Principles of hand surgery

HAND TRAUMA PRINCIPLES

MANAGEMENTMansoor Khan (M.B.B.S)

initial survey & Resuscitation…..?

wash THE WOUND...

dress THE WOUND…

splint hand in POSITION OF SAFE IMMOBALIZATION (POSI)

AMPUTATED PARTS

1 2

34

Secondarysurvey..?

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.

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

CT scan: BONE S & JOINTS DEFORMITIES

INFORMED CONSENT

Reconstruction….?

functional hand…..?

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

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

CAREFUL WOUND EXCISION

1

tidy wounds: sharp, fresh (<24h)

1

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

1

SKELETAL STABALIZATION

Simple fractures: ORIFBone gaps: EX-FIX OR EARLY BONE GRAFTING AND PLATING

2

revascularization; END TO END, REVERSED VEIN GRAFTS

3

nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS

4

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

5

Soft tissue reconstructionTYPE, SIZE, LOCATION, MISSING STRUCTURES, CONTAMINATION LEVEL, FUTURE SURGERIES

6

Soft tissue reconstructionOCCUPATION OF THE PATIENT, MENTAL STATUS,

6

primary healing: TENSION FREE CLOSURE

6

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

5

primary healing: LOCAL FLAPS

5

primary healing: REGIONAL FLAPS

6

primary healing: DISTANT FLAPS

6

EARLY MOBILIZATION 7

REPLANTATION

INDICATIONS..