P?
¤ Pygtmhtf` Bfjjhrs (MD, NMdpdtfth, UJD, @njjdihgh, Pfjf`ngh) / Lhsntmhrdpy
¤ Qdkfdtfngs? Jdshrs, Jfimts ( FUJ , JHK), Umntntmhrdpy (UK[), Qdkfnbrhquhg`y
¤ @mhlf`dj phhjs
¤ Khrldardsfng dgk lf`rnkhrldardsfng / Pcfg ghhkjfgi
¤ @dranxytmhrdpy
¤ Rhfg s`jhrntmhrdpfhs
¤ Gdfj rhouvhgdtfng
DKOXRDG[ [QHD[LHG[P?
¤ @nslh`hutf`s (lnfsturfzfgi, dgtf-nxykdgts, ̀ nnjfgi, snjdr s`rhhg, khpfilhgtdgts, …)
¤ Dgtf-Difgi Lhkf`fgh (kfhtdry dkvf`hs, bnnk suppjhlhgts, vftdlfgs, mnrlnghs, slncfgi stnp…)
o
Mdgkjfbts
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MdgkjfbtsKnrsdj s`dr
(Yhgkt)
Xjgdr s`dr
Udjldr + @nllfssurdj s`dr(Pdbbdr)
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Fgvdsfvh QhouvhgdtfngDutnjninus
Khrldj irdbts
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Djjnkhrl℡IDG@MF U., XPD
UMJHAH@[NLFHP
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Fg `dshs nb vhfgs lnrh tmdg 2-9 ll nb kfdlhthrGN LNQH [MDG 4 nr 1 RHFGP +++
UMJHAH@[NLFHP
! Umjhah`tnly
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! Umjhah`tnly
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KFUO LF@QNJFB[ « autthrbjy ³ (Qnldgn)
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KFUO LF@QNJFB[ « autthrbjy ³ (Qnldgn)
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BD[ IQDB[FGI
1 prn`hkurhs?
Bnurgfhr‖s prn`hkurh (njk)! diirhssfvh dspfrdtfng, gn `hgtrfbuidtfng, afi `dgujds, afi vnjulhs
< lnrh rhsnratfng (1 prn`hkurhs), julps fg 48%
@njhldg‖s prn`hkurh (ghw)!
snbt dspfrdtfng, `hgtrfbuidtfng, sldjj `dgujds, sldjj vnjulhs< jhss rhsnratfng (4 prn`hkurh)
! fg`rhdshk rdth nb DkP@ < trnpmf` hbbh`t
Yh ush tmh @njhldg‖s prn`hkurh
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UB Bnurgfhr, Udrfs
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15 `` fg tmh knrsul nb tmh wrfstay ngh fg`fsfng
@jnsurh nb tmh bfst
Mnlnihghnus kfstrfautfng
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Lftz lnkfbf`dtfng ?lujtfpjhs fg`fsfngs dgk @rfss`rnss bdt irdbtfgi
BD[ FLLHKFD[H DGK KFQH@[ MDQRHP[FGI
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BD[ FLLHKFD[H DGK KFQH@[ MDQRHP[FGI
; ll `dgujdsdspfrdtfng
Gn `hgtrfbuidtfng
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15 `` syrfgihs
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1 ll `dgujds bnr fgoh`tfng
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" Gn ghhk nb sph`fbf` ldthrfdj
" Pmnrt
" 85 tn 95% nb rhsnratfng (ghhk nb 4 tn 1 ntmhrs fgoh`tfngs)" julps fg 48%, tn rhlnvh
" gng mnlnihghnus kfstrfautfng nb tmh bdt
Dkvdgtdihs nb Bnurgfhr‖s prn`hkurh
Kfsdkvdgtdihs nb Bnurgfhr‖s prn`hkurh
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Julps fg 48% (bdtty `yst)
! Jfpnstru`turh nb tmh knrsul nb tmh mdgk
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! Jfpnstru`turh nb tmh knrsul nb tmh mdgk
Pykghy @NJHLDG, GV
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" ngjy 05% nb bdt rhsnratfng (gn ghhk nb 1gk prn`hkurh)
" gn julps
" trnpmf` hbbh`t khlngstrdthk
" sph`fbf` ldthrfdj
" jngi prn`hkurh
Dkvdgtdihs nb @njhldgs‖ prn`hkurh
Kfsdkvdgtdihs nb @njhldgs‖ prn`hkurh
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AVQNG® `dgujds
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Dspfrdtfng (1 ll) Fgoh`tfng (4 ll)
Mdrvhstfgi nb tmh bdtty tfssuh(dspfrdtfng ugkhr jnw khprhssfng)
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(dspfrdtfng ugkhr jnw khprhssfng)
45 `` syrfgih
1 ll `dgujd
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`hgtrfbuidtfng
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@njhldg‖s `hgtrfbuidtfng prntn`nj
? 0lfguths dt 0555 r.p.l
0 `nlpnghgts ? nfjbdtajnnk
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ajnnk
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8/18/2019 Aesthetics in Hand Surgery
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Qhlnvdj nb tmh nfj dgk tmhajnnk
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4 `` syrfgih
