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A 45-year-old carpenter sustained a table saw injury to his right hand while at work earlier today. Evaluation in the Emergency Department reveals the defect depicted in Figure A. An island volar advancement flap was selected for wound closure. What is the largest defect that could be covered with this technique?
less than 1 cm
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A 6-year-old girl sustains transverse amputations through her long and ring fingertips after getting her hand caught in a lawn mower. She presents to the emergency room 30 minutes after the injury with the amputated tissue which was placed on ice in a waterproof bag. On physical exam the amputation levels are found to be 6 millimeters distal to the lunula. The wounds are noted to be fairly contaminated with no evidence of exposed bone. Skin defects are less than 1 centimeter. Which of the following is the most appropriate management at this time?
Emergent replantation of the amputated parts
Revision amputation through the distal interphalangeal joint
Thorough irrigation and debridement followed by elective Moberg advancement flaps
Thorough irrigation and debridement followed by elective Z-plasty reconstruction
Thorough irrigation and debridement, soft dressing application, and follow-up within 1 week
Which of the following hand injuries seen in Figures A-E is most appropriately treated with a first dorsal metacarpal artery flap?
Which of the following hand injuries is most appropriately treated with a volar advancement (Moberg) flap closure?
A 6-year-old boy sustained a finger tip amputation shown in Figure A after grabbing a broken glass out of the dishwasher. Your plan was to perform a bedside irrigation and debridement of the finger after digital anesthetic block and apply antibiotic ointment with a sterile dressing. Upon exploration of the wound you notice that distal phalanx is exposed. Your plan should change to include which of the following treatments?
Homodigital island flap
Volar flap advancement
V-Y advancement flap
No change from your initial plan of ointment and dressing
You are taking care of an adult patient with significant scar contracture in her first web space after a thermal burn. Which of the following techniques will allow you to lengthen her scar approximately 75%?
Two-flap Z-plasty with 60 degree limbs
Two flap Z-plasty with 25 degree limbs
Island pedical flap
Split-thickness skin graft
A 28-year-old factory worker has his ring finger caught in the machinery at work. A photograph of the injury is shown in Figure A. Which of the following procedures will best supply coverage of the wound?
Amputation through the proximal interphalangeal joint
Shortening of the distal phalanx, nail bed removal, and V-Y flap
Which of the following complications is most likely to occur following the procedure on the middle finger of a right hand shown in Figure A?
Cosmetic mismatch of the skin
Median nerve motor branch injury
Recipient site sensitivity
Flexion contracture at the recipient proximal interphalangeal joint
A 29-year-old intravenous drug user undergoes irrigation and debridement of a ring finger abscess. After adequate eradication of the infection, he is left with the skin defect shown in Figure A. What is the most appropriate treatment at this time?
Local woundcare and healing by secondary intention
A 25-year-old left hand dominant musician sustains an injury to the left thumb shown in Figure A. He is unable to extend the interphalangeal joint and has less than 2 second capillary refill at the thumb. What is the most appropriate method to achieve soft tissue coverage after extensor tendon repair or transfer?
Moberg advancement flap
Vacuum-assisted wound closure
First dorsal metacarpal artery (Kite) flap