Main 2 (fingertip, nail bed, thumb recon)

Question 1

Classification of fingertip injuries (4)

Answer 1

1) Volar oblique w/o bone exposed
2) Volar oblique with bone exposed
3) Transverse
4) Dorsal oblique

Question 2

Reconstructive options for fingertip injuries (7)

Answer 2

Primary closure
Healing by secondary intention
Composite grafting
STSF/FTSG
Homodigital flap
Heterodigital flap
Replant

Question 3

Criteria (2) for appropriate healing by secondary intention for fingertip injuries

Answer 3

<1.5cm2
Minimal exposed bone

Question 4

Approximate healing time for fingertip injuries left to heal by secondary intention

Answer 4

4 weeks

Question 5

Advantages (4) of letting fingertip heal by secondary intention

Answer 5

Good aesthetic result
Preserves length
Near normal sensibility
Early return to work (with dressing and protective cap)

Question 6

Indication for FTSG for fingertip injuries and donor site

Answer 6

if deficit >1.5cm2

Donor: thenar or hypothenar eminence for glabrous skin

Question 7

Name 5 homodigital flap options for fingertip injuries, including thumb

Answer 7

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

Question 8

Indication for V-Y advancement flap (Atasoy)

Distance of potential advancement

Answer 8

Dorsal oblique and some transverse injuries

1cm advancement

Question 9

Indication for lateral V-Y advancement flap Kutler and difference with Atasoy flap

Answer 9

Lateral oblique deficit

Triangular flap is designed over radial and/or ulnar distal tip

Question 10

Design and vascularisation of oblique triangular neurovascular island flap

Answer 10

Unilateral triangular flap with apex located proximal to the PIP joint
Includes neurovascular bundle

Question 11

Through which vascular structure is based the flow of the reverse flow/retrograde homodigital island flap

Answer 11

Through either the deep transverse palmar arch or transverse digital artery anastomose

Question 12

Complications (5) of the reverse flow/retrograde homodigital island flap

Answer 12

Insensate
Venous congestion
Partial flap loss
Cold intolerance
Flexion contracture

Question 13

Name 6 heterodigital and regional flap for funger coverage

Answer 13

Cross-finger flap

Reverse cross-finger flap

Heterodigital neurovascular pedicled falp (Littler)

FDMA/Kite Flap

Quaba flap

Thenar flap

Question 14

Indication for cross-finger flap

Answer 14

Volar deficits, typically at P2 level

Question 15

Describe the elevation design and divison of cross finger flap

Answer 15

Raised above parathenon on dorsum of adjacent donor finger, flipped 180°

FTSG donor site

Flap division at 14-21days

Question 16

Indication for reverse cross-finger flap

Answer 16

Coverage of dorsal deficits

Question 17

Describe the elevation design and divison of reverse cross finger flap

Answer 17

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

Question 18

Indication for Littler flap/Heterodigital neurovascular pedicled falp

Answer 18

Ulnar thumb pulp deficit

Question 19

Design of Littler flap/Heterodigital neurovascular pedicled falp

Answer 19

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

Question 20

Which test must be done before proceeding with Littler flap/Heterodigital neurovascular pedicled falp

Answer 20

Digital allen test to confirm vascularisation of:

1) controlateral digital artery of donor finger
2) controlateral digital artery of the adjacent finger

Question 21

Indication for FDMA/Kite flap

Answer 21

Soft tissue deffect of the thumb

Question 22

Markings of FDMA/Kite flap

Answer 22

Skin paddle over index dorsum up to P1

Question 23

Neurovascular structures in FDMA/Kite flap

Answer 23

Artery: first dorsal metacarpal artery from radial artery

Nerve: can include terminal nerve of radial nerve

Question 24

Describ Quaba flap

What is it vascularisation based on specifically

Answer 24

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

Question 25

Indication for Quaba flap

Answer 25

Can cover dorsal PIP and up to DIP

Question 26

Indication for thenar flap

Answer 26

Oblique volar injury of D2 or D3 <30 years old ideally

Question 27

Division timing of thenar flap

Answer 27

10-14 days

Question 28

Complication fo thenar flap

Answer 28

PIP contracture/stiffness

Question 29

Reconstructive options for thumb soft tissue deficit (3)

Answer 29

Moberg Kite Flap Littler

Question 30

Types of nail bed injury (4)

Answer 30

Simple laceration Stellate laceration Severe crush Nail bed avulsion

Question 31

Treatment of subungeal hematoma if pain vs no pain

Answer 31

If no pain: observation If pain: trephination

Question 32

Technique of nail plate trephination

Answer 32

Pierce nail plate with ophtalmic cautery Irrigate Cover with nonadherent sterile gauze

Question 33

Method of repair of nail bed

Answer 33

Simple laceration: dermabond Complexe: palin gut sutures

Question 34

Indications for nail bed grafting for sterile matrix avulsion

Answer 34

<50%: harvest split thickness nail bed from same digit >50%: harvest split thickness nail bed from great toe

Question 35

Repair for germinal matrix nail bed avulsion

Answer 35

<2mm width: Lateral bipedicled advancement >2mm width: full thickness nail bed graft from lateral nail bed of great toe OR bilaminate neodermis graft

Question 36

How much time does it take to expect final nail appearance after nail bed repair

Answer 36

3 nail cycles therefore 1 year

Question 37

Complications of nail bed injury (6)

Answer 37

Hook nail deformity Nail ridge Split nail Dull nail (dorsal roof injury) Short nail Nail absence

Question 38

quelles cellules forment l'ongle

Answer 38

cellules squameuses kératinisée

Question 39

4 composantes du Périonychium

Answer 39

nail fold nail plate nail bed hyponychium

Question 40

définir hyponychium

Answer 40

jonction matrice stérile avec bout du doigt

Question 41

définir paronychium

Answer 41

peau de chaque côté de l'ongle (pli latéral)

Question 42

définir Eponychium

Answer 42

peau proximale à l'ongle qui recouvre le pli de l'ongle

Question 43

qu'est-ce qui compose le nail fold

Answer 43

ventral floor dorsal roof

Question 44

qu'est-ce que la Matrice germinale et sa fonction

Answer 44

Région au ventral floor proximal à la lunula Responsable de 90% de la production de l'ongle

Question 45

qu'est-ce que la Matrice stérile et sa fonction

Answer 45

nail bed distal à la lunula responsable de l'adhérence du nail plate site secondaire de production de l'ongle

Question 46

nommer les 3 sites de croissance de l'ongle

Answer 46

Matrice germinale Dorsal roof du nail fold Matrice stérile

Question 47

facteurs qui augmentent la croissance de l'ongle

Answer 47

Doigt plus long Mois d'été Jeunes Rongueurs d'ongle

Question 48

nommer 4 utilités de l'ongle

Answer 48

protection sensation aide à la pince grattage

Question 49

à quelle distance de l'extenseur l'ongle débute-t-il?

Answer 49

1.2mm

Question 50

qu'elle structure donne de la stabilité à la pulpe

Answer 50

septa fibreux (vont du périoste jusqu'au derme)