Hand Surgery
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Hand Surgery
Oleh
Betha Egih Riestiano
Pembimbing
Beta Subakti N, dr. Sp.BP-RE (K)
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Poin - poin Cedera pada Tangan : Luka tajam, luka remuk, dan
degloving Cedera Finger Tip Fraktur yang Terlibat Operasi Elektif : Teknik perbaikan : teknik jahitan dan penempatan luka insisi Penggunaan Z-Plasty Penggunaan Skin Graft Penggunaan Flap Perawatan Pasca Operasi :Dresssing awal, pencegahan
edema, dressing anjutan.
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Cedera pada Tangan
• Jenisnya : - Luka tajam
- Luka remuk
- Luka degloving• Manajemen : - Tidy
- Untidy
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Cedera pada Tangan
Luka tajam- Derajat kerusakan jelas- Tendon&saraf sering terlibat- Tulang jarang terlibat- Eksplorasi torniquet- Penutupan kulit dengan graft/flap- Amputasipertimbangan banyak faktor
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Cedera pada Tangan
Luka Remuk- Ringan sampai berat- Tendon &saraf jarang terlibat- Tulang dan jaringan lunak sering terlibat- Kerusakan lebih berat dari yang terlihat- Poin penting :
- Tentukan jaringan non viabel
- Tentukan bagian yang layak di tutup7
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Cedera pada Tangan
Luka Remuk- Minimalkan raw surfacejahit rapat - Elevasi (min 48 jam)cegah edema
(dengan/tanpa gips)- Insisi relaksasikadang diperlukan
(menutup sisi palmar)
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Cedera pada Tangan
Degloving - Perbedaan degloving & avulsijaringan
terlibat- Degloving : terbatas pada kulit dan
fascia(fascia superfisial terlibat, profunda jarang)
- Avulsi : melibatkan struktur lebih dalam (kombinasi degloving dan avulsi)
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Cedera pada Tangan
Degloving- Palmar : antara aponeurosis & tendon
flexor(vaskuler terlindungi struktur aponeurosis)
- Dorsum : rentan cedera vaskuler&tendon- Penilaian kerusakan penting- Degloving jari tunggalcedera jari cincin
(skeletonisasi)prosedur bedah mikro
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Degloving Ibu Jari
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Neurovascular Island Flap
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Cedera Finger Tip
- Komponen esensial distal jari : Kuku, pulp dan phalang
- FTG sangat baik digunakan- Flap cedera kulit & pulp(tanpa
melibatkan tulang &kuku)- Pertimbangan sembuh spontan (terutama
pada anak- anak)
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Teknik Perbaikan dan Rekonstruksi
• Mempertimbangkan Sifat kulit :- Kulit palmar rigid, terfiksir, imobile, kurang
laksitas- Daerah netral antara bagian
lateral&medial- Kulit dorsal flexibel, mobile, laksitas lebih
baik
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Teknik Jahitan
- Kulit palmar+benangreaksi (epitel cepat tumbuh dijalur benangkomedo dan kemerahan)
- Nylonkurang bereaksi- Catgut bisa digunakan (terutama pada
anak)
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Penempatan Luka Parut
- Hindari insisilipatan kulit - Hindari insisi memanjang- Usahakan insisi daerah netral- Z-plasysering digunakan
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Lokasi Insisi(Penempatan Parut)
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Teknik Insisi Garis Netral
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Penggunaan Z-Plasty
• Mencegah kontrakturluka linier (eksposur)
• Tidak untuk luka kontraktur luas&difus
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Multiple Z-Plasty
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Lebih Dari Satu Jari
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Z-Plasty pada Web
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Penggunaan Skin Graft
• Secara Umum Baik dengan Full Thickness• PalmarFTG lebih baik• Dorsum STG lebih sesuai
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Donor Skin Graft
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Penggunaan Flap
Pedicled flap : lokal (transposisi&rotasi) dan distant(direct, tubed axial pattern, radial forearm&posterior interosseus)
Free flap : radial forearm & lateral upper arm
- Lokasi defek & luka satu sisi (tangan yang sama)
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Tubed Axial Pattern Flap
Groin flap Deltopectoral flap 26
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Posterior Interosseus Flap
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Preparasi Defek
• Tepi dieksisijaringan sehat• Eksisi sesuai penempatan parut• Defek ditutupperbaikan struktur
lain(tendon,dll)
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Defek Proksimal dari Web
• Daerah dorsumrotasi atau transposisi• Bila rentan nekrosis(usia tua)tempat lain
(cross-arm/radial forearm)
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Flap Transposisi
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Cross-arm Flap
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Defek Distal dari Web
• Local flap cedera jari tunggal, defek kecil(Cross finger Flap, VY-Flap)
• Distant flapcedera jari multiple, defek luas (Groin Flap)
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Distant Flap
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Cross-finger Flap
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VY-Flap
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Perawatan Pasca operasi
• Immobiliasasi • Penggunaan Gips• Pencegahan edema
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Posisi Tangan
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Perawatan Pasca operasi
• Imobilisasi(Posisi Tangan)- Posisi fungsional (imobilisasi jangka
pendek)- Posisi immobilisasi (jangka panjang)• Pencegahan edema- Elevasi setinggi jantung- Hindari konstriksi pergelangan- Tangan harus menggantung bebas
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TERIMAKASIH
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