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4 ll fgoh`tfng `dgujds
[h`mgfquh nb stru`turdj bdt irdbtfgi
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[h`mgfquh nb stru`turdj bdt irdbtfgi
@rhdtfng nb d tugghj wftm tmh 4 ll `dgujd
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Fgoh`tfng infgi ad`cwdrk fg tmh tugghj oust `rhdthk
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Lujtf-jdyhr dgk lujtf-kfrh`tfng fgoh`tfng
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rhvds`ujdrfzdtfng
BD[ IQDB[FGI (@njhldg‖s prn`hkurh)
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BD[ IQDB[FGI (@njhldg s prn`hkurh)
45 lfgf-fg`fsfngs 05 ``
Mdgk knrsul
U4
Kfstdj knrsdj
bnrhdrl
[mhgdr
hlfghg`h
Mypntmhgdr
hlfghg`h
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JHRHJ NB IQDB[FGI?
danvh dgk drnugk
tmh vhgnus jdyhr
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8/18/2019 Aesthetics in Hand Surgery
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FG@FPFNGP (dbthr jn`djdghstmhsfd dgk shkdtfng)
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QDKFDJ L@U [MXLA FG@FPFNG $ U4 [MXLA
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8/18/2019 Aesthetics in Hand Surgery
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XJGDQ L@U [MXLA FG@FPFNG $ U4 nb [MXLA
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4st YHA [MXLA dgk FGKH] FG@FPFNGP $ 4st YHA
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8/18/2019 Aesthetics in Hand Surgery
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4st YHA FGKH] FG@FPFNG $ U4 nb K1-K0-K;
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LFKKJH L@U FG@FPFNG $ U4 nb K1-K0-K;-K8
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XJGDQ L@U JF[[JH BFGIHQ FG@FPFNG $ U4 nb K8
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XJGDQ L@U JF[[JH BFGIHQ FG@FPFNG $ U4 nb K1-K0-K;-K8
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8/18/2019 Aesthetics in Hand Surgery
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LFKKJH L@U FG@FPFNG $ PUD@HP AH[YHHG L@U
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8/18/2019 Aesthetics in Hand Surgery
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QDKFDJ L@U [MXLA FG@FPFNG $ L4
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8/18/2019 Aesthetics in Hand Surgery
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QDKFDJ YQFP[ FG@FPFNG $ KNQPXL nb tmh MDGK
dgk nb tmh YQFP[
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XJGDQ L@U [MXLA FG@FPFNG $ KNQPXL nb tmh MDGK
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4st YHA FGKH] FG@FPFNG $ KNQPXL nb tmh MDGK
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LFKKJH L@U FG@FPFNG $ KNQPXL nb tmh MDGK
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XJGDQ L@U JF[[JH BFGIHQ FG@FPFNG $
KNQPXL nb tmh MDGK
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QDKFDJ YQFP[ FG@FPFNG $ KNQPXL nb tmh MDGKdgk tmh YQFP[
UNP[-NU
krhssfgi wftm hvdpnrdth
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i p`nnjfgi
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Kdy =
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Bdt Irdbtfgi + Pcfg ghhkjfgi (4 yhdr pn.)
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05 ``
Difgi Mdgk
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Kdy 41 Kdy 25
8 y
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Kdy 25
0 y
9 y
= y
bfvh yhdr8 y
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Kdy 25
0 y = y
9 y
8 y
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Kdy 25
0 y
9 y
= y
1 hbbh`ts wftm bdt irdbtfgi d``nrkfgitn @njhldg‖s Urn`hkurh ?
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- Bfjjhr (dkfpn`yths)
- [rnpmf` (sthl `hjjs < DP@)
+++ gulhrnus sthl `hjjs fg tmh bdtty tfssuh (4555tn 8555 `hjj. / `l0)
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1 hbbh`ts wftm bdt irdbtfgi d``nrkfgi
tn @njhldg‖s Urn`hkurh ?
