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33 Cards in this Set

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