Date post: | 31-Dec-2015 |
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Hand injuries
Priorities
Function, Function, Function! Must be able to test sensory, motor and
tendon function. Should be able to draw a cross-section of wrist. If tendon, nerve or vascular injury, consult.
Know the location of all important deep structures
Priorities
Adequate coverage of important structures Consider if simple repair of laceratons
crossing joint will lead to limiting contracture
Must know proper bandaging and splinting
Method for sterile field and exsanguination of digit
Why a “fight bite”, even seen early needs exploration. Hidden tendon injury and joint violation
Anatomy of finger nail
“Trap door” will have associated nail bed injury and probable open fracture
Remove nail with blunt dissection with iris scissors then pull with clamp
Use cleaned whole nail as dressing, base under cuticle to prevent nail matrix to eponychium adhesion. If nail not possible, adaptic or foil from suture package
After nail removal
Irrigate open wound carefully, remove foreign material,
Debride conservatively if at all, very little excess tissue for repair
Close nail bed laceration with 6-0 absorbable (eccentric hand guys would use 8-0 and loops, If you try this you will need very fine instruments, such as castro-viejo driver and tying forceps)