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33 Cards in this Set
- Front
- Back
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What is the preferred treatment for a fingertip amputation injury that is less than 1 cm2 without exposed bone?
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Allow to heal by secondary intention
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What is the preferred treatment for a fingertip amputation injury that is greater than or equal to 1 cm2?
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Hypothenar full thickness skin graft
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What is the preferred treatment if bone exposed?
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Rongeur the bone back first, but take care to maintain adequate nailbed support
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Is there a patient population in whom healing by secondary intention may be I appropriate, even with exposed bone?
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The very young (less than 2 to 3 years old)
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In what patients can a composite flap (essentially a biologic bandage) be used?
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Appropriate for patients up to 3 years old with fingertip arnputations
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What are the treatment options for more extensive volar digital tissue loss (volar oblique injury) with exposed bone?
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Cross finger flap
Thenar flaps |
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For what two fingers can a thenar flap be used?
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Index finger
Long finger |
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At what time should the thenar flap be divided?
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2 to 3 weeks
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What is the principal complication of a thenar flap in a patient over 40 years
old? |
PIP joint contracture
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What are other options for proximal volar digital coverage?
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Axial flag flap
Vascular island flap |
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What are the treatment options for transverse amputation or dorsal oblique amputation with exposed
bone? |
Volar V-Y flap
Double lateral V-Y flap |
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What are the three treatment options for volar oblique or transverse tissue loss in the thumb?
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Moberg flap (if <2 cm2)
Heterodigital island flap Cross finger flap (if 2 to 3 cm2) |
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What is the preferred treatment for dorsal tissue loss in the thumb?
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Dorsal first metacarpal artery island flap
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For coverage of the dorsal hand when underlying soft tissue bed is adequate, what type of graft is best?
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Meshed split-thickness skin graft (not a full-thickness graft)
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What are two indications for amputation?
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Complete degloving
Bony injury with associated nerve or vessel injury |
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What is the most important factor in determining outcome?
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The type and amount of material injected
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What are three negative prognostic factors?
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Presentation >l 0 hours after injury
>7000 psi injection pressure Oil-based paints and industrial solvents |
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What is the amputation rate after a high-pressure injection injury?
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50%
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What is the preferred treatment?
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Aggressive surgical management with prompt incision and drainage (I&D)
and wide mechanical debridement |
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What are the warm ischemia time limits for replantation for the digit and forearm?
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Less than 12 hours for digit
Less than 6 hours for forearm |
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What are the cool ischemia time limits?
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Less than 24 hours for digit
Less than 12 hours for forearm |
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What factor principally determines whether a replant will be technically possible and successful?
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Mechanism of injury
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Under what conditions might digital replantation be preferred?
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Thumb
Multiple digits Partial hand amputation Any upper extremity part in children Above the wrist Individual digits amputated distal to FDS (zone 1) |
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What is the Mangled Extremity Severity Scale (MESS) score used for, and what are its components?
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To predict the outcome of a limb salvage attempt; it consists of injury, ischemia, shock, age
(Hansen, JTrauma 1990) |
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What is the signilicance of a MESS score >7?
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Poor limb viability prognosis
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What is the significance of a MESS score <4?
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Relatively good prognosis for limb viability
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What is the fastest technique to address multiple digital amputations? In what order?
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Structure-by-structure approach results in a higher viability rate
Order of structures: bone, extensors, ilexors, artery, nerye, vein (acronym BEFANV) |
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In what order should structures be attached for a forearm replant?
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Artery first
Inclusion of a fasciotomy is mandatory |
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In what order should digits be reattached?
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Thumb
Long Ring I Small Index |
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What form of postoperative monitoring is most reliable?
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Doppler
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What is the most common cause of early replant failure (within 12 hours of surgery)?
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Thrombosis secondary to vasospasm
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What is the most common cause of late replant failure (after 12 hours)?
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Venous congestion (most common cause of loss)
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What are the two most common complications after replant surgery?
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Infection (No. 1)
Cold intolerance |
