Principles of Hand surgery

1. PRINCIPLES
HAND TRAUMA
MANAGEMENT
Mansoor Khan (M.B.B.S)

3. initial survey &
Resuscitation…..?

5. wash THE WOUND...

6. dress THE WOUND…

7. splint hand in POSITION OF
SAFE IMMOBALIZATION (POSI)

8. AMPUTATED PARTS
1
2
4
3

9. Secondary
survey..?

10. 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.

11. vascularity: PERIPHERAL PULSES, CAPILLARY REFILL

13. muscle/tendons: LOSS OF MOVEMENT,
DECREASED POWER OR PAINFUL MOVEMENT

14. soft tissue defect:SIZE, LOCATION, CONTAMINATION
LEVEL, DONOR SITE ASSESSMENT

15. fractures: PAIN, TENDERNESS,
DEFORMITIES (SCISSORING OF FINGERS)

16. x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE
VIEWS

17. CT scan: BONE S & JOINTS DEFORMITIES

19. INFORMED CONSENT

20. Reconstruction….?

22. SENSIBILITY,
FLEXIBLE DIGITS (ATLEAST TWO..)
POWER & ACTIVE MOVEMENT
ACCEPTIBLE ASTHETICS
functional hand…..?

23. 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

25. 1
CAREFUL WOUND EXCISION

26. 1
tidy wounds: sharp, fresh (<24h)

27. 1
untidy wounds: CRUSHED, CONTAMINATED, INFECTED,
DEVITALIZED, DELAYED….. Delayed primary closure

28. 2
SKELETAL STABALIZATION
Simple fractures: ORIF
Bone gaps: EX-FIX OR
EARLY BONE GRAFTING
AND PLATING

29. 3
revascularization; END TO END, REVERSED VEIN GRAFTS

30. 4
nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS

31. Tendons
reconstruction
early: WHEN EARLY
MOBILIZATION IS
POSSIBLE (SIMPLE
FRACTURES)
staged:
MULTIPLE/COMPLEX
FRACTURES,
PULLEYS/SYNOVIAL
SHEATHS DESTRUCTION,
CONTAMINATION
5

32. 6
Soft tissue
reconstruction
TYPE, SIZE,
LOCATION,
MISSING
STRUCTURES,
CONTAMINATION
LEVEL, FUTURE
SURGERIES

33. 6
Soft tissue reconstruction
OCCUPATION OF THE PATIENT,
MENTAL STATUS,

34. 6
primary healing: TENSION FREE CLOSURE

35. 5
primary healing: SKIN GRAFTING
AVOID: exposed vital structures, plan of
re-exploration)

36. 5
primary healing: LOCAL FLAPS

37. 6
primary healing: REGIONAL FLAPS

38. 6
primary healing: DISTANT FLAPS

39. EARLY MOBILIZATION
7

40. REPLANTATION

41. INDICATIONS..