Principles of hand surgery

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Mansoor Khan

Principles of Hand surgery

Saúde e medicina

PRINCIPLES

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

splint hand in POSITION OF
SAFE IMMOBALIZATION (POSI)

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.

vascularity: PERIPHERAL PULSES, CAPILLARY REFILL

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

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

$fractures: PAIN, TENDERNESS, DEFORMITIES (SCISSORING OF FINGERS)$

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

SENSIBILITY,
FLEXIBLE DIGITS (ATLEAST TWO..)
POWER & ACTIVE MOVEMENT
ACCEPTIBLE ASTHETICS

functional hand…..?

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

1

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

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

3

revascularization; END TO END, REVERSED VEIN GRAFTS

4

nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS

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

5

6

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

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

6

primary healing: TENSION FREE CLOSURE

5

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

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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

12.

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

18.

19. INFORMED CONSENT

20. Reconstruction….?

21.

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

24.

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..