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--- md:secondary_surgery_trauma [2020/08/08 03:42]
admin
+++ md:secondary_surgery_trauma [2020/08/11 09:27] (current)
admin [Replantation]
@@ Line 4: / Line 4: @@
 ===Classification of secondary surgery===
+from [[jnl:rajasabapathy2013]]
   * repair of structures not primarily repaired
   * promote healing/enhance function e.g. malunion, nonunion, tenolysis
   * enhance function - arthrodesis, bone lengthening, tendon transfers etc.
-{where is this definition from?}
 ==== Replantation ====
-  * [[jnl:sabapathy2013|Replantation - secondary surgery]]
+  * [[jnl:rajasabapathy2013|Replantation - secondary surgery]]
     * Rate of secondary surgery in replantation is high, and may be multiple
     * In replantation - try to do everything primarily -- hard to comeback to do secondary recon
@@ Line 49: / Line 49: @@
 ====Alternatives to secondary reconstruction====
-- Functional outcome following traumatic upper limb amputation and prosthetic limb fitting☆
+  * [[jnl:pinzur1994|Functional outcome following traumatic upper limb amputation and prosthetic limb fitting]]
-Author links open overlay panelMichael S.PinzurMDJuanAngelatsMDTerry R.LightMDRicardoIzuierdoMDTeresaPluthRN
+    * early fitting better results
-https://doi.org/10.1016/0363-5023(94)90197-X
+    * compare with [[jnl:chevrier1956]]: lower usage rate at follow up ? because of long interval between diagnosis and referral; but group also different (not just trauma)
-Abstract
-Nineteen consecutive patients underwent traumatic upper limb amputation for nonreconstructible or replantible upper limb injury at a Level I trauma center over a 9-year-period. Eleven amputations were at the transradial level, five were transhumeral, and three were shoulder disarticulation. Eighteen patients underwent prosthetic limb fitting. Fifteen of the 18 initially underwent preparatory prosthetic limb fitting within 30 days following amputation with a body-powered, cable-driven prosthesis. Seventeen of the 18 achieved sufficient proficiency with their prostheses to allow them to return to work. Of these, 15 maintained daily functional prosthetic use of at least 8 hours daily at a followup examination of 12 to 110 months. Use of prosthetic limb following traumatic upper limb amputation carries a high probability for functional rehabilitation if limb fitting and prosthetic training are instituted as soon as the residual limb can tolerate the prosthetic socket as opposed to waiting for the residual limb to “mature”.
-Pollicization
-used less in microsurgical age
-- may be best option
-  - nearer to CMCJ
-  - disadvantages
-    - sensation - still IF
-	- loss of digit
-Planning
-- IF by far most common - but can use other digits
-  - consider if injured other digits
-Binhammer and Lister's article is quite good
-- tendon transfer for opposition - FDS RF
-- Fixation
-- shortening - distally or proximally -- ? length
-- check circulation
--
-##################################
-Osteoplastic thumb reconstruction
-##################################
-## flap - groin/abdominal vs radial forearm
-  - size: 6-7 cm
-  - 1-2 cm shortening
-  - avoid circular seam - either oval or zig-zag
-  - seam in palmar side of "thumb"
-## bone - iliac crest, tibia, radius
-  - make thumb slightly shorter than other side
-  - bone fixation --> wedge into MC/P1
-## neurovascular island flap - ulnar side of MF
+====Options====
-  - ulnar side of RF
+===Pollicization===
-  - make sure it is big enough
+[[md:trauma_pollicization|Pollicization]]
+  * used less in microsurgical age
+    * may be best option
+      * nearer to CMCJ
+    * disadvantages
+      * sensation - still IF
+      * loss of digit
+== Planning ==
+  * IF by far most common - but can use other digits
+    * consider if injured other digits
-## nerve repair  +/-
+Binhammer and Lister's article is quite good
+  * tendon transfer for opposition - FDS RF
+  * Fixation
+  * shortening - distally or proximally -- ? length
+  * check circulation
-- Staging - 3 vs 2 vs 1 stage
+===Thumb lengthening===
-Issues
+Ivan Matev's chapter in Foucher's book:
-- sensory recovery
-- flap necrosis
-- bone graft resorption - related to flap
+  * 50% easy, 80% possible, sometimes 100% in young
+  * young - slower (1mm /d) but more lengthening
+  * older - more likely bone graft (45-60 days) if no good callus - in situ
+  * problems - union, angulation, infection, MCPJ flexion
+  * need good skin first
+  * can paint nail
+  * make sure CMCJ is good, skin at tip is good first, sometimes need to deepen/widen web
-Outcomes
+===Osteoplastic thumb reconstruction==
-Outcomes in mutilating hand injuries
