Date post: | 18-Dec-2014 |
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Health & Medicine |
Upload: | mansoor-khan |
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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..