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Manual of Reconstructive Hand Surgery
G Karthikeyan
SECTION 1: GENERAL CONSIDERATIONS
1:
Examination of the Hand
Seating the Patient
Communicating with the Patient
Eliciting the History
Examination of the Patient
SECTION 2: SKIN RECONSTRUCTION
2:
Assessment of Skin Loss on the Hand
Introduction
Assessment of the Raw Area
Assessment of the Patient
3:
Littler's Island Flap
Introduction
Advantages
Disadvantages
Presurgical Counseling
Surgical Steps
Postoperative Protocol
4:
First Dorsal Metacarpal Artery Flap
Introduction
Advantages of the Flap
Disadvantages of the Flap
Presurgical Counseling
Surgical Steps
Postoperative Protocol
5:
Reverse Dorsal Metacarpal Artery Flap
Introduction
Advantages of the Flap
Disadvantages of the Flap
Presurgical Counseling
Surgical Steps
Postoperative Protocol
6:
Posterior Interosseous Artery Flap
INTRODUCTION
Indications
Advantages
Disadvantages
Presurgical Counseling
Surgical Steps
Postoperative Protocol
7:
Radial Artery Forearm Flap
INTRODUCTION
Advantages
Disadvantages
Presurgical Counseling
Surgical Steps
Postoperative Protocol
8:
Buried Abdominal Flap
INTRODUCTION
Presurgical Counseling
Surgical Steps
Postoperative Protocol after Flap Stage I
Postoperative Protocol after Flap Stage II
9:
Vascularized Free Anterolateral Thigh Flap
INTRODUCTION
Presurgical Counseling
Surgical Steps
Preparation on the Hand
Preparation on the Thigh
Vascular Anastomosis
SECTION 3: OTHER POST-TRAUMATIC SEQUELAE ON THE SKIN
10:
Adherent Scars and Contractures
INTRODUCTION
Examination of the Scar
Management Protocol
SECTION 4: TENDON RECONSTRUCTION
11:
Tendon Reconstruction—Assessment
INTRODUCTION
Clinical Examination
Deciding on the Plan of Management
12:
Repair of Avulsed Flexor Tendon
INTRODUCTION
Presurgical Counseling
Surgical Steps
Postoperative Protocol
13:
Flexor Tendon Grafting
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
14:
Staged Flexor Tendon Reconstruction
Introduction
Presurgical Counseling
Stage I
Stage II
Surgical Steps
Stage I
Postoperative Protocol for Stage I
Stage II
Postoperative Protocol for Stage II
15:
Flexor Tenolysis
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
16:
Extensor Tendon Reconstruction
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
17:
Extensor Indicis Proprius to Extensor Pollicis Longus Tendon Transfer
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
18:
Flexor Digitorum Superficialis to Flexor Pollicis Longus Tendon Transfer
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
SECTION 5: BONE RECONSTRUCTION
19:
Bone Reconstruction—Assessment
Introduction
History
Nature of Injury
Duration
Nature of Previous Management
Skin
Deformity
Sinus
Abnormal Mobility
Management
20:
Open Reduction Internal Fixation of Fractures
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
21:
Bone Grafting
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
22:
Vascularized Fibula Transfer
Introduction
Presurgical Counseling
Surgical Steps
Vascular Anastomosis
Postoperative Protocol
SECTION 6: JOINT RECONSTRUCTION
23:
Joint Reconstruction—Assessment
Introduction
Clinical Examination
Planning the Management
24:
Chronic Metacarpophalangeal Joint Dislocation Reduction
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
25:
Arthrolysis
Introduction
Arthrolysis of the Proximal Interphalangeal Joint of the Finger
Presurgical Counseling
Surgical Steps
Postoperative Protocol
Arthrolysis of the Metacarpophalangeal Joint of the Finger
Presurgical Counseling
Surgical Steps
Postoperative Protocol
26:
Vascularized Toe Metatarsophalangeal Joint Transfer
Introduction
Presurgical Counseling
Preparation
Surgical Steps
Recipient Site Dissection
Fixation of the Toe Metatarsophalangeal Joint Flap
Postoperative Protocol
SECTION 7: NERVE RECONSTRUCTION
27:
Nerve Reconstruction—Assessment
28:
Nerve Reconstruction—Management
Approaches and Exploration
Nerve Repair
Nerve Grafting
Postoperative Protocol
SECTION 8: COMPLEX POST-TRAUMATIC PROBLEMS
29:
Complex Post-traumatic Problems
Introduction
Priority of Management
First Make a Plan According to Diagnosis
Classify According to Postoperative Regimen
Classify According to Time Schedule
Classify According to Priority Lists
Priority Lists
If Both Upper Limbs are Involved
If Multiple Fingers are Involved
If Multiple Tissues are Involved (Table 8.29.1)
SECTION 9: THUMB RECONSTRUCTION
30:
Principles and Decision Making in Thumb Reconstruction
Principles
Decision Making
General Factors
Local Factors
Type I
Type II
Type III
Type IV
Type V
31:
Procedures for Reconstruction of Type I Amputations
Transverse and Volar Oblique Amputations
Lateral Advancement Flaps of Kütler
Surgical Steps
Postoperative Regimen
Dorsal Oblique Amputations
Volar Advancement Flap of Atasoy
