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md:secondary_surgery_trauma [2020/08/08 03:52]
admin [Options] 		md:secondary_surgery_trauma [2020/08/11 09:27] (current)
admin [Replantation]
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 ===Classification of secondary surgery=== ===Classification of secondary surgery===
 +from [[jnl:rajasabapathy2013]]
   * repair of structures not primarily repaired   * repair of structures not primarily repaired
   * promote healing/enhance function e.g. malunion, nonunion, tenolysis   * promote healing/enhance function e.g. malunion, nonunion, tenolysis
   * enhance function - arthrodesis, bone lengthening, tendon transfers etc.   * enhance function - arthrodesis, bone lengthening, tendon transfers etc.
    
-{where is this definition from?} 
  
 ==== Replantation ==== ==== Replantation ====
-  * [[jnl:sabapathy2013|Replantation - secondary surgery]]+  * [[jnl:rajasabapathy2013|Replantation - secondary surgery]]
     * Rate of secondary surgery in replantation is high, and may be multiple     * 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     * In replantation - try to do everything primarily -- hard to comeback to do secondary recon
Line 51: Line 51:
   * [[jnl:pinzur1994|Functional outcome following traumatic upper limb amputation and prosthetic limb fitting]]   * [[jnl:pinzur1994|Functional outcome following traumatic upper limb amputation and prosthetic limb fitting]]
     * early fitting better results     * early fitting better results
 +    * 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)
  
  
-################################## 
-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]]+
  
-Pollicization+==Issues== 
 +  * sensory recovery 
 +  * flap necrosis 
 +  * bone graft resorption - related to flap
  
-used less in microsurgical age +====Outcomes in mutilating hand injuries ====
-- 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 +
--  +
- +
-===Thumb lengthening=== +
-Ivan Matev's chapter in Foucher's book:+
  
-  - 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==== ====References====
Line 135: 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   - 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.   - 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   - 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.   - 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   - [[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.   - How to use the ICF: A Practical Manual for using the International CLassification of Functioning, Disability and Health (ICF). (2013). WHO.
md/secondary_surgery_trauma.1596858757.txt.gz · Last modified: 2020/08/08 03:52 by admin

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