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PRINCIPLES

HAND TRAUMA
MANAGEMENT
Mansoor Khan (M.B.B.S)
initial survey &
Resuscitation…..?
wash THE WOUND...
dress THE WOUND…
splint hand in POSITION OF
SAFE IMMOBALIZATION (POSI)
AMPUTATED PARTS

1

2

4

3
Secondary
survey..?
SECONDARY SURVEY

HISTORY
Occupation, hobbies, hand
dominance, mechanism of
injury, position of hand
during the insult, du...
vascularity: PERIPHERAL PULSES, CAPILLARY REFILL
muscle/tendons: LOSS OF MOVEMENT,
DECREASED POWER OR PAINFUL MOVEMENT
soft tissue defect:SIZE, LOCATION, CONTAMINATION
LEVEL, DONOR SITE ASSESSMENT
fractures: PAIN, TENDERNESS,
DEFORMITIES (SCISSORING OF FINGERS)
x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE
VIEWS
CT scan: BONE S & JOINTS DEFORMITIES
INFORMED CONSENT
Reconstruction….?
SENSIBILITY,
FLEXIBLE DIGITS (ATLEAST TWO..)
POWER & ACTIVE MOVEMENT
ACCEPTIBLE ASTHETICS

functional hand…..?
UPPER LIMB
RECONSTRUCTION

Delayed
approach

Skeletal
stabalization/
vascularity/ skin
cover -- early

Nerve/tendon/skel
e...
1

CAREFUL WOUND EXCISION
1

tidy wounds: sharp, fresh (<24h)
1

untidy wounds: CRUSHED, CONTAMINATED, INFECTED,
DEVITALIZED, DELAYED….. Delayed primary closure
2
SKELETAL STABALIZATION

Simple fractures: ORIF
Bone gaps: EX-FIX OR
EARLY BONE GRAFTING
AND PLATING
3

revascularization; END TO END, REVERSED VEIN GRAFTS
4

nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS
Tendons
reconstruction
early: WHEN EARLY
MOBILIZATION IS
POSSIBLE (SIMPLE
FRACTURES)
staged:
MULTIPLE/COMPLEX
FRACTURES,
P...
6

Soft tissue
reconstruction
TYPE, SIZE,
LOCATION,
MISSING
STRUCTURES,
CONTAMINATION
LEVEL, FUTURE
SURGERIES
6
Soft tissue reconstruction
OCCUPATION OF THE PATIENT,
MENTAL STATUS,
6

primary healing: TENSION FREE CLOSURE
5

primary healing: SKIN GRAFTING
AVOID: exposed vital structures, plan of
re-exploration)
5

primary healing: LOCAL FLAPS
6
primary healing: REGIONAL FLAPS
6

primary healing: DISTANT FLAPS
EARLY MOBILIZATION

7
REPLANTATION
INDICATIONS..
Principles of hand surgery
Principles of hand surgery
Principles of hand surgery
Principles of hand surgery
Principles of hand surgery
Principles of hand surgery
Principles of hand surgery
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Principles of hand surgery

  1. 1. PRINCIPLES HAND TRAUMA MANAGEMENT Mansoor Khan (M.B.B.S)
  2. 2. initial survey & Resuscitation…..?
  3. 3. wash THE WOUND...
  4. 4. dress THE WOUND…
  5. 5. splint hand in POSITION OF SAFE IMMOBALIZATION (POSI)
  6. 6. AMPUTATED PARTS 1 2 4 3
  7. 7. Secondary survey..?
  8. 8. SECONDARY SURVEY HISTORY Occupation, hobbies, hand dominance, mechanism of injury, position of hand during the insult, duration, treatments already offered, protocol of amputated part transportation, Past history: Co-morbidities, any past surgery of on the injured part.
  9. 9. vascularity: PERIPHERAL PULSES, CAPILLARY REFILL
  10. 10. muscle/tendons: LOSS OF MOVEMENT, DECREASED POWER OR PAINFUL MOVEMENT
  11. 11. soft tissue defect:SIZE, LOCATION, CONTAMINATION LEVEL, DONOR SITE ASSESSMENT
  12. 12. fractures: PAIN, TENDERNESS, DEFORMITIES (SCISSORING OF FINGERS)
  13. 13. x-ray series: ANTERIO-POSTERIOR, LATERAL AND OBLIQUE VIEWS
  14. 14. CT scan: BONE S & JOINTS DEFORMITIES
  15. 15. INFORMED CONSENT
  16. 16. Reconstruction….?
  17. 17. SENSIBILITY, FLEXIBLE DIGITS (ATLEAST TWO..) POWER & ACTIVE MOVEMENT ACCEPTIBLE ASTHETICS functional hand…..?
  18. 18. UPPER LIMB RECONSTRUCTION Delayed approach Skeletal stabalization/ vascularity/ skin cover -- early Nerve/tendon/skel etal reconstruction is delayed Early All the components are reconstructed within 72hrs
  19. 19. 1 CAREFUL WOUND EXCISION
  20. 20. 1 tidy wounds: sharp, fresh (<24h)
  21. 21. 1 untidy wounds: CRUSHED, CONTAMINATED, INFECTED, DEVITALIZED, DELAYED….. Delayed primary closure
  22. 22. 2 SKELETAL STABALIZATION Simple fractures: ORIF Bone gaps: EX-FIX OR EARLY BONE GRAFTING AND PLATING
  23. 23. 3 revascularization; END TO END, REVERSED VEIN GRAFTS
  24. 24. 4 nerves: NERVE REPAIR, TRANSFER, SENSATE FLAPS
  25. 25. Tendons reconstruction early: WHEN EARLY MOBILIZATION IS POSSIBLE (SIMPLE FRACTURES) staged: MULTIPLE/COMPLEX FRACTURES, PULLEYS/SYNOVIAL SHEATHS DESTRUCTION, CONTAMINATION 5
  26. 26. 6 Soft tissue reconstruction TYPE, SIZE, LOCATION, MISSING STRUCTURES, CONTAMINATION LEVEL, FUTURE SURGERIES
  27. 27. 6 Soft tissue reconstruction OCCUPATION OF THE PATIENT, MENTAL STATUS,
  28. 28. 6 primary healing: TENSION FREE CLOSURE
  29. 29. 5 primary healing: SKIN GRAFTING AVOID: exposed vital structures, plan of re-exploration)
  30. 30. 5 primary healing: LOCAL FLAPS
  31. 31. 6 primary healing: REGIONAL FLAPS
  32. 32. 6 primary healing: DISTANT FLAPS
  33. 33. EARLY MOBILIZATION 7
  34. 34. REPLANTATION
  35. 35. INDICATIONS..
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