Hand Flashcards
Single finger replantation, replant?
Relative contraindication, as replant 1 finger has to immobilise the rest of the fingers
Pt unable to go to work & stiff hands due to immobilisation
Mangled limb definition
When 3 out of 4 tissues involved
- Muscle
- Nerve
- Vessel
- Bone
MESS score LL vs UL
Applicable for LL, but NOT for UL, cos UL we try to save
Sequence of replantation
Principle:
1. Skeletal stabilization before soft tissue repair
2. Repair deep to superficial structure (eg: FDP - nerve - FDS)
3. If ischaemic time is long, repair artery 1st before tendons, then vein
Sequence:
1. Wound debridement, structure identified
2. Bone stabilization
3. Tendons
4. Vessels
Replantation, indications:
Absolute indication:
- thumb at any level
- multiple digits
- through palm
- almost all parts in children
- wrist or proximal to wrist
Relative indications:
- single digit [distal to FDS insertion - zone 1]
- ring avulsion
- through or above elbow
Replantation, contraindications:
Absolute contraindications:
- severe vascular disorder
- mangled limb or crush injury
- segmental amputation
- ischaemic time >6H (large muscle content)
Relative contraindications:
- single digit proximal to FDS insertion (zone II); [ring finger injury @zone II has better comesis & grip strength with 4th ray resection & 5th ray transposition]
- medically unfit pt
- disabling psychiatric illness
- tissue contamination
- prolonged ischaemic time >12H (no muscle content)
Vascular reperfusion injury /
Ischaemic reperfusion injury:
Paradoxical concept whereby more cellular damage that already caused by ischaemic / hypoxia
Scaphoid fracture: ideal length for Asian population
16 to 20mm
Nerve recovering sign?
- return of sensation
- return of motor function
[Hand Course Sabah 2023]
Advancing tinel: neuroma vs nerve recovery
- neuroma - static tinel
- recovering nerve - advancing tinel
[Hand Course Sabah 2023]
Electromyography, recovering of muscle function:
- increasing amplitude
- reduces fassiculations
- improve CAMP (compound action membrane potential)
[Hand Course Sabah 2023]
Sural nerve graft, how long?
20 t0 25mm
[Hand Course Sabah 2023]
Nerve repair:
- vasa nervorum (correct align/orientation]
- tension free repair
- end-to-end repair
- conduit ~3cm
- if dirty, debride and tagged
- if clean, can consider nerve graft
Brans tendon transfer / tripple transfer:
PT to ECRB
PL to EPL
FCR to EDC
Why ECRB not ECRL, because ECRB more central
ECRB attached to base of 3rd MCB
ECRL attached to base of 2nd MCB
[Hand Course Sabah 2023]