Surgical Steps
Postoperative Regimen
Oblique Amputation Type “A”
Oblique Triangular Flap of Professor R Venkataswami
Surgical Steps
Postoperative Regimen
Oblique Amputation Type “B”
Dorsal Transposition Flap
Surgical Steps
Postoperative Regimen
32:
Procedures for Reconstruction of Type II Amputations
Introduction
Staged Island Flap of Professor R Venkataswami
Advantages
Disadvantages
Presurgical Counseling
Surgical Steps
Stage I
Stage II
33:
Procedures for Reconstruction of Type III Amputations
Osteoplastic Reconstruction
Advantages
Disadvantages
Surgical Steps
Surgical Procedure of Component I (Tubed Groin Flap)
Surgical Procedure of Component II (Ulnar Bone Graft Application)
Surgical Procedure of Component III (Littler's Neurovascular Island Flap)
Postoperative Protocol
Vascularized Wrap-around Great Toe Transfer
Preparation
Surgical Steps
Recipient Site Dissection
Harvesting the Ulnar Bone Graft
Fixation of the Toe Flap
Postoperative Protocol
34:
Procedures for Reconstruction of Type VI Amputations
Vascularized Second Toe Transfer
Preparation
Surgical Steps
Recipient Site Dissection
Fixation of the Toe Flap
Postoperative Protocol
35:
Procedures for Reconstruction of Type V Amputations
Pollicization
Presurgical Counseling
Surgical Steps
SECTION 10: TUMORS
36:
Ganglion Excision
Introduction
Salient Features of the Condition
Surgical Steps
Postoperative Protocol
SECTION 11: DEGENERATIVE CONDITIONS
37:
Dupuytren's Contracture—Assessment
Introduction
History
Symptoms
Clinical Examination
Staging
Planning the Management
Planning the Timing of the Surgery
38:
Dupuytren's Contracture—Management
Fasciectomy
Surgical Steps
Postoperative Protocol
SECTION 12: INFECTION
39:
Hansen's Disease and Sequelae
History
Clinical Examination
Type of Hand
Attitude of the Hand
Appearance of the Hand
For the Ulnar Nerve
For the Median Nerve
For the Radial Nerve
40:
Opponensplasty with Flexor Digitorum Superficialis of Ring Finger
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
41:
Opponensplasty with Abductor Digiti Minimi Muscle (Huber's Transfer)
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
42:
Claw Correction— Lasso Procedure
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
43:
Claw Correction—Extensor to Flexor 4-Tailed Tendon Transfer (Ef4t) Procedure
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
44:
Claw Correction— Fowler Procedure
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
45:
Tendon Transfer for Radial Nerve Palsy
Introduction
Presurgical Counseling
Surgical Steps
Postoperative Protocol
SECTION 13: CONGENITAL DISORDERS
46:
Congenital Disorders—Assessment
INTRODUCTION
Assessment Criteria—General
The Details that Must be Collected are:
Assessment Criteria—Specific
47:
Syndactyly
Assessment (Syndactyly)
Management Schedule
Surgery (Syndactyly)
Presurgical Counseling
Surgical Steps
Postoperative Protocol
48:
Cleft Hand
Assessment (Cleft Hand)
Typical Cleft
Atypical Cleft
Functional Problems
Management Protocol
Simple Closure of the Cleft—Method of Barsky
Presurgical Counseling
Surgical Steps
Postoperative Protocol
Release of Adduction Contracture of Thumb and Closure of the Cleft (Method of Littler)
Presurgical Counseling
Surgical Steps
Postoperative Protocol
49:
Trigger Thumb Release
INTRODUCTION
Surgical Steps
Postoperative Protocol
50:
Macrodactyly
Assessment (Macrodactyly)
Functional Problems
Management Protocol
Decision Making
Presurgical Counseling
Surgical Steps
Postoperative Protocol
51:
Hypoplastic Thumb—Pollicization
Assessment (Hypoplastic Thumb)
Pollicization
Presurgical Counseling
Surgical Steps
Steps of Finger Dissection
Steps of Musculoskeletal Stabilization
Postoperative Protocol
SECTION 14: COMMON CLINICAL CONDITIONS
52:
Contractures on the Upper Limb—Assessment
Introduction
Examination of the Contracture
Contracture of the Finger
Additional Examination Criteria
Thumb
Palm
Dorsum
Wrist
Elbow
Axilla
General Examination
Factors Affecting the Surgical Management
Age
Associated Neck Contracture
Bilateral Upper Limb Contracture
Contractures on Two Sites of the Same Upper Limb
Priority of Contracture Release
Cause of the Contracture
Protocols for Resurfacing after Contracture Release on the Upper Limb
53:
Contractures on the Upper Limb—Management
Introduction
Release of Contracture
Surgical Steps
Z-plasty
Surgical Steps
Postoperative Protocol
Square Flap Method
Surgical Steps
Postoperative Protocol
Five Flap Method of Thumb Web Release
Surgical Steps
Postoperative Protocol
SECTION 15: ADULT BRACHIAL PLEXUS INJURIES
54:
Adult Brachial Plexus Injuries—Assessment
Introduction
Level of the Lesion
Nature of the Lesion
Plan of Management
Clinical Examination
Motor Examination
Sensory Examination
Investigations
Documentation
Decision Making: What is to be Done?
