Reconstructive Surgeries
Tendon Repair

Tendon repair refers to the surgical repair of damaged or torn tendons, which are cord-like structures made of strong fibrous connective tissue that connect muscles to bones. The shoulder, elbow, knee, and ankle joints are the most commonly affected by tendon injuries. The goal of tendon repair is to restore the normal function of joints or their surrounding tissues following a tendon laceration.

Procedure

Local, regional or general anesthesia is administered to the patient depending on the extent and location of tendon damage. With a general anesthetic, the patient is asleep during surgery. With a regional anesthetic, a specific region of nerves is anesthetized; with a local anesthetic, the patient remains alert during the surgery, and only the incision location is anesthetized.

After the overlying skin has been cleansed with an antiseptic solution and covered with a sterile drape, the surgeon makes an incision over the injured tendon. When the tendon has been located and identified, the surgeon sutures the damaged or torn ends of the tendon together. If the tendon has been severely injured, a tendon graft may be required. This is a procedure in which a piece of tendon is taken from the foot or other part of the body and used to repair the damaged tendon. If required, tendons are reattached to the surrounding connective tissue. The surgeon inspects the area for injuries to nerves and blood vessels, and closes the incision.

Is it a safe procedure?

Tendon repair surgery includes the risks associated with any procedure requiring anesthesia, such as reactions to medications and breathing difficulties. Risks associated with any surgery are also present, such as bleeding and infection. Additional risks specific to tendon repair include: formation of scar tissue that may prevent smooth movements (adequate tendon gliding); nerve damage; and partial loss of function in the involved joint.

Webbed Fingers (Syndactyle)

Webbed toes are the common name for syndactyly affecting the feet. It is characterized by the fusion of two or more digits of the feet. This is normal in many birds, such as ducks; amphibians, such as frogs; and mammals, such as kangaroos. In humans it is considered unusual, occurring in approximately one in 2,000 to 2,500 live births.

There are various levels of webbing, from partial to complete. For example, the rare Hose's Civet, a viverrid endemic to northern Borneo, has partially webbed feet. Most commonly the second and third toes are webbed or joined by skin and flexible tissue. This can reach either part way up or nearly all the way up the toe.

Procedure

Polydactyl can be corrected by surgical removal of the extra digit or partial digit. Syndactyly can also be corrected surgically. This is usually accomplished with the addition of a skin graft from the groin.

There are several ways to perform this type of surgery; the design of the operation depends both on the features of the hand or foot and the surgeon's experience. The surgery is usually performed with zigzag cuts that cross back and forth across the fingers or toes so that the scars do not interfere with growth of the digits.

The procedure is performed under general anesthesia. The skin areas to be repaired are marked and the surgeon then proceeds to incise the skin, lifting small flaps at the sides of the fingers or toes and in the web. These flaps are sutured into position, leaving absent areas of skin. These areas may be filled in with full thickness skin grafts, usually taken from the skin in the groin area.

Is it a safe procedure?

Webbed finger or toe repair surgery carries the risks associated with any anesthesia, such as adverse reactions to medications, breathing problems, and sore throat from intubation. Risks associated with any surgery are excessive bleeding and infection.

Specific risks associated with the repair surgery include possible loss of skin graft and circulation damage from the cast or bandages.

The results of webbed finger or toe repair depend on the degree of fusion of the digits and the repair is usually successful. When joined fingers share a single fingernail, the creation of two normal-looking nails is rarely possible. One nail will look more normal than the other. Some children may require a second surgery, depending on the type of syndactyly. If polydactyl or syndactyly is just cosmetic and not symptomatic of a condition or disorder, the outcome of surgery is usually very good. If it is symptomatic, the outcome will rely heavily on the management of the disorder.

