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Flaps in Hand and Upper Limb Reconstruction
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A BASIC KNOWLEDGE 1 Systematics and topography of the upper limb 2 Applied anatomy 2.1 Biomechanics of the skin 2.2 Functional units and subunits at the upper limb 2.3 Concept of "low-resistance zones" at the upper limb 2.4 Concept of "functional unit soft tissues/bone 3 Functional, aesthetic and social aspects of the upper limb 4 Generalities in flap surgery 4.1 Skin flaps (including perforator flaps) 4.2. Fascia and adipo-fascial flaps 4.3 Muscle flaps 4.4. Bone flaps (vascularized bone grafts) 4.5 Compound flaps B FLAPS AND FURTHER TREATMENT OPTIONS FOR COVERAGE OF SOFT TISSUE AND BONE DEFECTS AT THE UPPER LIMB 5. Skin Flaps 5.1 Pedicled skin flaps from the Hand Region 5.1.1 4 Flap Z-Plasty according to WOOLF and BROADBENT 5.1.2 Butterfly Plasty according to SHAW 5.1.3 Trident Flap Plasty according to HIROSHOWITZ resp.GLICENSTEIN 5.1.4 3 Flap Transposition Plasty according to LEVANDOVSKY 5.1.5 Dorso-palmar Transposition Flap according to FLATT 5.1.6 Nail-Bed Transposition Flap according to SHEPARD 5.1.7 Radio-lateral Index finger Transposition Flap according to SPINNER 5.1.8 Palmar pedicled transposition flap according to VASCONEZ 5.1.9 Latero-digital transposition flap according to BUNNEL 5.1.10 Palmar transposition flap according to HUESTON 5.1.11 Dorsal transposition flap according to HUESTON 5.1.12 Palmar advancement "flap family" according to MOBERG 5.1.13 Palmar advancement flap according to TRANQUILLI-LEALI 5.1.14 Homodigital latero-digital island flap according to JOSHI 5.1.15 Lateral advancement flap family according to GEISSENDORFER resp. KUTLER 5.1.16 Homodigital neurovascular exchange island flap according to FOUCHER 5.1.17 Homodigital reverse island-flap according to OBERLIN 5.1.18 Thenar flap according to GATEWOOD 5.1.19 Dorsal cross-finger flap according to CRONIN 5.1.20 Palmar cross-finger flap according to ISELIN 5.1.21 Dorsal sensible cross-finger flap according to GAUL 5.1.22 Dorsal flag flap according to VILAIN 5.1.23 Dorsal middle phalanx island flap according to BUCHLER 5.1.24 Latero-digital al island flap according to ROSE 5.1.25 Heterodigital island flap according to LITTLER 5.1.26 Dorso-commusural flap according to DAUTEL 5.1.27 Dorsal 1st metacarpal artery (DFMC) flap according to HILGENFELDT 5..1.28 Dorsal 2nd metacarpal artery flap according to EARLEY and MILNER 5.1.29 Distally based dorsal radial neurocutaneous metacarpal flap according to BERTELLI and KHOURY 5.2 Pedicled flaps from the Forearm region 5.2.1 Pedicled Radial artery flap according to YANG 5.2.2 Antecubital perforator flap according to CORMACK/LAMBERTY 5.2.3 Ulnar artery Forearm flap according to LOVIE 5.2.4 Distal ulnar artery perforator flap according to BECKER 5.2.5 Posterior interosseus artery flap according to PENTEADO/ZANCOLLI 5.2.6 Anterior interosseous artery flap according to HU 5.2.7 Distally based lateral antebrachial neurocutaneous flap according to BERTELLI 5.3 Pedicled skin flaps from the Upper Arm Region 5.3.1 Lateral upper arm flap according to SONG 5.3.2 Medial Upper Arm flap according to DANIEL 5.3.3 Posterior upper arm flap according to MASQUELET 5.4 Pedicled skin flaps from the Thorax Region 5.4.1 Parascapula flap according to NASSIF 5.5 Pedicled skin flaps from a distant region 5.5.1 Cross-arm flap according to McCASH 5.5.2 Pocket flap according to MARINO 5.5.3 Abdominal flap according to ZOLTAN 5.5.4 Groin flap according to McGREGOR 5.6 Generally usable pedicled skin flaps 5.6.1 Transposition Flap 5.6.2 Rotation flap according to IMRE 5.6.3 W-plasty according to BORGES 5.6.4 2 Flap Z-Plasty according to HORNER 5.6.5 Double inverted Z- Plasty according to PICK 5.6.6 Rhomboid flap according to LIMBERG 5.7 Free microvascular skin flaps 5.7.1 Free venous flap according to YOSHIMURA 5.7.2 Free Anterolateral Thigh flap according to SONG 5.7.3 Free A. dorsalis pedis flap according to McGRAW 6 Fascia and adipo-fascial flaps 6.1 Pedicled fascia flaps from the Hand Region 6.1.1 Hypothenar