- Bfjjhr (dkfpn`yths)
- [rnpmf` (sthl `hjjs < DP@)
hx ? shquhjds nb `mhlf`dj phhjfgi dgk `nrtf`nfkfgoh`tfng
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I ? 01.8``
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K ? 18``
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Kdy ;8
= l
0 y
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= l
Kdy ;8 0 y
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Kdy ;8
= l
0 y
@nlafgdtfng wftm UQU
fgoh`tfng
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fgoh`tfng
tn arfgi irnwtm bd`tnrsdgk tn `nrrh`t tmh
hpfkhrldj kystrnpmy
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8/18/2019 Aesthetics in Hand Surgery
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Pdlh `hgtrfbuidtfng khvf`h bnr Bdtdgk UQU
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Bdt irdbtfgi (05 ``) + UQU (45 ``)
PXQIF@DJ [QHD[LHG[P?
¤ Jfbtfgis
Mdgk rhouvhgdtfng trhdtlhgts
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¤ Bdt irdbtfgi
¤ Khrldj irdbts? dutnjninus (smhht nr `rusmhk+fgoh`thk ) nr djjnihgf` (hx? Djjnkhrl® )
¤ Khrldj-bdt irdbtfgi (hg ajn` nr fgoh`thk shpdrdthjy)¤ Bds`fdj irdbts (thlpnrdjfs bds`fd, bds`fd jdtd, juladr bds`fd)
¤ Khrldj Puastftuths wftm 4 sthp prn`hkurh (Fgthird® KQ[ Pfgijh Jdyhr, Ldtrfkhrl® 4ll)
¤ Ujfdajh afnldthrfdj smhhts (Pfjf`ngh, Inrh-thx ® )
¤ Ujdsld fgoh`tfngs (UQU, UQIB)
¤ Umjhah`tnlfhs
¤ @nrrh`tfng nb onfgt drtmrnsf` khbnrldtfngs (KFUO, 4st @L@, …)
LHKF@DJ [QHD[LHG[P?
¤ Pygtmhtf` Bfjjhrs (MD, NMdpdtfth, UJD, @njjdihgh, Pfjf`ngh) / Lhsntmhrdpy
¤ Qdkfdtfngs? Jdshrs, Jfimts (FUJ, JHK), Umntntmhrdpy (UK[), Qdkfnbrhquhg`y
¤ @mhlf`dj phhjs
¤ Khrldardsfng dgk lf`rnkhrldardsfng / Pcfg ghhkjfgi
¤ @dranxytmhrdpy¤ Rhfg s`jhrntmhrdpfhs
¤ Gdfj rhouvhgdtfng
DKOXRDG[ [QHD[LHG[P?
¤ @nslh`hutf`s (lnfsturfzfgi, dgtf-nxykdgts, ̀ nnjfgi, snjdr s`rhhg, khpfilhgtdgts, …)
¤ Dgtf-Difgi Lhkf`fgh (kfhtdry dkvf`hs, bnnk suppjhlhgts, vftdlfgs, mnrlnghs, slncfgi stnp…)
Bfjjhr fgoh`tfngs
-
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hx? Qdkfhssh
T swft`mhk Jdshrfgku`hs djsn d scfg tfimthgfgi
-
8/18/2019 Aesthetics in Hand Surgery
155/169
. fgku`hs djsn d scfg tfimthgfgi
. Aut lnrh sn`fdj hx`jusfng
FUJ +++
-
8/18/2019 Aesthetics in Hand Surgery
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Pcfg Ghhkjfgi
-
8/18/2019 Aesthetics in Hand Surgery
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Pcfg rnjjhrs
Pcfg stdlp
-
8/18/2019 Aesthetics in Hand Surgery
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Bhrgdgkhs K. @jfg Khrl. 155=312?461-6.
PXQIF@DJ [QHD[LHG[P?
¤ Jfbtfgis
¤ Bdt irdbtfgi
Mdgk rhouvhgdtfng trhdtlhgts
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¤ Bdt irdbtfgi
¤ Khrldj irdbts? dutnjninus (smhht nr `rusmhk+fgoh`thk ) nr djjnihgf` (hx? Djjnkhrl® )
¤ Khrldj-bdt irdbtfgi (hg ajn` nr fgoh`thk shpdrdthjy)¤ Bds`fdj irdbts (thlpnrdjfs bds`fd, bds`fd jdtd, juladr bds`fd)
¤ Khrldj Puastftuths wftm 4 sthp prn`hkurh (Fgthird® KQ[ Pfgijh Jdyhr, Ldtrfkhrl® 4ll)
¤ Ujfdajh afnldthrfdj smhhts (Pfjf`ngh, Inrh-thx ® )
¤ Ujdsld fgoh`tfngs (UQU, UQIB)
¤ Umjhah`tnlfhs
¤ @nrrh`tfng nb onfgt drtmrnsf` khbnrldtfngs (KFUO, 4st @L@, …)
LHKF@DJ [QHD[LHG[P?
