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Microsurgery

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.

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Microsurgery

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  1. Microsurgery Dr. Çağatay Uluçay Yeditepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji AD

  2. Gentle & Powerful – Sensitive & Skillful

  3. Normal hand position

  4. Position of rest

  5. Hand – Edema(Swelling)

  6. Elevation?

  7. Position of immobilisation

  8. Hand functional positions

  9. Hand incisions

  10. Hand incisions

  11. Normal alignment and rotational deformity

  12. Mallet deformity

  13. Flexor tendon injury

  14. Zones for tendon repair

  15. Flexor Tendon Anatomy

  16. Methods of tendon repair

  17. 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

  18. Severe hand injury survey Blood supply Stable skeleton Viable skin cover Basic function Occupation

  19. Serious hand trauma-after debridement Longitudinal/ extensile exposures Compartment decompression Skeletal alignment/ fixation Musculo-tendon repair Vessel repair/ graft Nerve repair

  20. 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

  21. 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

  22. Nerve Repair Partial nerve Full nerve Regrow at 1mm per day Splintage rehabilitation

  23. Gracillis free flap

  24. Thoracodorsal artery perforator flap

  25. Radial forearm free flap

  26. Hand Infection Bacterial Viral Fungal Protozoal 64% grow multiple organisms

  27. Hand Infection: anatomical compartments Nail fold (paronychia) Pulp space Tendon sheath Web space Deep palmar space Septic arthritis

  28. Infection: history Time lapse cellulitis 24 hours tendon sheath 48 hours web space deep palm days paronychia pulp space 4-5 days septic arthritis <2 weeks

  29. Web space infection

  30. Deep palmar infection

  31. Infection: tendon sheath Finger in slight flexion Uniformly red and swollen Intense pain on attempted extension Tenderness along line of sheath

  32. Drainage of tendon sheath

  33. Drainage of mid-palmar space

  34. Infection: septic arthritis Usually secondary to human bite Swelling out of proportion to inflammation Restricted motion Instability Discharging sinus X-ray changes

  35. Paronychia

  36. Pulp space infection

  37. Herpetic whitlow

  38. Hand trauma and IV Drug Abuse

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