hand injury presentation to be use in safety comaign

Hand injury presentation for safety campaign

1. Principles of Hand Injury
management
DR. B SURESH GANDHI
Assistant professor
Saveetha medical college.
3.1.12

2. THE HAND
•Sophisticated tool,
•Organ of communication
•Expressing range of emotions

3. HAND GRIPS

4. Most useful function

5. BLOOD SUPPLY

6. ALLENS TEST

7. NERVE SUPPLY

8. Anatomy

10. David P. Green et al .
careful attention to detail and precise, gentle
technique are essential for success
The ability to do an operation is not necessarily
an indication to do that procedure

11. David P. Green et al .
•Do what is needed, not what is possible.
•Surgeons must keep in mind that
“the enemy of good is better,”

12. Imaging

13. Diagnosis
•Side
•Mode of injury
•type of injury. Crush/cut
•Level of injury
•Functional loss
•Neurovascular injury

14. Anesthesia
•Regional vsGeneral
•Auxillaryblock
techniques, doses, what drug, duration
•Wrist block
•Digital nerve block

15. David P. Green et al
•“the No. 1 rule of surgery”—start in an area
of normal anatomy! In both trauma and
reconstructive surgery,

16. Priorities of reconstruction
•bone and joint stabilization,
•soft tissue coverage,
•nerve,
•tendon

17. Essentials during procedure
•Good light
•Magnification
•Tourniquet
•Good anatomy
•Good assistant

18. POSITION OF HAND
REST FUNCTIONAL

19. Postoperative care
•compression dressing
help control capillary oozing but not too tight to restrict venous return.
•The finger webs must be separated
sufficiently to prevent maceration
Neatness is important because the patient may judge the quality of
the operation by the external appearance of the dressing
•Hand elevation

20. HAND INJURIES
•COMMENEST OF ALL INJURIES
•GOOD EVALUATION,METICULOUS CARE,
AND DEDICATED REHABILITATION

21. 3 MONTHS POST OP

22. AFTER 3 MONTHS

23. ASSESSMENT
•HISTORY
•EXAMINATION,
CIRCULATION, SOFT TISSUE COVER, BONES, JOINTS NERVE TENDONS
•X RAYS,
AP, LATERAL AND OBLIQUE VIEWS

24. Examination

25. PRINCIPLES
•Circulation
•Swelling
•Skin cover
•Nerve and tendon injuries
•Splintage , position of safe

26. SKIN CONVER
Reconstructive Lift

27. PRIMARY TREAMENT
•ABC
•ANTIBIOTICS
•WOUND EXPLORATRION
GOODLIGHT
MAGNIFICATION(MICROSCOPE)
TOURNIQUET
ANATOMY

28. FLEXOR TENDON INJURIES f Injury
FDS Insertion
Flexor Sheath
(proximal)
TCL
(distal edge) Carpal Tunnel

30. MODIFIED KESSLERS

31. EXTENSOR TENDON INJURIES
Zone I
Mallet Injury
Zone III
Boutonniere Deformity

32. FINGER TIP INJURIES
•SIZE OF THE WOUND
•BONE EXPOSED
•NAIL BED INJRUES

33. Subungual haematoma

34. Decision making….
•Size of the wound
•Bone exposed
•Dorsum/volar

35. Nail plate and bed

36. Composite grafting

37. Composite graft

38. How to proceed

39. FPL injury

40. V Y PLASTY
SUBUNGUAL HAEMATOMA

41. Closed ppx #

42. REPLANTATION
•TRANSPORT
STERILE SALINE GAUZEIN A PLASTIC BAG
PLACED IN WATERY ICE.
COLD ISCHEMIC TIME IS 30HRS
WARM TIME < 6 HRS

43. TISSUE REPAIR
•BONE FIXATION
•ARTERY
•VEIN
•NERVES
•EXTENSORS
•FLEXORS

45. FINGER
REPLANTATION

46. LATE RECONSTRUCTION
•2
ND
TOE TRANSFER