¤ Pygtmhtf` Bfjjhrs (MD, NMdpdtfth, UJD, @njjdihgh, Pfjf`ngh) / Lhsntmhrdpy
¤ Qdkfdtfngs? Jdshrs, Jfimts (FUJ, JHK), Umntntmhrdpy (UK[), Qdkfnbrhquhg`y
¤ @mhlf`dj phhjs
¤ Khrldardsfng dgk lf`rnkhrldardsfng / Pcfg ghhkjfgi
¤ @dranxytmhrdpy¤ Rhfg s`jhrntmhrdpfhs
¤ Gdfj rhouvhgdtfng
DKOXRDG[ [QHD[LHG[P?
¤ @nslh`hutf`s (lnfsturfzfgi, dgtf-nxykdgts, ̀ nnjfgi, snjdr s`rhhg, khpfilhgtdgts, …)
¤ Dgtf-Difgi Lhkf`fgh (kfhtdry dkvf`hs, bnnk suppjhlhgts, vftdlfgs, mnrlnghs, slncfgi stnp…)
@NPLH@HX[F@P
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UQHRHG[wftm DN] prn-phghtrdtfgi tn stnpbrhh rdkf`djs dt tmh `hjjujdr jhvhj
@NQQH@[Yftm stdfg `nlpjhx
UQN[H@[wftm d pnthgt XR bfjthr
+ +
LNFP[XQF_FGI@QHDL
@NPLH@HX[F@P
-
8/18/2019 Aesthetics in Hand Surgery
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DG[F-DIFGI IJNRH
krhssfgi wftm hvdpnrdth`nnjfgi
LHID MDGK P[QD[HIVPXQIF@DJ [QHD[LHG[P?
¤ Jfbtfgis
¤ Bdt irdbtfgi
-
8/18/2019 Aesthetics in Hand Surgery
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¤ Bdt irdbtfgi
¤ Khrldj irdbts? dutnjninus (smhht nr `rusmhk+fgoh`thk ) nr djjnihgf` (hx? Djjnkhrl® )
¤ Khrldj-bdt irdbtfgi (hg ajn` nr fgoh`thk shpdrdthjy)¤ Bds`fdj irdbts (thlpnrdjfs bds`fd, bds`fd jdtd, juladr bds`fd)
¤ Khrldj Puastftuths wftm 4 sthp prn`hkurh (Fgthird® KQ[ Pfgijh Jdyhr, Ldtrfkhrl® 4ll)
¤ Ujfdajh afnldthrfdj smhhts (Pfjf`ngh, Inrh-thx ® )
¤ Ujdsld fgoh`tfngs (UQU , UQIB)
¤ Umjhah`tnlfhs
¤ @nrrh`tfng nb onfgt drtmrnsf` khbnrldtfngs (KFUO, 4st @L@, …)
LHKF@DJ [QHD[LHG[P?
¤ Pygtmhtf` Bfjjhrs (MD, NMdpdtfth, UJD, @njjdiígh, Pfjf`ngh) / Lhsntmhrdpy
¤ Qdkfdtfngs? Jdshrs, Jfimts (FUJ, JHK), Umntntmhrdpy (UK[), Qdkfnbrhquhg`y, …
¤ @mhlf`dj phhjs
¤ Khrldardsfng dgk lf`rnkhrldardsfng / Pcfg ghhkjfgi
¤ @dranxytmhrdpy
¤ Rhfg s`jhrntmhrdpfhs
¤ Gdfj rhouvhgdtfng
DKOXRDG[ [QHD[LHG[P?
¤ Pcfg-`drh `rhdls (lnfsturfzfgi, dgtf-nxykdgts, snjdr s`rhhg, khpfilhgtdgts, …)
¤ Dgtf-Difgi Lhkf`fgh (kfhtdry dkvf`hs, bnnk suppjhlhgts, vftdlfgs, mnrlnghs, slncfgi stnp…)
LHID MDGK P[QD[HIV
PXQIF@DJ [QHD[LHG[P?
