Principles of hand surgery
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Transcript of Principles of hand surgery
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HAND TRAUMA PRINCIPLES
MANAGEMENTMansoor Khan (M.B.B.S)
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initial survey & Resuscitation…..?
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wash THE WOUND...
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dress THE WOUND…
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splint hand in POSITION OF SAFE IMMOBALIZATION (POSI)
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AMPUTATED PARTS
1 2
34
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Secondarysurvey..?
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SECONDARY SURVEY
HISTORYOccupation, hobbies, handdominance, mechanism ofinjury, position of handduring the insult, duration,treatments already offered,protocol of amputated parttransportation,
Past history: Co-morbidities, any past surgery of on the injured part.
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vascularity: PERIPHERAL PULSES, CAPILLARY REFILL
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muscle/tendons: LOSS OF MOVEMENT, DECREASED POWER OR PAINFUL MOVEMENT
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soft tissue defect:SIZE, LOCATION, CONTAMINATION LEVEL, DONOR SITE ASSESSMENT
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fractures: PAIN, TENDERNESS, DEFORMITIES (SCISSORING OF FINGERS)
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x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE VIEWS
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CT scan: BONE S & JOINTS DEFORMITIES
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INFORMED CONSENT
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Reconstruction….?
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functional hand…..?
SENSIBILITY,FLEXIBLE DIGITS (ATLEAST TWO..)POWER & ACTIVE MOVEMENTACCEPTIBLE ASTHETICS
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UPPER LIMB RECONSTRUCTION
Delayed approach
Skeletal stabalization/
vascularity/ skin cover -- early
Nerve/tendon/skeletal reconstruction
is delayed
Early
All the components are
reconstructed within 72hrs
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CAREFUL WOUND EXCISION
1
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tidy wounds: sharp, fresh (<24h)
1
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untidy wounds: CRUSHED, CONTAMINATED, INFECTED, DEVITALIZED, DELAYED….. Delayed primary closure
1
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SKELETAL STABALIZATION
Simple fractures: ORIFBone gaps: EX-FIX OR EARLY BONE GRAFTING AND PLATING
2
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revascularization; END TO END, REVERSED VEIN GRAFTS
3
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nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS
4
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Tendonsreconstructionearly: WHEN EARLY MOBILIZATION IS POSSIBLE (SIMPLE FRACTURES)staged: MULTIPLE/COMPLEX FRACTURES, PULLEYS/SYNOVIAL SHEATHS DESTRUCTION, CONTAMINATION
5
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Soft tissue reconstructionTYPE, SIZE, LOCATION, MISSING STRUCTURES, CONTAMINATION LEVEL, FUTURE SURGERIES
6
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Soft tissue reconstructionOCCUPATION OF THE PATIENT, MENTAL STATUS,
6
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primary healing: TENSION FREE CLOSURE
6
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primary healing: SKIN GRAFTING AVOID: exposed vital structures, plan of re-exploration)
5
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primary healing: LOCAL FLAPS
5
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primary healing: REGIONAL FLAPS
6
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primary healing: DISTANT FLAPS
6
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EARLY MOBILIZATION 7
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REPLANTATION
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INDICATIONS..
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