fat pad (adipofascial) flap 6.2 Pedicled fascia flaps from the forearm region 6.3 Pedicled fascia flaps from the upper arm regions 6.4 Pedicled fascia flaps from the thorax regions 6.5 Free microvascular fascia flaps 6.5.1 Free microvasculare A. temporalis superficialis fascia flap according to SMITH 7. Muscle-Flaps 7.1 Pedicled muscle flaps from the Hand Region 7.1.1 1st dorsal interosseus muscle flap according to MATHES 7.1.2 2nd and 3rd interosseus muscle flap according to HIERNER 7.1.3 Abductor pollicis brevis muscle flap according to MATHES 7.1.4 Lumbrical muscle flap according to WILGIS 7.1.5 Abductor digiti minimi muscle flap according to HUBER/NICOLAYSEN 7.2 Pedicled muscle flaps from the Forearm Region 7.2.1 Pronator quadratus muscle flap according to DELLON 7.2.2 Brachioradialis muscle flap according to GER 7.3 Pedicled muscle flaps from the elbow region 7.3.1 Anconaeus flap according to CARDANY 7.4 Pedicled muscle flaps from the Thorax Region 7.4.1 M. serratus anterior flap according to TAKAYANAGI 7.4.2 Latissimus dorsi-flap according to OLIVARI 7.4.3 Bipolar complete pectoralis major flap according to DAUTRY resp. CARROLL 7.5 Free microvascular muscle flaps 7.5.1 Free multifunctional splitted segmental myocutaneous gracilis muscle flap according to HARII resp. MANTKELOW 8 Bone Flaps (Vascularised Bone Grafts) 8.1 Pedicled bone flaps from the Hand Region 8.1.1 Callotaxis Lengthening according to ILIZAROV/MATEV 8.1.2 Pisiform bone Transfer according to BECK 8.1.3 Second metacarpal bone flap according to BRUNELLI 8.2 Pedicled bone flaps from the Forearm Region 8.2.1 Dorso-radial radius bone transfer according to ZAIDEMBERG 8.3 Free microvascular bone flaps 8.3.1 Anterior iliac crest (DCIA) flap according to TAYLOR 8.3.2 Free microvascular Fibula bone flap according to UEBA 8.3.3 Medial femoral condyle vascularized bone graft according to Masquelet 9. Compound Flaps 9.1 Pedicled compound flaps from the Hand Region 9.1.1 Pollicisation according to GOSSET 9.1.2 Ray transposition according to GRAHAM/CAROLL 9.1.3 Homodigital DIP-to-PIP joint transfer according to FOUCHER 9.2 Free microvascular compound flaps 9.2.1 Free great toe transfer according to CORBETT/BUNCKE 9.2.2 Modified Wrap-around flap according to MORRISON/STEICHEN 9.2.3 Free second toe transfer according to YANG 9.2.4 Free MTP joint transfer according to MATHES 9.2.5 Free PIP joint transfer according to FOUCHER 10 Further treatment options for coverage of soft tissue and bone defects at the upper limb 10.1 Skin and soft tissue defects 10.1.1 Primary wound closure 10.1.2 Controlled secondary wound healing of acute wounds ("cicatrisation dirigee") 10.1.3 Split-thickness skin grafting according to OLLIER/THIERSCH 10.1.4 Full-thickness skin grafting according to WOLFE/KRAUSE 10.1.5 Split Nailbed-Transplantation according to SHEPARD 10.1.6 Skin Expansion according to NEUMANN resp. RADOVAN 10.1.7 Continous soft tissue distraction according to MESSINA 10.1.8 Synovial Flap according to WULLE 10.2 Bone and compound defects 10.2.1 Non-vascularized cancellous bone grafting according to MATTI 10.2.2. "Tissue-bank Concept" according to CHASE 10.2.3 Amputation distal to the radio-carpal joint (Microamputation) 10.2.4 Amputation proximal to the radio-carpal joint (Macroamputation) 10.2.5 Replantation distal to the radio-carpal joint (Microreplantation) according to KOMATSU and TAMAI 10.2.6 Replantation proximal to the radio-carpal joint (Macroreplantation) according to MALT and McKAHN C PRE-AND POSTOPERATIVE ADDITIONAL THERAPY 11 Basic principles and goals of physiotherapy at the upper limb region 12 Basic principles of scar treatment 13 Basic principles of prosthetics4 D DIFFERENTIAL THERAPY 14 Basic principles of defect management at the upper limb and hand global defect management at the combined hand and upper limb clinic 15 Skin and soft tissue defect at the upper limb 16 Nail and nailbed defects 17 Fractures, bone defects and joint defects 18 Amputation-like and amputation injuries at the upper limb 19 Reconstruction of grip function

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