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Upper Limb And Microsurgery Units Units

HAND & MICROSURGERY UNIT

 
Introduction
 
Hand and Microsurgery Unit at Hospital Universiti Sains Malaysia is one of the major tertiary level centre for hand referrals from across East region of Malaysia. Our hand and microsurgery unit is designed to train future orthopaedic surgeon dedicated to the study of the upper limb and to expose the residents to a variety of problems affecting the hand, shoulder and elbow.The hand residents play an integral role in education by contributing and organizing weekly conferences, anatomy labs, and informal resident teaching sessions. Apart from that, to provide optimal patient care, we work closely with many other health specialists, including anaesthetists and anaesthetic physicians' assistants, hand therapists, theatre staff, nursing staff, radiologists and neurophysiologists.
 
Objectives
 
  • To develop interest in solving clinical and basic science problems in the field of hand surgery.
  • To develop patterns of lifelong learning about the field of hand surgery as well as an interest in making contributions to this field of knowledge.
  • To spread information and updates to undergraduates, postgraduate students, USM staff, other medical practitioners and the public by organizing and carrying out activities in the field, which consists of seminar, discussions, forums, courses and workshops.
  • To produce orthopaedic surgeons who are technically competent in managing hand cases as well as the overall well-being of their patients.
  • To have our residents become leaders in the hand surgery field in the future.
 
Vision and Mission
 
  • To provide high quality training in the field of hand surgery with an internationally recognised high standard of competence and knowledge.
  • To perform useful and high quality research, related to the field of hand surgery, which may aid in advancing knowledge and outcomes in the field, both locally and internationally.
  • To provide expertise and high quality care for all patients, with conditions affecting the upper limb that can benefit from hand therapy or hand surgery with a comprehensive approach.
 
Activities
 
 
Yearly Meetings and Workshops·       
  • Focus on Anatomyis an in-depth review of one aspect of upper-extremity anatomy.       
  • A Flap Courseis offered yearly unless Focus on Anatomy is on flap.
  • EMG/NCS
 
 
Cylic Lectures
 
Weekly:
  • Case presentations
  • Journal Club
 
Montly:
  • Biomechanics
  • Anotomy lab dissection
 
Quarterly:
  • Morbidity & Mortality
 
Periodic:
  • Question review
 
Specific Core Lectures
 
Examination:
 
  • Hand
  • Wrist
  • Elbow
  • Shoulder
  • Brachial plexus
  • Cervical spine
  • Nerve compression
 
Nerve
  • Nonsurgical neuropathies
  • Dystrophy/chronic regional pain
  • Painful neuromas/neurolysis
  • Pain management
  • Nerve compression
  • Examination: Compressive neuropathies
  • Neuromicroanatomy, physiology
  •  Nerve blood flow
  • Sense and sensibility
  • Compression controversy
  • Primary neurorrhaphy
  • Nerve grafting in acute/chronic injury
  • Vascularized nerve graft
  • Carpal tunnel syndrome
  • Carpal tunnel: open vs closed
  • Median nerve compression outside the carpal tunnel
  • Radial compressive neuropathy
  • Ulnar compressive neuropathy
  • Thoracic outlet compression
  • Decision making in nerve compression
  • History of nerve compression
  • Ulnar nerve palsy
  • Radial nerve palsy
  • Median nerve palsy
  • Brachial plexus
  • Obstetrical palsy
  • Tendon transfers in tetraplegia
  • Tendon transfers in plexus
  • Combined nerve palsy
  • Cerebral palsy/stroke
 
Trauma:
  • