cobertura cutanea en la mano
TRANSCRIPT
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COBERTURA CUTANEA EN
LA MANO
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COBERTURA CUTANEA EN LA MANO
URGENCIAS
•Anamnesis: Causa, profesión.
•Examen físico cuidadoso
•Rx
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COBERTURA CUTANEA EN LA MANO
De entrada
•Limpieza con irrigación abundante.
•Excisión de tejidos desvitalizados.
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COBERTURA CUTANEA EN LA MANO
•Fijación ósea.
•Reparación de estructuras nobles.
•Cobertura cutanea.
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COBERTURA CUTANEA EN LA MANO
Si las condiciones locales son buenas puede hacerse una reparación completa en un solo tiempo.
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COBERTURA CUTANEA EN LA MANO
Si tenemos dudas sobre los riesgos de infección o vitalidad de los tejidos es mejor esperar unos días para realizar la reparación.
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COBERTURA CUTANEA EN LA MANO
La reconstruccón puede ser:
•Urgente (24 horas)
•Precoz (1 semana)
•Tardía
En la mano cuanto antes mejor
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COBERTURA CUTANEA EN LA MANO
Objetivos
•Mantener función
•Estetica
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COBERTURA CUTANEA EN LA MANO
Pulpejos
•Mantener longitud
•Sensibilidad
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COBERTURA CUTANEA EN LA MANO
Cicatrización per secundam
•En defectos pequeños
•Cura diaria
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COBERTURA CUTANEA EN LA MANO
Injertos
• Lecho adecuado
•Espesor parcial o total
•De oreja, área hipoptenar, cara volar de muñeca o codo, cara interna del brazo, área inguinal.
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COBERTURA CUTANEA EN LA MANO
Injertos
• Lecho adecuado
•Espesor parcial o total
•De oreja, área hipoptenar, cara volar de muñeca o codo, cara interna del brazo, área inguinal.
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COBERTURA CUTANEA EN LA MANO
Indicaciones colgajos
• Lecho inadecuado para injerto
• Necesidad de almohadillado
• Estructuras nobles expuestas
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COBERTURA CUTANEA EN LA MANO
Colgajos locales
• Indicados si el defecto es mayor de un tercio de la longitud de la falange.
• Ideal si aportan sensibilidad.
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COBERTURA CUTANEA EN LA MANO
Colgajos clasicos
• Kutler (Triangular bilateral)
• Atasoy (Triangular volar)
• Moberg
• Colgajo tenar
• Cross-finger
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COBERTURA CUTANEA EN LA MANO
Colgajos de la mano
• “ a distancia”: Cross, tenar
• Avance: Kutler, Atasoy, Moberg...
• Transposición: Colgajo en bandera
• Isla: Littler, Maruyama, Foucher.
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COBERTURA CUTANEA EN LA MANO
Colgajos pediculados (De antebrazo)
• Radial o Chino
• Cubital
• Dorso-cubital
• Interóseo posterior
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COBERTURA CUTANEA EN LA MANO
Grandes defectos
• Cross-arm
• Colgajo de antebrazo
• Microcirugía
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Lo más reciente:
Colgajos homodigitales a flujo revertido.
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Pequeños defectos mano o dedos
Colgajos basados en las arterias dorsales intermetacarpianas, de flujo proximal o invertido.
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Actualmente el Cross-arm o el colgajo de Mcgregor se usan si falla otra opción reconstructiva (Colgajos pediculados de antebrazo o libres)
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Colgajo Radial
(Chino)
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Pensar en el pie como banco para la mano
• Colgajos: Instep, Morrison, dorsal del pie.
• Injertos: Instep
• Articulaciones
• Lechos ungueales.
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