-Severe extremity injuries
-KCC Hand Clinics 2020
+  * flap - groin/abdominal vs radial forearm
+    * size: 6-7 cm
+    * 1-2 cm shortening
+    * avoid circular seam - either oval or zig-zag
+    * seam in palmar side of "thumb"
-- MSK Trauma big burden -- especially developing countries
+  * bone - iliac crest, tibia, radius
-- need for outcome measures -- move towards PROMs
+    *  make thumb slightly shorter than other side
-  - PROMs context specific -- different countries and cultures --> different
+    * bone fixation --> wedge into MC/P1
-  - disability vs impairment -- measures don't map well
-  - different PROMs don't correlate well too
-- individualized treatment - need shared decision making
+  * neurovascular island flap - ulnar side of MF
+    * ulnar side of RF
+    * make sure it is big enough
+  * nerve repair  +/-
-====Options====
+  * Staging - 3 vs 2 vs 1 stage
-===Pollicization===
-[[md:trauma_pollicization|Pollicization]]
-===Thumb lengthening===
+==Issues==
-Ivan Matev's chapter in Foucher's book:
+  * sensory recovery
+  * flap necrosis
+  * bone graft resorption - related to flap
+====Outcomes in mutilating hand injuries ====
-  - 50% easy, 80% possible, sometimes 100% in young
+  * see [[jnl:giladi2016]]
-  - young - slower (1mm /d) but more lengthening
+  *  MSK Trauma big burden -- especially developing countries
-  - older - more likely bone graft (45-60 days) if no good callus - in situ
+    *  need for outcome measures -- move towards PROMs
-  - problems - union, angulation, infection, MCPJ flexion
+  *  PROMs context specific -- different countries and cultures --> different
-  - need good skin first
+  *  disability vs impairment -- measures don't map well
-  - can pain nail
+  *  different PROMs don't correlate well too
-  - make sure CMCJ is good, skin at tip is good first, sometimes need to deepen/widen web
+  *  individualized treatment - need shared decision making
 ====References====
@@ Line 136: / Line 130: @@
   - Brown, P. W. (1982). Less than ten—Surgeons with amputated fingers. The Journal of Hand Surgery, 7(1), 31–37. https://doi.org/10.1016/S0363-5023(82)80010-5
   - Cheung, K., Hatchell, A., & Thoma, A. (2013). Approach to traumatic hand injuries for primary care physicians. Canadian Family Physician Medecin De Famille Canadien, 59(6), 614–618.
+  - Chevrier, J. M., Gingras, G., Lemieux, R., Mongeau, M., Susset, V., & Voyer, R. (1956). [[jnl:chevrier1956|Psycho-social and rehabilitative aspects of upper extremity amputees]]. Canadian Medical Association Journal, 75(10), 819–823.
   - Foo, A., & Sebastin, S. J. (2016). Secondary Interventions for Mutilating Hand Injuries. Hand Clinics, 32(4), 555–567. https://doi.org/10.1016/j.hcl.2016.07.006
   - Foucher, G. (1997). Reconstructive surgery in hand mutilation. Martin Dunitz.
-  - Giladi, A. M., Ranganathan, K., & Chung, K. C. (2016). Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries. Hand Clinics, 32(4), 465–475. https://doi.org/10.1016/j.hcl.2016.06.002
+  - Giladi, A. M., Ranganathan, K., & Chung, K. C. (2016). [[jnl:giladi2016|Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries]]. Hand Clinics, 32(4), 465–475. https://doi.org/10.1016/j.hcl.2016.06.002
-  - Gingras, G., & Lemieux, R. (1956). PSYCHO-SOCIAL AND REHABILITATIVE ASPECTS OF UPPER EXTREMITY AMPUTEES. 75, 5.
   - [[jnl:graham2016|Graham, D.]], Bhardwaj, P., & Sabapathy, S. R. (2016). Secondary Thumb Reconstruction in a Mutilated Hand. Hand Clinics, 32(4), 533–547. https://doi.org/10.1016/j.hcl.2016.07.005
   - How to use the ICF: A Practical Manual for using the International CLassification of Functioning, Disability and Health (ICF). (2013). WHO.
   - Krueger, C. A., Wenke, J. C., Cho, M. S., & Hsu, J. R. (2014). Common Factors and Outcome in Late Upper Extremity Amputations After Military Injury: Journal of Orthopaedic Trauma, 28(4), 227–231. https://doi.org/10.1097/BOT.0b013e3182a665f5
+  - Pinzur, M. S., Angelats, J., Light, T. R., Izuierdo, R., & Pluth, T. (1994). [[jnl:pinzur1994|Functional outcome following traumatic upper limb amputation and prosthetic limb fitting]]. The Journal of Hand Surgery, 19(5), 836–839. https://doi.org/10.1016/0363-5023(94)90197-X
   - Sabapathy, S. R., & Bhardwaj, P. (2013). [[jnl:sabapathy2013|Secondary procedures in replantation]]. Seminars in Plastic Surgery, 27(4), 198–204. https://doi.org/10.1055/s-0033-1360587
   - Swiontkowksi, M. F. (2011a). Traumatic and Trauma-Related Amputations: Part I: General Principles and Lower-Extremity Amputations. Yearbook of Orthopedics, 2011, 55–57. https://doi.org/10.1016/j.yort.2011.04.016

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