1、HAND INJURYAnatomy:nSkinnBonenTendonnNervenBlood vesselTwo important posture (rest and function)Emergency management:nbleeding controlndressingnfirst aid splintClinical examination of injured hand Test of tendon functionnT h e s t u d y o f posture of hand and functionnthe tendon tension in the fing
2、er.flexor profound digitorum tendon testnThe distal interphalangeal joint flexor.flexor digitorum superficial tendon testnProximal interphalangeal joint flextion Extensor tendon rupturenMallet fingerTEST OF NERVE FUNCTIONntests of sensory nerve functionTEST OF NERVE FUNCTIONntests of motor functionn
3、The thener and hypothenernUlnar nerve and median nerveTESTS FOR BONE INJURYnfracturenDislocationnJoint injurynX-raySkin cover in the hand(inspect the viability)nSize of defectnSkin ColornTemperaturenCapillary responsenFlap edge bleedingnDye injectionprimary treatment for open hand injured nAnesthesi
4、anCleansingcleansing of the l i m b o r p a r t exclusive of the actual wound.Cleansing of the wound itself.3.Debridment:purpose:decrease contamination prepare damaged tissue for healing.Debridment is performed by 2 ways.1.Cleansing:flush out contaminant and removal of foreign body.2.Excision:remova
5、l of everything detrimental to wound healing.Preserve all possible things that is useful for hand function.Final assessmentnIs there loss?nWhat structures are exposed?nW i l l t h e s k i n survive?nWhat structures are damaged?Delayed primary closurenDoubt still persists as to the viability of tissu
6、e after debridement.nTwo-three days later.nwound closure.Indication for primary closurenThe tidy hand injury:those caused by choppers,cutting,knives,axes or glassIndication for delayed primary closurenThe untidy hand injury.:those caused by mobile machinery,power-driven saws,power presses and buzz p
7、lanesThe procedure of operationn The use of tourniquetnHemostasisnPrimary dressing at operationnImmobilizationnAntibioticsnAntisera.The management of skin covernLeaving wound opennDirect closurenFree skin grafts Skin flapsnLocal flapsnIsland flapsnFingertip injuriesnDistally based radial forearm fla
8、pnIsland flaps with a vein only nDistant pedicle flaps within the handnCross finger flapnThe thenar flap Skin flapsnDistant pedicle flapnMicrovascular free flapsnSmall skin defectsnLarge skin defectsnSensate skin replacementnComposite free tissue transferTendon injurynThe tendon ruptureTypes of teno
9、rrhapies:Principles of primary repair nthe advent of new suture techniques,n materials n early motion Zone 2-no mans landnFibrosseous digital canal=sheathPrinciples of the repair techniquenavoid tension during repair and mobilizationnperform only if there is a clean,incised wound.natraumatic surgica
10、l technique.nf i n e i n s t r u m e n t a t i o n a n d magnificationnappropriate suture material.Principles of the repair techniquenmeticulous restoration of tendon continuity and gliding functionnmeticulous hemostasisnmaintain the pulley and close the sheathnimmediate controlled mobilizationn a t
11、echnically proficient surgeon.Nerve injuriesnThe anatomy of nervenEpineuriumnPerineuriumMethods of nerve repairnEnd-to-end repair nEpineurial suturenFascicular suturenGroup fascicular sutureIndications for nerve graftnNerve graft are indicated when the fascicle cannot be approximated without tension
12、 using a 10/0 nylon suture to perform either an epineurial,interfascicular or group fascicular repair.nGap is more than 2 cm.Identifacation of corresponding fascicular bundlesnAnatomically nHistochemicallynElectrophysiologicallySource of free nerve graftsnDonor:nSural nervensuperficial branch of the
13、 radial never.nMedial and lateral antebrachial cutaneous nerves.Diagnosis of Bone fracture and Joint injury of the hand ndeformity and nx-ray examination.Principal of Treatment nreduction n fixation Close fracturen Splint,n casting,nplaster,ntranscutanous-pin fixation.Open fracturen debridment nRedu
14、ction ninternal fixation.(Screw,plate,K-pin,wire,external-fixative equipment)Replantation(Indications)nthumb;multiple digits;single digit distal sublimes insertionnChildren;wrist;transmetacarpal.Relative indicationnmultiple level injuries;n mental disability;n nerve avulsion;nfavorable amputation in patient of more than 60 years.nRing avulsion Contraindications:nsystemic illness;nassociated life-threatening injuries;nmangled parts;nsingle digit proximal to sublimes insertion.Preservation of divided finger nDry cooling preservation in 4C10C
