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Handbook on Flaps in Crush Injuries of the Hand
Dhiren Mahida
1:
Introduction
TERMINOLOGY
Degloving Injury
Avulsion Injury
Crush Injury
Flap Terminology
Indications for Pedicle Flap
Contraindications for Pedicle Flap
Classification of Degloving Injuries by Different Authors
AIMS OF MANAGEMENT IN HAND INJURIES
Order of Priority for Open Wound Management
ASSESSMENT OF INJURY
Type of Injury
Part of Injury
Skin
Superficial/Deep Fascia
Tendon
Blood Vessels
Muscles
Bone
Nerves
SURGICAL PROCEDURES/OPTIONS AVAILABLE
2:
Debridement
METHOD
Cleaning
Excision
3:
Healing by Secondary Intention
4:
Fasciotomy
SIGNS AND SYMPTOMS
CLINICAL FEATURES
PERSISTENT PAIN, THAT IS PROGRESSIVE AND UNRELIEVED BY IMMOBILIZATION AND INCREASED BY PASSIVE STRETCHING, IS THE HALLMARK OF A DEVELOPING COMPARTMENT SYNDROME
Differential Diagnosis
Techniques
Indications for Fasciotomy
OTHER INVESTIGATIONS
TREATMENT (FIGURES 4.1 AND 4.2)
5:
Free Skin Grafts
SPLIT THICKNESS GRAFT
Properties of STG
Sites for taking STG
Method of STG
Drawbacks
FULL THICKNESS GRAFT (FIGS 5.3A AND B)
Ideal Donor Sites
Indication
Contraindications
Technique of Full Thickness Graft
6:
Vacuum-assisted Closure
7:
Local Flaps (Principles and Techniques)
ROTATION AND TRANSPOSITION FLAP (FIGS 7.1 TO 7.3)
Transposition Flap Assessment Techniques
Transposition Flap Techniques: Extension Cut
Transposition Techniques: Cut Back (Figs 7.6 to 7.8)
LATERAL DIGITAL FLAP (FIGS 7.9A AND B)
Indications
Technique
ADVANCEMENT FLAP (FIGS 7.10A AND B)
RHOMBOID FLAP OF LIMBERG (FIGS 7.11 TO 7.13)
DUFOURMENTAL FLAP (FIG. 7.14)
Complications
DORSAL DIGITAL ADVANCEMENT/REGRESSION (FIGS 7.15 AND 7.16)
Indications
THE DORSAL REVERSE ADIPOFASCIAL FLAP FOR FINGERTIP RECONSTRUCTION
Indications
Blood Supply
Advantages
Method (Figs 7.17A to D)
Adipofascial Flap (Figs 7.18A to H)
Dorsal Adipofascial Turnover Flap for Dorsal Defects of Finger Injury
Z-PLASTY TECHNIQUES (FIG. 7.20)
Indications
Standard 60° Z-Plasty Methods
SIMPLE Z-PLASTY OF THUMB WEB SPACE (FIGS 7.21 TO 7.24)
Indication
Aim
Method
HUESTON FLAP (FIGS 7.25A TO C)
Indications
SOUQUET FLAP (FIGS 7.27A TO C)
V-Y ADVANCEMENT (FIGS 7.29 TO 7.32)
Indications
Contraindication
Blood Supply
Important Considerations
Method
Atasoy-Kleinert V-Y Flap (Figs 7.31A to D)
Drawbacks and Complications
BILATERAL KUTLER's V-Y PLASTY (FIGS 7.33 TO 7.35)
VENKATASWAMI-SUBRAMANIAN FLAP (FIGS 7.36 TO 7.38)
Indication
Method
PALMAR BIPEDICLE ADVANCEMENT FLAP (FIGS 7.39 TO 7.41)
Indications
Advantages
Disadvantages
Technique
JOSHI'S DORSOLATERAL NEUROVASCULAR ISLAND FLAP (FIGS 7.42 TO 7.44)
Indications
Contraindications
Method
Joshi's Flap in Index Fingertip Amputation
Cadaveric Dissection Depicting Dr Joshi's Flap on the Thumb
Advantages
Drawbacks/Problems
PALMAR DIGITAL MONOPEDICLE FLAP (FIGS 7.45 TO 7.47)
Indications
Technique
Postoperative
Advantage
Disadvantages
Clinical Application in a Middle Finger Distal Phalange Amputation
DISTALLY BASED DIGITAL ISLAND FLAP
Indication
Blood Supply
Method
Postoperative
Advantages
Disadvantage
Distally Based Digital Island Flap (From Dorsum of Middle Phalange to Cover Defect on Volar Surface of Distal Phalange; Figs 7.50 to 7.52)
ANNULAR FLAP
Indication
Contraindication
Method
THE CROSS-FINGER FLAP (FIGS 7.55 AND 7.56)
Indications
Contraindications
Surgical Techniques
CLASSICAL LATERALLY BASED FLAP (FIGS 7.57 AND 7.58)
Indication
Technique
Dos’ and Don'ts of Surgery
DISTALLY BASED CROSS-FINGER FLAP (FIGS 7.59 AND 7.60)
Indication
Blood Supply
Technique
PROXIMALLY BASED CROSS-FINGER FLAP (FLAG-FLAP VARIANT)
REVERSE CROSS-FINGER FLAP (FIGS 7.62 AND 7.63)
Indication
Technique
Complication/Disadvantage
