collar and cuff seem to be for clavicle
indications for external fixation?
rehabilitation - start immediately proximal and distal muscles/joints
Bone Healing
primary healing vs secondary hea;ling
healing factors
cancellous bone heal faster than cortical bone
upper limb faster than lower limb
Open Fractures
sometimes its obvious
Days of putting external fixators are over
- resuscitation also!
damage control orthopaedics
"button holes the skin"
A - orthopaedics
B - plastic surgeon
SIX HOURS before going OR for intiial debridement because bacterial colony count but latest studies show can wait for next day for through debrideemt?
formal debridement = the would is extended out and bone taken out extended, irigated until dully cleaned and put back
irrigation after the debridement not before
why no tourniquet = because hard to distinguish between dead and live tissue
when in doubt, cut it out
pulsed lavage vs gravity. pulsed lavage can knock off tissue
only close if sure - some are kept open
advent of the vac?
does not extend the time for coverage or closure - do not extend more than a week
initial debridgement asap (4-6 hours), orthopaedic treatmnt (within 24-48) hours, closing the wound within 7 days a week
gastroc/soleus fr tibia - many times cannot be used coz damage
much higher narcotic dependancy
ROM = ranged of motion
Subtopics
microsurgical experitise and vasculaity
by definition non-vascular tissues therefore needs recipient capillaries
STSG generally but large wounds or crticial FTSG
FTSG longer durability hands
cannot expand
random - no vascularity pattern
axial - anatomical arteriovenous system axially
based on vascular pattern
palmar = volar
Plastic surgery stuff
