Hand repair and reconstruction: basic and complex
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| Other Authors: | |
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| Format: | Book |
| Language: | English |
| Published: |
Philadelphia, Pa.
Elsevier
2014
|
| Series: | Clinics in plastic surgery
41,3 |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XX S., S. 325 - 635 zahlr. Ill. |
| ISBN: | 9780323311694 |
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| adam_text | Titel: Hand repair and reconstruction
Autor: Tang, Jin Bo
Jahr: 2014
Hand Repair and Reconstruction: Basic and Complex
Contents
Preface: Hand Repair and Reconstruction
Jin Bo Tang and Michael W. Neumeister
XIII
Editorial: Treatment in Hand Surgery: Practical Tips to Make Complex Cases Simple
Jin Bo Tang
xv
Special Editorial Feature: New Tendon, Nerve, and Bone Surgical Methods
Impacting the Practice of Hand Surgery
Jin Bo Tang and Bella Avanessian
XIX
Repair and Reconstruction of Thumb and Finger Tip Injuries: A Global View
325
Jin Bo Tang, David Elliot, Roberto Adani, Michel Saint-Cyr, and Felix Stang
In this review, an international group of senior hand surgeons was asked to provide
their currently used methods, views, and advice on thumb and fingertip repair. The
basic requirements and methods of thumb and fingertip repair are first outlined,
followed by descriptions of the methods favored by individual units or surgeons.
More recent innovative methods and modifications are described and challenging
topics are discussed. This review ends by illustrating and discussing a few explor-
atory treatments that hold promise of greatly changing future perspectives of this
common clinical problem.
Microsurgical Soft Tissue and Bone Transfers in Complex Hand Trauma 361
Roberto Adani, Luigi Tarallo, Armando Fonzone Caccese, Luca Delcroix,
Etienne Cardin-Langlois, and Marco Innocenti
Treatment of complex hand trauma includes adequate debridement of nonviable
tissue, early reconstruction, and careful selection of various available surgical proce-
dures tailored to patients needs and requests. Debridement of all necrotic tissue is
crucial before any attempt at reconstruction. Surgeons should also consider cos-
metic outcomes of the reconstructed hand and donor-site morbidity. For best re-
sults reconstruction should be performed early, with proper early postoperative
therapy. This article reviews the principles and surgical options in the management
of complex hand injuries involving the dorsal and the palmar aspects of the hand,
and the different types of tissue in the hand.
Replantation: Current Concepts and Outcomes 385
Reuben A. Bueno Jr, Bruno Battiston, Davide Ciclamini, Paolo Titolo, Bernardino Panero,
and Pierluigi Tos
Techniques to improve the chance of successful replantation of digits are well es-
tablished. Indications and contraindications for replantation are generally agreed
on, but they continue to evolve as excellent outcomes are achieved at centers
with experience and expertise. Form and function can be restored with avulsion in-
juries and distal amputations, with good results and high patient satisfaction. In-
creased financial pressure to control the costs of health care and increased
accountability for evidence-based outcomes may lead to the regionalization of re-
plantation care and shared decision making in recommending replantation or revi-
sion amputation.
vi»
Contents
Immediate Tissue Transplantation in Upper Limb Trauma: Spare Parts Reconstruction 397
Chih Hung Lin, Kelli Webb, and Michael W. Neumeister
The management of mutilated upper extremity wounds offers challenges for all hand
surgeons. Loss of composite tissues usually requires grafts or flaps to gain coverage
and restore function. Nonsalvagable digits or amputated parts are a source of spare
tissues that can be used for reconstruction of the hand or limb. Immediate tissue
transplantation is a resourceful technique for hand surgeons to limit donor morbidity
while making the most out of a terrible injury to the hand or upper extremity. This
article reviews the various methods by which immediate tissue transplantation can
be employed in hand trauma.
