Main 2 (fingertip, nail bed, thumb recon) Flashcards
Classification of fingertip injuries (4)
1) Volar oblique w/o bone exposed
2) Volar oblique with bone exposed
3) Transverse
4) Dorsal oblique
Reconstructive options for fingertip injuries (7)
Primary closure
Healing by secondary intention
Composite grafting
STSF/FTSG
Homodigital flap
Heterodigital flap
Replant
Criteria (2) for appropriate healing by secondary intention for fingertip injuries
<1.5cm2
Minimal exposed bone
Approximate healing time for fingertip injuries left to heal by secondary intention
4 weeks
Advantages (4) of letting fingertip heal by secondary intention
Good aesthetic result
Preserves length
Near normal sensibility
Early return to work (with dressing and protective cap)
Indication for FTSG for fingertip injuries and donor site
if deficit >1.5cm2
Donor: thenar or hypothenar eminence for glabrous skin
Name 5 homodigital flap options for fingertip injuries, including thumb
V-Y advancement (Atasoy)
Lateral V-Y advancement (Kutler)
Moberg/Volar advancement flap (thumb)
Lambeau en ‘îlot neurovasculaire triangulaire oblique (venkataswamy)
Lambeau en îlot homodigital rétrograde
Indication for V-Y advancement flap (Atasoy)
Distance of potential advancement
Dorsal oblique and some transverse injuries
1cm advancement
Indication for lateral V-Y advancement flap Kutler and difference with Atasoy flap
Lateral oblique deficit
Triangular flap is designed over radial and/or ulnar distal tip
Design and vascularisation of oblique triangular neurovascular island flap
Unilateral triangular flap with apex located proximal to the PIP joint
Includes neurovascular bundle
Through which vascular structure is based the flow of the reverse flow/retrograde homodigital island flap
Through either the deep transverse palmar arch or transverse digital artery anastomose
Complications (5) of the reverse flow/retrograde homodigital island flap
Insensate
Venous congestion
Partial flap loss
Cold intolerance
Flexion contracture
Name 6 heterodigital and regional flap for funger coverage
Cross-finger flap
Reverse cross-finger flap
Heterodigital neurovascular pedicled falp (Littler)
FDMA/Kite Flap
Quaba flap
Thenar flap
Indication for cross-finger flap
Volar deficits, typically at P2 level
Describe the elevation design and divison of cross finger flap
Raised above parathenon on dorsum of adjacent donor finger, flipped 180°
FTSG donor site
Flap division at 14-21days
Indication for reverse cross-finger flap
Coverage of dorsal deficits
Describe the elevation design and divison of reverse cross finger flap
Elevate thin full thickness dorsal flap from adjacent finger, then elevate subcutaneous flap that is flapped 180° to cover dorsal deficit
FTSG on top of subcutaneous flap
Think full thickness flap used to cover donor site
Indication for Littler flap/Heterodigital neurovascular pedicled falp
Ulnar thumb pulp deficit
Design of Littler flap/Heterodigital neurovascular pedicled falp
Donor: ulnar pulp of D3 or radial D4 (median innervated donor better)
Harvest island flap on one neurovascualr bundle
Dissection back to common digital artery and nerve (ligate proper digital artery of adjacent finger)
Tunnel flap
Inset on thumb
FTSG donor
Which test must be done before proceeding with Littler flap/Heterodigital neurovascular pedicled falp
Digital allen test to confirm vascularisation of:
1) controlateral digital artery of donor finger
2) controlateral digital artery of the adjacent finger
Indication for FDMA/Kite flap
Soft tissue deffect of the thumb
Markings of FDMA/Kite flap
Skin paddle over index dorsum up to P1
Neurovascular structures in FDMA/Kite flap
Artery: first dorsal metacarpal artery from radial artery
Nerve: can include terminal nerve of radial nerve
Describ Quaba flap
What is it vascularisation based on specifically
Perforator de l’artère métacarpienne dorsale is above metacarpal neck distal to junctura tendinum
Reverse flow from first dorsal metacarpal artery (Maruyama)
Based on palmar/dorsal anastomosis between dorsal metacarpal artery and common digital artery
Quaba is on perforator
Maruyama is to take the actual artery
Indication for Quaba flap
Can cover dorsal PIP and up to DIP
Indication for thenar flap
Oblique volar injury of D2 or D3
<30 years old ideally
Division timing of thenar flap
10-14 days
Complication fo thenar flap
PIP contracture/stiffness
Reconstructive options for thumb soft tissue deficit (3)
Moberg
Kite Flap
Littler
Types of nail bed injury (4)
Simple laceration
Stellate laceration
Severe crush
Nail bed avulsion
Treatment of subungeal hematoma if pain vs no pain
If no pain: observation
If pain: trephination
Technique of nail plate trephination
Pierce nail plate with ophtalmic cautery
Irrigate
Cover with nonadherent sterile gauze
Method of repair of nail bed
Simple laceration: dermabond
Complexe: palin gut sutures
Indications for nail bed grafting for sterile matrix avulsion
<50%: harvest split thickness nail bed from same digit
> 50%: harvest split thickness nail bed from great toe
Repair for germinal matrix nail bed avulsion
<2mm width: Lateral bipedicled advancement
> 2mm width: full thickness nail bed graft from lateral nail bed of great toe OR bilaminate neodermis graft
How much time does it take to expect final nail appearance after nail bed repair
3 nail cycles therefore 1 year
Complications of nail bed injury (6)
Hook nail deformity
Nail ridge
Split nail
Dull nail (dorsal roof injury)
Short nail
Nail absence
quelles cellules forment l’ongle
cellules squameuses kératinisée
4 composantes du Périonychium
nail fold
nail plate
nail bed
hyponychium
définir hyponychium
jonction matrice stérile avec bout du doigt
définir paronychium
peau de chaque côté de l’ongle (pli latéral)
définir Eponychium
peau proximale à l’ongle qui recouvre le pli de l’ongle
qu’est-ce qui compose le nail fold
ventral floor
dorsal roof
qu’est-ce que la Matrice germinale et sa fonction
Région au ventral floor proximal à la lunula
Responsable de 90% de la production de l’ongle
qu’est-ce que la Matrice stérile et sa fonction
nail bed distal à la lunula
responsable de l’adhérence du nail plate
site secondaire de production de l’ongle
nommer les 3 sites de croissance de l’ongle
Matrice germinale
Dorsal roof du nail fold
Matrice stérile
facteurs qui augmentent la croissance de l’ongle
Doigt plus long
Mois d’été
Jeunes
Rongueurs d’ongle
nommer 4 utilités de l’ongle
protection
sensation
aide à la pince
grattage
à quelle distance de l’extenseur l’ongle débute-t-il?
1.2mm
qu’elle structure donne de la stabilité à la pulpe
septa fibreux (vont du périoste jusqu’au derme)
