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--- md:secondary_surgery_trauma [2020/08/11 09:07]
admin [References]
+++ 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 61: / Line 61: @@
 [[md:trauma_pollicization|Pollicization]]
-Pollicization
+  * used less in microsurgical age
+    * may be best option
-used less in microsurgical age
+      * nearer to CMCJ
-- may be best option
+    * disadvantages
-  - nearer to CMCJ
+      * sensation - still IF
-  - disadvantages
+      * loss of digit
-    - sensation - still IF
-	- loss of digit
-Planning
+== Planning ==
-- IF by far most common - but can use other digits
+  * IF by far most common - but can use other digits
-  - consider if injured other digits
+    * consider if injured other digits
 Binhammer and Lister's article is quite good
-- tendon transfer for opposition - FDS RF
+  * tendon transfer for opposition - FDS RF
-- Fixation
+  * Fixation
-- shortening - distally or proximally -- ? length
+  * shortening - distally or proximally -- ? length
-- check circulation
+  * check circulation
--
 ===Thumb lengthening===
 Ivan Matev's chapter in Foucher's book:
-  - 50% easy, 80% possible, sometimes 100% in young
+  * 50% easy, 80% possible, sometimes 100% in young
-  - young - slower (1mm /d) but more lengthening
+  * young - slower (1mm /d) but more lengthening
-  - older - more likely bone graft (45-60 days) if no good callus - in situ
+  * older - more likely bone graft (45-60 days) if no good callus - in situ
-  - problems - union, angulation, infection, MCPJ flexion
+  * problems - union, angulation, infection, MCPJ flexion
-  - need good skin first
+  * need good skin first
-  - can pain nail
+  * can paint nail
-  - make sure CMCJ is good, skin at tip is good first, sometimes need to deepen/widen web
+  * make sure CMCJ is good, skin at tip is good first, sometimes need to deepen/widen web
-##################################
-Osteoplastic thumb reconstruction
-##################################
-## flap - groin/abdominal vs radial forearm
+===Osteoplastic thumb reconstruction==
-  - 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
+  * flap - groin/abdominal vs radial forearm
-  - make thumb slightly shorter than other side
+    * size: 6-7 cm
-  - bone fixation --> wedge into MC/P1
+    * 1-2 cm shortening
+    * avoid circular seam - either oval or zig-zag
+    * seam in palmar side of "thumb"
-## neurovascular island flap - ulnar side of MF
+  * bone - iliac crest, tibia, radius
-  - ulnar side of RF
+    *  make thumb slightly shorter than other side
-  - make sure it is big enough
+    * bone fixation --> wedge into MC/P1
+  * neurovascular island flap - ulnar side of MF
+    * ulnar side of RF
+    * make sure it is big enough
-## nerve repair  +/-
+  * nerve repair  +/-
-- Staging - 3 vs 2 vs 1 stage
-Issues
-- sensory recovery
-- flap necrosis
-- bone graft resorption - related to flap
+  * Staging - 3 vs 2 vs 1 stage
+==Issues==
+  * sensory recovery
+  * flap necrosis
+  * bone graft resorption - related to flap
 ====Outcomes in mutilating hand injuries ====

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