Transanal Endoscopic microsurgery by using Single incision port
Microsurgery
43
Microsurgery Dr. Çağatay Uluçay Yeditepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji
description
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. - PowerPoint PPT Presentation
Transcript of Microsurgery
Microsurgery
Dr. Çağatay UluçayYeditepe 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 < 1cmType II tidy wound 1-2 cmType IIIA >2cm; soiledType IIIB IIIA + periosteal strippingType IIICneurovascular damage
Severe hand injury survey
Blood supplyStable skeletonViable skin coverBasic functionOccupation
Serious hand trauma-after debridement
Longitudinal/ extensile exposuresCompartment decompressionSkeletal alignment/ fixationMusculo-tendon repairVessel repair/ graftNerve 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
ChildrenThink about avulsed digits and crushed
distal parts
Hand Replantation7 months off work50% get only protective sensation50% range of movement60% need > 2 operationsMedical cost 5-15 times amputation
Nerve Repair
Partial nerveFull nerveRegrow at 1mm
per daySplintagerehabilitation
Gracillis free flap
Thoracodorsal artery perforator flap
Radial forearm free flap
Hand Infection
BacterialViralFungalProtozoal64% grow
multiple organisms
Hand Infection: anatomical compartments
Nail fold (paronychia)Pulp spaceTendon sheathWeb spaceDeep palmar spaceSeptic arthritis
Infection: historyTime lapse cellulitis 24
hours tendon sheath
48 hours web space deep palm days paronychia pulp space 4-5
days septic arthritis
<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 arthritisUsually secondary to human biteSwelling out of proportion to
inflammationRestricted motionInstabilityDischarging sinusX-ray changes
Paronychia
Pulp space infection
Hand trauma and IV Drug Abuse
