hand

Overview of Hand Anatomy and Surgical Procedures

Introduction

• Discussion about hand anatomy and its significance in surgical procedures.

• Emphasis on the importance of understanding anatomical positioning from Anatomy and Physiology (A&P).

Anatomical Positioning of the Hand

• Supine Position:

  • The palm facing upward, akin to holding a bowl of soup and dumping it out.

• Radial and Ulnar Sides of the Hand:

  • Radial Side: Associated with the thumb; the word 'radius' is longer and relates to the longer bone.

  • Ulnar Side: Corresponds to the medial side of the hand.

Bone Structure of the Hand

• Carpal Bones:

  • Total of 8 carpal bones.

• Metacarpals:

  • 5 metacarpals present in the hand.

• Phalanges:

  • A total of 40 phalanges in both hands (14 in each hand).

  • Each finger has 3 phalanges except the thumb which has 2.

Joint Movements

• Diarthrosis:

  • Definition: Joints that are freely movable, classified as synovial hinge joints.

  • Includes interphalangeal joints formed between phalanges.

• Connection made to later discussions on ortho (orthopedic surgery).

Muscle and Tendon Functionality

• Almost 40 muscles and their coordinating tendons are involved in wrist, hand, and finger movements.

• Mention of congenital deformities, diseases, or trauma that can result in changes in hand appearance or function, often requiring surgical intervention.

Specialization in Hand Surgery

• Some healthcare professionals specialize strictly in hand procedures, including:

  • Orthopedic surgeons.

  • Plastic surgeons.

• Median Nerve Surgery:

  • Commonly referred to as carpal tunnel surgery.

  • Can be performed by plastic surgeons or neurosurgeons.

Types of Hand Injuries

• Various forms of trauma:

  • Cuts.

  • Sprains.

  • Fractures (e.g., humorous anecdote about a coworker’s foot injury).

  • Burns.

  • Crushing injuries (described detailed injury in a surgical context).

Goals of Surgical Intervention

• Primary Goals:

  • Restore both appearance and function of the hand post-injury.

  • Address accidents causing loss of digits, particularly thumb amputations.

• Recognition of the significant impact on functionality due to an amputated thumb or digit.

Replantation of Severed Digits

• Factors for Successful Replantation:

  1. Type of Injury: Clean injury vs. crushing injury.

  2. Location of Amputation: Critical to know the area of injury (e.g., tip vs. below knuckle).

  3. Extent of Damage: Evaluate both soft tissue and underlying structures like blood vessels, nerves, and tendons.

• Description of a traumatic case where a hand injury involved tendon work after a degloving injury.

• Steps for digit reattachment:

  1. Bone: First, bone must be attached using plates, screws, or wires.

  2. Tendons: Reconnection follows.

  3. Vessels: Anastomosis comes next.

  4. Nerves: Last to be repaired and heal, often resulting in prolonged or permanent sensory changes such as tingling.

Care for Severed Parts

• Importance of immediate action post-severance:

  • Patient should bring the severed digit, if possible.

  • Immediate cooling methods such as ice should be employed.

  • Possible misstatements about using milk for preservation (often associated with teeth).

  • The time elapsed since severance is crucial for potential reattachment.

Anecdote on a Patient's Injury

• Real-world scenario of an injury where the fingertip was severed due to a truck door accident.

  • The functionality of the nail bed and outcomes of stitching and flap procedures after the injury.

• Comparison of adult vs. child injuries where children may regenerate fingertips due to stem cells present.

Conclusions and Noteworthy Insights

• Review of the significant capabilities of pediatric patients in regeneration compared to adults.

• Discussed impact of injuries and the role of stem cells in healing in young children.

• Mentioned both common and rare injury cases that highlight the complexity of hand injuries and the intricacies of surgical recovery.