Soft Tissue Reconstruction of the Upper Extremity and Management of Fingertip and Nail Bed Injuries Flashcards
A functional hand should possess a stable wrist and at least two opposing, sensate, and painless digits. One finger should be mobile and opposed with another stable finger, with a space between the digits
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An acceptable hand consists of a thumb and at least three fingers
that have supple interphalangeal joint motion,adequate length, and
preserved sensibility.
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prolonged application of NPWT can lead to scaring
because granulation tissue may form over the wound bed and cause scarring over time.
prolonged use of NPWT in
the hand causes contracture and stiffness
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If the patient has vital structures that are exposed in the hand , the surgeon must consider an immediate flap
coverage
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The most effective way to preserve the vital components is to consider
early soft tissue coverage as the first step in the management
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surgeons
prefer the use of a fasciocutaneous flap over a muscle flap
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A fasciocutaneous flap is more pliable and has greater gliding capacity, which
facilitates tendon gliding without impairment during motion
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Distantflap in the hand almost always requires two stages for harvest and inset
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A free flap is advantageous because permits earlier rehabilitation
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FTSG
can restore more durability and sensibility, while it can minimize the
risk of contracture
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. The thick dermal layer of the glabrous skin is
rich in exocrine sweat glands, blood vessels, and sensory nerve endings
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STSGs are typically used for the reconstruction of defects
of the palm of the hand
F Dorsum of the hand
Dermal substitutes require a noninfected and well-vascularized wound bed
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Dermal substitutes are used for the
reconstruction of acute and chronic burns of the hand
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dermal substitutes are a good alternative if the patient cannot tolerate a prolonged operation or needs a shorter period of immobilization
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dermal substitute templates lack many essential components of normal skin, such as hair follicles, sweat glands, or other
skin appendages. Furthermore, sensory recovery is unsatisfactory
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Reconstruction of soft tissue defects via dermal substitutes typically requires STSG in single stage
F In a two-stage reconstruction,
split-thickness
skin grafting can be done 2 to 3 weeks after dermal substitute placement
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Full-thickness skin grafting with a dermal substitute
is not recommended
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Small fingertip defects that are less than 2 cm’ with minimal bony
exposure or nail matrix involvement should be healed by secondary
intention.
F Small fingertip defects that are less than I cm’
Secondary intention can restore sensation
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Secondary intention achieve comparable functionality to skin grafts
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Less than 1 cm may indicate reconstruction using local tissue coverage,
such as V-Y volar or lateral advancement flaps
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The V-Y advancement flap is most suitable for coverage of transverse or dorsal oblique
fingertip amputations that have exposed bones
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> 1cm larger or composite defects
will require more soft tissue, suggesting homodigital, heterodigital,
locoregional, or free tissue transfers
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if the defect of the pulp covers two-thirds of the digital pulp
of the first three fingers we should do the microvascular toe pulp or the glabrous skin of the foot transfers
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A defect without any bony exposure that affects less than half of
the finger pulp can heal by secondary intention.
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the Moberg
flap used to reconstruct the volar defect only
Volar or ulnar side defects
A Moberg flap can advance distally by 1.5 to 2 cm without causing flexor contracture
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