RADIAL SENSORY NERVE INNERVATED CROSS-FINGER FLAP (FIGS 7.64 AND 7.65)
Indication
Relative Contraindication
Method
Drawbacks/Complications
INNERVATED CROSS-FINGER FLAP
Indication
Technique
Disadvantage
DUAL INNERVATED CROSS-FINGER FLAP (FIGS 7.66 AND 7.67)
TURKISH FLAP (C-RING CROSS-FINGER FLAP) (FIG. 7.68)
Indications
Contraindication
Method
CROSS FINGER FLAP OVERRIDING A CROSS FINGER FLAP (FIGS 7.69 A TO C)
Flap on a Flap
FLAP ON A FLAP ON A FLAP (FIGS 7.70 TO 7.75)
Three Cross-Finger Flaps Over Riding One Another
DORSAL TO DORSOLATERAL COVERAGE (DORSAL MIDDLE PHALANGEAL ARTERY FLAP) (FIGS 7.76 TO 7.80)
Indication
Blood Supply
Dorsal digital artery
Advantages of the Cross-finger Flap
Drawbacks and Disadvantages
Complications (Figs 7.79 and 7.80)
Complications
Complications
RESULTS OF CROSS-FINGER FLAP
Discussion
Varieties
FLAG FLAP (FIGS 7.81 TO 7.83)
Indication
Blood Supply
Method
Advantage
Disadvantage
KITE FLAP (FIGS 7.84 TO 7.89)
Indication
Blood Supply
Technique
Advantage
Disadvantages
Holevich Flap (Figs 7.84 and 7.85)
DORSAL METACARPAL FLAPS: DISTALLY BASED 2ND DORSAL METACARPAL ARTERY FLAP (FIG. 7.90)
Indications
Blood Supply
Method
Advantage
Disadvantage
Foucher Kite Flap
Complications Encountered
VARIATIONS OF DORSAL METACARPAL ARTERY/FLAG FLAP (FIGS 7.93 AND 7.94)
REVERSE ULNAR PARAMETACARPAL ARTERY FLAP (FIGS 7.95A TO C)
Indication
Blood Supply
Method
Advantages
Disadvantages
THENAR FLAPS (FIGS 7.96 TO 7.101)
Indication
Types
Blood Supply
Method
Advantages
Disadvantages
REVERSED RADIAL ARTERY FOREARM FLAP (CHINESE FLAP) (FIGS 7.102 TO 7.104)
Indication
Blood Supply
Method
Variations
Advantages
Disadvantages
ULNAR ARTERY FOREARM FLAP (FIG. 7.105)
Indication
Blood Supply
Method
Postoperative
Advantages
Disadvantages
POSTERIOR INTEROSSEOUS ARTERY FLAP (FIGS 7.106 AND 7.107)
Indication
Contraindication
Blood Supply
Method
Advantages
Disadvantages
8:
Distant Flaps
TYPES
RANDOM PATTERN DISTANT FLAPS (FIGS 8.1A TO C)
Blood Supply
Ideal Sites
Method
REVERSED DELTOPECTORAL FLAP
Indication
Blood Supply
Method
Neurovascular Island Flap of Litter
DELTOPECTORAL FLAP (FIGS 8.4 AND 8.5)
Indications
Blood Supply
Surface Markings
Method
GROIN FLAP (FIGS 8.6 TO 8.9)
Indications
Anatomy
Method
Example 1
Example 2
Example 3
Example 4
Example 5
Example 6
9:
Composite Grafting and Flaps Using Dead Bone as Graft
COMPOSITE GRAFTING
Method
Contraindications
10:
Interesting Clinical Cases
CASE 1
CASE 2
CASE 3: CRUSHED HAND WITH EXTENSIVE DEVITALIZATION
CASE 4: CRUSH INJURY OF MIDDLE, RING AND LITTLE FINGER
CASE 5
11:
Amputations
INDICATIONS
PRINCIPLES AND GOALS OF AMPUTATION
DIGITAL TIP AMPUTATIONS (FIGS 11.1A AND B)
Amputation through Middle Phalange
Amputation through Proximal Phalange
METACARPAL RAY AMPUTATION
Indications
Method
Index Finger Ray Amputation (Figs 11.2A to D)
Index Finger Amputation
FILLET FLAPS
PHALANGIZATION OF METACARPAL BY WEB SPACE DEEPENING
Indications
Method (Figs 11.8A and B)
PHALANGIZATION OF THE METACARPAL HEAD (MODIFIED)
Indications
Method (Figs 11.9 and 11.10)
POLLICIZATION OF AN INDEX FINGER STUMP (FIGS 11.11 AND 11.12)
Indication
Method
Complications Encountered
THE GILLES COCKED-HAT FLAP (FIGS 11.17A TO D)
Indication
Method
Drawbacks
12:
Splints and Fixatures in Crush Injuries
SPLINTS (FIGS 12.1 AND 12.2)
JESS FIXTURES (FIG. 12.3)
Example (Figs 12.5 to 12.8)
13:
Microvascular Techniques
INDICATIONS
RELATIVE CONTRAINDICATIONS
PATIENT SELECTION
TRANSPORT OF AMPUTATED PART/PRESERVATION
INSTRUMENTS
SURGEON REQUIREMENTS
TECHNIQUES
Traumatic Avulsion of Thumb in a Young Girl (Fig. 13.2)
OTHER PRACTICAL METHODS
MEASURES TO SALVAGE A FAILING FLAP
Bibliography
INDEX
TOC
Index
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