microsurgery

Microsurgery

Dr. Çağatay UluçayYeditepe Üniversitesi Tıp Fakültesi

Ortopedi ve Travmatoloji AD

Gentle & Powerful – Sensitive & Skillful

Normal hand position

Position of rest

Hand – Edema(Swelling)

Elevation?

Position of immobilisation

Hand functional positions

Hand incisions

Hand incisions

Normal alignment and rotational deformity

Mallet deformity

Flexor tendon injury

Zones for tendon repair

Flexor Tendon Anatomy

Methods of tendon repair

Open fractures - classification

Type I tidy wound < 1cmType II tidy wound 1-2 cmType IIIA >2cm; soiledType IIIB IIIA + periosteal strippingType IIICneurovascular damage

Severe hand injury survey

Blood supplyStable skeletonViable skin coverBasic functionOccupation

Serious hand trauma-after debridement

Longitudinal/ extensile exposuresCompartment decompressionSkeletal alignment/ fixationMusculo-tendon repairVessel repair/ graftNerve repair

Replantation - indications

All amputations at the level of the arm, forearm, carpus and metacarpus

All amputations of thumb prox to mid distal phalanx

In multiple digits replant as many as possible

Most digits amputated distal to prox phalanx

ChildrenThink about avulsed digits and crushed

distal parts

Hand Replantation7 months off work50% get only protective sensation50% range of movement60% need > 2 operationsMedical cost 5-15 times amputation

Nerve Repair

Partial nerveFull nerveRegrow at 1mm

per daySplintagerehabilitation

Gracillis free flap

Thoracodorsal artery perforator flap

Radial forearm free flap

Hand Infection

BacterialViralFungalProtozoal64% grow

multiple organisms

Hand Infection: anatomical compartments

Nail fold (paronychia)Pulp spaceTendon sheathWeb spaceDeep palmar spaceSeptic arthritis

Infection: historyTime lapse cellulitis 24

hours tendon sheath

48 hours web space deep palm days paronychia pulp space 4-5

days septic arthritis

<2 weeks

Web space infection

Deep palmar infection

Infection: tendon sheath

Finger in slight flexion

Uniformly red and swollen

Intense pain on attempted extension

Tenderness along line of sheath

Drainage of tendon sheath

Drainage of mid-palmar space

Infection: septic arthritisUsually secondary to human biteSwelling out of proportion to

inflammationRestricted motionInstabilityDischarging sinusX-ray changes

Paronychia

Pulp space infection

Herpetic whitlow

Hand trauma and IV Drug Abuse