Cosmetic Reconstruction of the Digits in the Hand by Composite Tissue Grafting 407
Zeng Tao Wang and Wen Hai Sun
This article presents the authors methods of digital reconstruction using composite
tissue transfer. The authors present their approach to achieve restoration of full
cosmetic appearance of the reconstructed thumbs or fingers while preserving the
function and cosmetic appearance of the donor foot. The reconstructive procedures
for each degree of digit defect are discussed in detail, and pitfalls and technical tips
are given. This article summarizes the authors experience in reconstruction of 646
digits since 1998 and the challenges that they faced in the complex microsurgical
reconstruction necessary to pursue the goal of restoring the cosmetic appearance
of reconstructed digits and donor feet.
Methods and Pitfalls in Treatment of Fractures in the Digits 429
Reena A. Bhatt, Scott Schmidt, and Felix Stang
This article describes the indications for and methods of managing phalangeal
fractures. Fractures around the finger joints are particularly difficult to treat. The
technical details and pitfalls for these cases are discussed in detail. The problems
associated with the phalangeal fractures such as articular destruction, nonunion,
and postoperative care are also discussed. The authors present their preferred
surgical treatment, with review of recent advancement regarding the treatment of
phalangeal fractures.
Non-surgical Management of Metacarpal Fractures 451
Michael W. Neumeister, Kelli Webb, and Kate McKenna
Metacarpal fractures are among the most common fractures of the upper extremity.
Surgical management is generally offered for unstable or significantly displaced
fractures. A more conservative, nonsurgical approach, however, may provide
safe, rapid recovery while maintaining normal active range of motion. This article re-
views the nonsurgical approach, protocols, and outcomes of metacarpal fractures.
Surgical Treatment, Hardware Removal, and the Wide-Awake Approach for
Metacarpal Fractures 463
Shu Guo Xing and Jin Bo Tang
Most fractures are managed nonoperatively. Those displaced unstable fractures
require percutaneous fixation of single (or double) intramedullary Kirschner wires.
Only large, oblique fractures must be fixed with screws or a plate. Indications for
plating metacarpal fractures are limited in multiple unstable shaft or oblique fractures.
After internal fixation, the patient actively moves the digits over a limited range under
protection. This article reviews indications and techniques of surgical treatment, hard-
ware removal, and the wide-awake approaches for surgery of these fractures.
Contents
Distal Radius Fracture: Diagnosis, Treatment, and Controversies
Jin Bo Tang
This article presents the diagnosis and treatment of distal radius fractures with em-
phasis on (1) current common principles, (2) the author s current practices, and (3)
controversies. The author emphasizes that displaced distal radius fractures should
be approached first with a trial of closed reduction, with or without percutaneous
pinning. If this reduction is unstable or unsuccessful, open reduction is indicated.
Early treatments include percutaneous pinning through the distal radioulnar joint,
early or delayed reattachment/repair of the avulsed dorsal periphery of the triangular
fibrocartilage complex (TFCC), reattachment of the TFCC to the ulna fovea, and late
reconstruction.
Management of the Stiff Finger: Evidence and Outcomes
Guang Yang, Evan P. McGlinn, and Kevin C. Chung
The term stiff finger refers to a reduction in the range of motion in the finger.
Prevention of stiff fingers by judicious mobilization of the joints is prudent to avoid
more complicated treatment after established stiffness occurs. Static progressive
and dynamic splints are considered effective non-operative interventions to treat
stiff fingers. Capsulotomy and collateral ligament release and other soft tissue re-
lease of the MCP and PIP joint are also discussed in this article. Future outcomes
research is vital to assessing the effectiveness of these surgical procedures and
guiding postoperative treatments.
Evidence-based Flexor Tendon Repair
Isabella M. Mehling, Annika Arsalan-Werner, and Michael Sauerbier
The goal of flexor tendon repair is to achieve normal range of motion of the finger
or thumb. The surgical approach depends on the level of injury. MultiStrand core
suture repairs are recommended for primary flexor tendon repair. It is evident that
at least 4 strands are required to an initiate and active range of motion protocol.
The epitendinous suture can also increase the strength of the repair. Careful atten-
tion to the post-operative therapy regiment is critical to a successful repair.