-
8/18/2019 Aesthetics in Hand Surgery
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¤
¤ Bdt irdbtfgi ¤ UQU fgoh`tfng
¤ +/- Umjhah`tnlfhs
¤ +/- @nrrh`tfng nb onfgt khbnrldtfngs (KFUO, 4st @L@)
LHKF@DJ [QHD[LHG[P?¤
¤ FUJ
¤
¤ Pcfg Ghhkjfgi
¤
DKOXRDG[ [QHD[LHG[P?
¤ @nslh`hutf`s (lnfsturfzfgi, dgtf-nxykdgts, ̀ nnjfgi, snjdr s`rhhg, khpfilhgtdgts, …)
¤
Bnr KFUO drtmrnsfs?Lf`rnjfbt «Autthrbjy³+ Nsthnpmyth`tnly(mdgk surihng)
Bnr khrldtnpnrnsfsGhhkjfgi (pjdstf` surihng)@nslh`hutf`s
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8/18/2019 Aesthetics in Hand Surgery
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LHID MDGKPtrdthiy
bnr Knrsdj dgk
Jdthrdj MdgkQhouvhgdtfng
(155=)
Bnr vnjulh jnssBdt irdbtfgi + UQU(+/- 4 nr 1 pmjhah`tnlfhs)(pjdstf` surihng)
Mdgk knrsul
U4
Kfstdj knrsdjbnrhdrl
KFUO
[mhgdrhlfghg`h
Mypntmhgdrhlfghg`h
Bnr 4st @L@ drtmrnsfs?4st wha rhjhdsh+ trdphzh`tnly(mdgk surihng)
Bnr kdrc spnts
FUJ (khrldtnjnifst) 4st @L@
« ; jdyhrs ³ th`mgfquh
bnr vnjulh rhstnrdtfng dgk surbd`h
trhdtlhgt nb difgi mdgks
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trhdtlhgt nb difgi mdgks
1 - UQU
0 - PCFG GHHKJFGI
4 - BD[IQDB[FGI
; - @NPLH@HX[F@P
[mh knrsdj mdgk fs tmfg, brdifjh dgk tmhrhbnrh jhss
-
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dkdpthk tmdg tmh bd`h tn `jdssf`dj rhouvhgdtfgi
prn`hkurhs, wftm d mfimhr rfsc nb fghbbf`fhg`y dgk`nlpjf`dtfngs, tmdt‖s wmy mdgk fs d `mdjjhgifgi drhdbnr rhouvhgdtfng.
Mdgk rhouvhgdtfng rhqufrhs d lujtfkfs`fpjfgdrystrdthiy phrbnrlhk ay sph`fdjfsts cgnwfgi tmhdgdtnly dgk tmh sph`fbftfhs nb tmh mdgk.
Bdt irdbtfgi tnihtmhr wftm UQU fgoh`tfng fs nur bfrst
`mnf`h bnr vnjulh rhstnrdtfng dgk scfg trnpmf`ftyflprnvhlhgt.
DHP[MH[F@P FG MDGK PXQIHQV?
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F) Dhstmhtf` `ngsfkhrdtfngs fg mdgk surihry
FF) Mdgk dhstmhtf` rh`ngstru`tfng
FFF) Mdgk rhouvhgdtfng
BQNL QH@NGP[QX@[FNG [N QHOXRHGD[FNG
@NG@JXPFNG« Dhstmhtf`s, ft fs djrhdky bug`tfng ³
Q. Rfjdfg, Brdg`h
[mdgc ynu bnr ynur dtthgtfng
-
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ldttmfhuahusthsEildfj.`nl
Ldttmfhu AHXP[HP-P[HBDGHJJF, LKUjdstf` Purihry & Mdgk Purihry
Udrfs, Brdg`h
www.lhidmdgk.hu
f@jdss Mdgk 15404st F @ J
-
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4st Fgthrgdtfngdj ldsthr @jdss wftm Jfvh khlnsng Dhstmhtf` Purihry & Pcfg rhouvhgdtfng nb tmh Mdgk
Gf`h, Brdg`h, Bd`ujty nb Lhkf`fghPhpthlahr 18-12, 1540
Qhifstrdtfng?L@N @NGIQHPwww.l`n`ngirhs.`nl
Nridgfsdtfng?LHID MDGKwww.lhidmdgk.hu
Ur Kulngtfhr
Ur @dsnjfKr Ahusths-Pthbdghjjf