Decision Making: When is it to be Done?
Management Protocol After Clinical Examination
55:
Adult Brachial Plexus Injuries—Exploration
Presurgical Counseling
Position of the Patient
Preparation
Markings
Tumescent Infiltration
Surgical Steps
Decision Making
Neurolysis
Nerve Repair—Primary
Nerve Grafting
Nerve Transfer
Management Protocol After Exploration
56:
Adult Brachial Plexus Injuries—Nerve Surgery
Spinal Accessory Nerve Transfer
Surgical Steps
Intercostal Nerve Transfer
Contraindications
Surgical Steps
Oberlin Transfer
Presurgical Counseling
Surgical Steps
Contralateral C7 Transfer
Presurgical Counseling
Position of the Patient
Preparation
Surgical Steps
Harvesting the Vascularized Ulnar Nerve
57:
Adult Brachial Plexus Injuries—Muscle Transfer
Pedicled Latissimus Muscle Transfer for Elbow Flexion
Presurgical Counseling
Markings
Surgical Steps
Preparation of the Recipient Area on the Arm
Postoperative Protocol
58:
Obstetric Brachial Plexus Palsy—Assessment
Introduction
Muscle Power Grading
Shoulder Recovery (Mallet's Classification)
Elbow Recovery
Investigations
Examination of the Baby at the End of 2 Days
Examination of the Baby at the End of 1 Month
Examination of the Baby at the End of 3 Months
59:
Obstetric Brachial Plexus Palsy—Management
Introduction
Mod Quad Procedure
Presurgical Counseling
Position of the Patient
Preparation
Markings
Tumescent Infiltration
Step 1
Step 2
Step 3
Step 4
Postoperative Protocol
60:
Volkmann's Ischemic Contracture—Assessment
Introduction
Planning the Sequence of Surgical Procedures
61:
Volkmann's Ischemic Contracture—Management
Exploration
Surgical Steps
Postoperative Protocol
Tendon Lengthening
Surgical Steps
Postoperative Protocol
Muscle Slide Operation
Surgical Steps
Postoperative Protocol
Tendon Transfer—FDS to FDP
Surgical Steps
Postoperative Protocol
Tendon Transfer—Brachioradialis to FPL and ECRL to FDP
Surgical Steps
Postoperative Protocol
62:
Vascularized Gracilis Muscle Transfer
Introduction
Advantages
Disadvantage
Surgical Steps
Donor Site Dissection
Markings (Fig. 15.62.1)
Vascular Anastomosis
Recipient Site Dissection
SECTION 16: DIFFICULT HAND PROBLEMS
63:
The Mutilated Hand
Introduction
Surface Mutilation
Terminal Mutilation
Radial Post
Ulnar Post Absent
Radial Post Absent
Thumb Web Absent
Sequence of Surgery
Prosthetics
Training Prosthesis
Functional Prosthesis
Cosmetic Prosthesis
64:
Vascularized Double Toe Transfer
Indications
Preparation
Surgical Steps
Recipient Site Dissection
Fixation of the Double Toe Flap
SECTION 17: APPENDICES
I:
Preparation for Hand Surgery
Introduction
Preparation and Drapingof the Hand
II:
Preparation for a Free Flap
Preparation Before the Patient is Brought to the Operation Theater
Preparation While Anesthesia is Being Delivered
Preparation After the Anesthesia has been Delivered
III:
Preparing Instrument Sets for Use in Hand Surgery
Preparing Instrument Sets
Axillary Block Set
Basic Set
Bone Set
Skin Graft Set
Microsurgery Instruments Tray
IV:
Harvesting a Sural Nerve Graft
V:
Harvesting a Skin Graft
VI:
Harvesting an Ulnar Bone Graft
VII:
Harvesting a Palmaris Longus Tendon Graft
VIII:
Harvesting aFascia Lata Graft
SECTION 18: PROFORMAS
I:
Microsurgery Recording Chart
II:
Brachial Plexus Injury Evaluation
III:
Contracture of Upper Limb
Proforma for Assessment of Contracture on Upper Limb
IV:
Dupuytren's Contracture Evaluation
V:
Volkmann's Ischemic Contracture Evaluation
VI:
Bone Problem Evaluation
VII:
Joint Problem Evaluation
VIII:
Tendon Injury Evaluation
INDEX
TOC
Index
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