Extensor Tendon Repair and Reconstruction
Cornelius D. Schubert and Riccardo E. Giunta
Extensor tendon reconstruction requires various complex hand surgery techniques,
including direct tendon repair, tendon grafting transfer, and soft tissue reconstruc-
tion with local and free flaps. Choosing the best individual reconstruction plan for
the individual patient with an individual defect is crucial.
Clinical Applications of Autografts, Conduits, and Allografts in Repair of Nerve
Defects in the Hand: Current Guidelines
Brian Rinker and Krishna S. Vyas
Traumatic nerve injuries are common conditions treated by hand surgeons, and the
optimal treatment of a severed nerve requires providing a healthy wound bed, gen-
erous trimming to healthy nerve substance, and a minimal-tension approximation.
The gold standard for repair of a critical nerve gap has been the nerve autograft.
However, results are generally less favorable than direct suture. Autogenous and
synthetic conduits and processed nerve allografts have been developed as less
morbid and more convenient alternatives to autografts, but the reported outcomes
have been uneven. Engineered neural tissues show great promise in inducing nerve
regeneration across a gap.
Contents
Nerve Transfers 551
Thomas H. Tung
This article provides an update of the current state of motor and sensory nerve trans-
fers for the functional reconstruction of proximal and distal nerve lesions of the upper
extremity. General principles, indications, surgical options, and functional outcomes
are summarized for conventional transfers used in brachial plexus reconstruction,
more recently described distal nerve transfers for isolated nerve injuries in the ex-
tremity, and sensory nerve transfers performed both proximally and distally.
Entrapment Neuropathy of the Wrist, Forearm, and Elbow 561
Shu Guo Xing and Jin Bo Tang
This review discusses key diagnostic points and treatment guidelines for compres-
sion neuropathies of the wrist, forearm, and elbow. Recent treatment progress is re-
viewed, controversies are highlighted, and consensus is summarized. Limited or
mini-open releases and endoscopic carpal tunnel releases are considered equally
safe and efficient. Both methods are currently mainstays of surgical treatment.
Surgical Management of Painful Peripheral Nerves 589
David Elliot
This article deals with the classification, assessment, and management of painful
nerves of the distal upper limb. The author s preferred surgical and rehabilitation
techniques in managing these conditions are discussed in detail and include (1)
relocation of end-neuromas to specific sites, (2) division and relocation of painful
nerves in continuity (neuromas-in-continuity and scar-tethered nerves) involving
small nerves to the same sites, and (3) fascial wrapping of painful nerves in continuity
involving larger nerves such as the median and ulnar nerves. The results of these
treatments are presented as justification for current use of these techniques.
Techniques and Outcomes for Hand Surgery: Summary of Recent Literature 615
David J. Smith Jr
Abstracts and Commentaries for select hand surgery articles in the recent literature
related to surgical techniques and outcomes are provided from Year Book of
Plastic and Aesthetic Surgery: Some of the articles are: Refinements in Polliclza-
tion: A 30-Year Experience; Toe-To-Hand Transfer: Evolving Indications and Rele-
vant Outcomes; The Effectiveness of Pedicled Groin Flaps in the Treatment of
Hand Defects: Results of 49 Patients; Trend of Recovery after Simple Decompres-
sion for Treatment of Ulnar Neuropathy at the Elbow; Program Director Opinions of
Core Competencies in Hand Surgery Training: Analysis of Differences between
Plastic and Orthopedic Surgery Accredited Programs. More extensive literature
summaries and commentaries are published in Year Book of Plastic and Aesthetic
Surgery, edited by Stephen Miller MD. http://www.elsevier.com/journals/year-
book-of-plastic-and-aesthetic-surgery/1535-1513.
Early Practice: Early Practice in Hand Surgery 625
Kelli Webb and Michael W. Neumeister
This view of Early Practice of hand surgery presents the perspective of a PGY6 Res-
ident followed by the perspective of the expert clinician and trainer of new hand sur-
geons. Tips from both Resident and Expert provide the early practitioner useful
clinical advice as well thoughts on how to approach continued education through
the course of a career in hand surgery.
Index
631
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