手指解剖与检查.ppt

Hand anatomy and examination Dr. Mihaela Hriscu plastic surgeon Hand examination Look before you leap General observations: ° social/cultural background ° social/work requirements Hand examination - inspection Forearm Scars Hand posture Muscle wasting Deformities Shape of fingers Nails Colour, temperature, skin texture Sweating patterns Hand examination Screening examination only now you can touch Hand examination- sensation Compare light touch bilaterally Get the patient to pick up small objects Sensory mapping Hand examination Taylor your examination according to the history and screening examination Hand examination LOOK MOVE FEEL PROVOKE Hand examination Finger chain Metacarpals Carpal chain Wrist Forearm Hand examination Imagine the layers: *bone and joints *ligaments *tendons *neurovascular bundles *integument Functional units of the pulp A) distal pulp B) proximal pulp Distal pulp ( transversal cut) 1. Nail plate 2. Nail bed 3. Fat tissue 4. Fibrous septa 5. Skin Arrangement of dermatoglyphs A) distal pulp B) proximal pulp Tip pinch Proximal pulp ( transversal section) Fibrous septa Fat tissue Vascularisation of the pulp 1. Pulp arcade 2. Palmar collateral artery 3. Flexor tendon 4. Terminal branch of the pulp 5. Central artery of the pulp 6. Collateral branch of the pulp arch Functional anatomy af the mid-palmar digital area A) Topographical limits of the palmar digital surface B) Transversal section through the middle phalanx 1. Cleland’s ligament C) Cutaneous functional units, volar aspect of the digit 1. Pulp 2. and 3. Mid-palmar digital area Vascular anatomy, palmar aspect of the digit Deep venous network, venae comitantes A) Type 1: complete deep venous network 1. Distal anastomotic venous arch 2. Proximal anastomotic venous arch B) Type 2 : proximal deep venous network - draind directly into the dorsal network(4) through the intermediary communicating oblique b