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Microsurgery
Dr. Çağatay Uluçay
Yeditepe Üniversitesi Tıp Fakültesi
Ortopedi ve Travmatoloji AD
Gentle & Powerful – Sensitive &
Skillful
Normal hand position
Position of rest
Hand – Edema(Swelling)
Elevation?
Position of immobilisation
Hand functional positions
Hand incisions
Hand incisions
Normal alignment and rotational
deformity
Mallet deformity
Flexor tendon injury
Zones for tendon repair
Flexor Tendon Anatomy
Methods of tendon repair
Open fractures - classification
Type I
tidy wound < 1cm
Type II
tidy wound 1-2 cm
Type IIIA >2cm; soiled
Type IIIB IIIA + periosteal stripping
Type IIIC neurovascular damage
Severe hand injury survey
Blood supply
Stable skeleton
Viable skin cover
Basic function
Occupation
Serious hand trauma
-after debridement
Longitudinal/ extensile exposures
Compartment decompression
Skeletal alignment/ fixation
Musculo-tendon repair
Vessel repair/ graft
Nerve repair
Replantation - indications
All amputations at the level of the arm, forearm, carpus and
metacarpus
All amputations of thumb prox to mid distal phalanx
In multiple digits replant as many as possible
Most digits amputated distal to prox phalanx
Children
Think about avulsed digits and crushed distal parts
Hand Replantation
7 months off work
50% get only protective sensation
50% range of movement
60% need > 2 operations
Medical cost 5-15 times amputation
Nerve Repair
Partial nerve
Full nerve
Regrow at 1mm per day
Splintage
rehabilitation
Gracillis free flap
Thoracodorsal artery perforator
flap
Radial forearm free flap
Hand Infection
Bacterial
Viral
Fungal
Protozoal
64% grow multiple
organisms
Hand Infection:
anatomical compartments
Nail fold (paronychia)
Pulp space
Tendon sheath
Web space
Deep palmar space
Septic arthritis
Infection: history
Time lapse
cellulitis
tendon sheath
web space
deep palm
paronychia
pulp space
septic arthritis
24 hours
48 hours
days
4-5 days
<2 weeks
Web space infection
Deep palmar infection
Infection: tendon sheath
Finger in slight flexion
Uniformly red and
swollen
Intense pain on
attempted extension
Tenderness along line of
sheath
Drainage of tendon sheath
Drainage of mid-palmar space
Infection: septic arthritis
Usually secondary to human bite
Swelling out of proportion to inflammation
Restricted motion
Instability
Discharging sinus
X-ray changes
Paronychia
Pulp space infection
Herpetic whitlow
Hand trauma and IV Drug Abuse