外科-手的各类损害课件

HANDINJURY

Anatomy:

SkinBoneTendonNerveBloodvesselTwoimportantposture

(restandfunction)ClassificationofhandinjuryInjury:incision,laceration,crushing,twisting,cutting,amputationHighenergy(trafficaccident)Lowenergy(householdinjury,knife,glass)Emergencymanagement:bleedingcontroldressingfirstaidsplintClinicalexaminationofinjuredhand

Testoftendonfunction

Thestudyofpostureofhandandfunctionthetendontensioninthefinger.flexorprofounddigitorumtendontestThedistalinterphalangealjointflexor.flexordigitorumsuperficialtendontestProximalinterphalangealjointflextion

ExtensortendonruptureMalletfingerTESTOFNERVEFUNCTIONtestsofsensorynervefunctionTESTOFNERVEFUNCTIONtestsofmotorfunctionThethenerandhypothenerUlnarnerveandmediannerveTESTSFORBONEINJURYfractureDislocationJointinjuryX-raySkincoverinthehand(inspecttheviability)SizeofdefectSkinColorTemperatureCapillaryresponseFlapedgebleedingDyeinjectionprimarytreatmentforopenhandinjuredAnesthesiaCleansing cleansingofthelimborpartexclusiveoftheactualwound. Cleansingofthewounditself.3.Debridment:purpose:decreasecontaminationpreparedamagedtissueforhealing.

Debridmentisperformedby2ways.1.Cleansing:flushoutcontaminantandremovalofforeignbody.2.Excision:removalofeverythingdetrimentaltowoundhealing.Preserveallpossiblethingsthatisusefulforhandfunction.Finalassessment

Isthereloss?Whatstructuresareexposed?Willtheskinsurvive?Whatstructuresaredamaged?DelayedprimaryclosureDoubtstillpersistsastotheviabilityoftissueafterdebridement.Two-threedayslater.woundclosure.IndicationforprimaryclosureThetidyhandinjury:thosecausedbychoppers,cutting,knives,axesorglassIndicationfordelayedprimaryclosureTheuntidyhandinjury.:thosecausedbymobilemachinery,power-drivensaws,powerpressesandbuzzplanesTheprocedureofoperation

TheuseoftourniquetHemostasisPrimarydressingatoperationImmobilizationAntibioticsAntisera.ThemanagementofskincoverLeavingwoundopenDirectclosureFreeskingrafts

Skinflaps

LocalflapsIslandflapsFingertipinjuriesDistallybasedradialforearmflapIslandflapswithaveinonlyDistantpedicleflapswithinthehandCrossfingerflapThethenarflap

SkinflapsDistantpedicleflapMicrovascularfreeflapsSmallskindefectsLargeskindefectsSensateskinreplacementCompositefreetissuetransferTendoninjuryThetendonruptureTypesoftenorrhapies:Principlesofprimaryrepairtheadventofnewsuturetechniques,materialsearlymotionZone2-‘noman’sland’Fibrosseousdigitalcanal=sheathPrinciplesoftherepairtechniqueavoidtensionduringrepairandmobilizationperformonlyifthereisaclean,incisedwound.atraumaticsurgicaltechnique.fineinstrumentationandmagnificationappropriatesuturematerial.Principlesoftherepairtechniquemeticulousrestorationoftendoncontinuityandglidingfunctionmeticuloushemostasismaintainthepulleyandclosethesheathimmediatecontrolledmobilizationatechnicallyproficientsurgeon.NerveinjuriesTheanatomyofnerveEpineuriumPerineuriumMethodsofnerverepairEnd-to-endrepairEpineurialsutureFascicularsutureGroupfascicularsutureIndicationsfornervegraftNervegraftareindicatedwhenthefasciclecannotbeapproximatedwithouttensionusinga10/0nylonsuturetoperformeitheranepineurial,interfascicularorgroupfascicularrepair.Gapismorethan2cm.IdentifacationofcorrespondingfascicularbundlesAnatomicallyHistochemicallyElectrophysiologicallySourceoffreenervegraftsDonor:Suralnervesuperficialbranchoftheradialnever.Medialandlateralantebrachialcutaneousnerves.DiagnosisofBonefractureandJointinjuryofthehanddeformityandx-rayexamination.PrincipalofTreatmentreductionfixation

ClosefractureSplint,casting,plaster,transcutanous-pinfixation.

OpenfracturedebridmentReductioninternalfixation.(Screw,plate,K-pin,wire,external-fixativeequipment)Replantation(Indications)thumb;multipledigits;singledigitdistalsublimesinsertionChildren;wrist;transmetacarpal.Relativeindicationmultiplelevelinjuries;mentaldisability;nerveavulsion;favorableamputationinpatientofmoreth