Extra Finger (Polydactyl)

Polydactyl refers to extra digits - in the hand, extra fingers or thumbs. Polydactyl is one of the most common variations on the basic growth pattern of the hand. There are many different forms of polydactyly, ranging from

o a small extra bump on the side of the hand,

o a finger which widens to end in two fingertips,

o an extra finger which dangles by a thin cord from the hand,

o a hand which looks normal except that it has a thumb and five fingers, and

o An infinite number of other variations.

Usually, when a digit has duplicated, each half is somewhat smaller than usual, and it is common for the joints to angle to the sides, often in mirror image zig zag directions.

Procedure

The main treatment of polydactyly is surgery to remove the extra parts and more importantly to correct associated problems with what remains. This is sometimes fairly complicated surgery, because there may be variations in all of the structures of the digit which is kept - twisted bones, crooked joints, missing or extra tendons, nerves, and blood vessels. Abnormalities in the fingers which are kept may be more obvious after surgery than before, but with careful planning, a hand surgery specialist will attempt to anticipate and correct these problems at the time of surgery.

After surgery, it is usual to protect the hand in a large bandage for weeks to months, depending on what is done. Surgery done in childhood may need to be adjusted for growth with "touch up" surgery when the child is older.

Is a safe procedure?

The goals of surgery are to improve the appearance of the hand and to prevent progressive deformity from developing as the child grows. Surgery is generally successful in both of these areas, largely correcting the appearance and social stigmata of congenitalism.

In many cases, surgery results in a greatly improved but not perfectly normal appearance, and in some situations a normal appearance cannot be expected. For example, each of the duplicated thumbs in the above diagram is likely to be smaller than a normal thumb, and no amount of surgery will allow a smaller thumb to "catch up" and perfectly match a normal size thumb on the opposite hand.

Fortunately, unless there is something particularly eye-catching about the hand (like an extra finger or thumb), what people notice about another person's hand is not the appearance of an individual finger or thumb, but how the person uses their hand. Hiding one's hand actually draws attention to it, and if surgery allows the person to use their hand in a natural, unselfconscious way, many small details, such as a somewhat small thumb, will go unnoticed.

Reattachment Surgery

In the last several years thanks to the advancement of medical equipment and improved microsurgery techniques.Reattachment surgery is the surgical reattachment of a body part by microsurgical means, most commonly a finger, hand or arm that has been completely cut from a person's body. Reattachment of amputated parts has been performed on fingers, hands, forearms, arms, toes, feet, legs, ears, avulsed scalp injuries, a face, lips, penis and a tongue.

Procedure

Reattachment requires microsurgery and must be performed within several hours of the part's amputation at a medical centre with specialized equipment, surgeons and supporting staff. To improve the chances of a successful Reattachment, it is necessary to preserve the amputate as soon as possible in a cool (close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile "Amputate-Bags" available which help to perform a dry, cool and sterile preservation.

Parts without muscles such as fingers can be preserved for many hours, while major muscled containing parts such as arms need to be re attached and revascularized within 6-8 hours to survive. Outcome of major limb Reattachments can be predicted by the potasium level of the blood which flows out of the replanted part after revascularization as a high level can be a marker of muscle and tissue death.

It is important to also collect and to preserve those amputates which do not look like being "replantable". A microsurgeon needs all available parts of human tissue to cover the wound at the stump and thus to prevent further shortening of the stump. In some cases (e.g. forearm) the task of an important joint (e.g. elbow) can be conserved for improved prosthetic success.

Severe crush injuries, multilevel injuries, avulsion injuries, and in some cases jagged tearing of tissue, can preclude Reattachment and salvage, requiring revision amputation of the stump.

Is reattachment surgeries are safe?

The risks associated with all reconstructive surgeries are infection, bleeding, an unsightly scar, improper wound closure, and adverse reactions to anesthesia. Complications associated with flap reconstruction of the breasts include unusual firmness of the fatty tissue (fat necrosis), partial flap loss, fluid collection beneath the flap site, and muscle weakness (including abdominal hernias) at the donor site.


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