PlastikSurgery.in
BONY RECONSTRUCTION:
The hand consists of 27 bones- 8 carpal bones, 5 metacarpal bones, and 14 bones in fingers. Meticulous realignment of the bones is optimal for restoration of hand function. Several muscles and tendons are attached to each small bone of the hand and the different tendon and muscle interplay also influence the healing and functioning of the joints.
Treatment includes non-surgical with splinting or casting the hand or fingers after reducing the fractures or with fixation using small pins, screws, or K-wires.
FINGER TIP INJURIES:
One of the most common injuries that occur daily. The fingertip is important as a tactile and sensory organ. The fingertip injuries may be classified depending upon the mechanism of injury. The nail bed complex is a specialized structure vital for the protection of the fingertip. Reconstructing the nail complex and fingertip is vital for the preservation of tactile and sensory function.
NERVE REPAIRS:
Each finger is supplied by two digital nerves running along the lateral side of their length. They in turn arise from a common digital nerve branching from median nerve to medial 3 ½ digits and from ulnar nerve to lateral 1 ½ digit. The nail bed complex is supplied by the volar nerves. This digital nerve when cut needs coaptation to prevent ulceration and further fingertip injuries due to insensate fingertips. Most repairs require either loupe or microscopic magnification and need microsurgical expertise.
SOFT TISSUE RECONSTRUCTIONS:
Most crush injuries to the hand happen from the work site using heavy machine involve reconstruction of more than one structure. The tendons and neurovascular bundles need soft tissue cover to prevent infection and further injury.
LOCAL FLAPS:
- V-Y advancement Flaps- for fingertip injuries incorporating volar neurovascular bundle
- Thenar flaps- raised from the thenar eminence to cover fingertip injuries
- Cross finger flaps- raised from the extensor aspect of an adjacent finger, tailored to cover defects involving the volar side of the distal and middle phalanx. May be used as a reverse dermal flap for extensor aspect wounds of adjacent fingers. Used as a pedicled flap and flap division done later at two or three weeks.
- Homodigital Island Flap- flap raised based on either of the neurovascular bundles of a finger as an island flap attached only by the vascular pedicle. Maybe transposed to defect loosely to avoid compression. Tests must be done to assess the patency of the other vascular bundle. It may be raised as a distally based or proximally based flap.
- Dorsal Metacarpal artery Flap- flap based on the first and second metacarpal artery. Used to cover defects over the dorsum of hand up to PIPJ and thumb defects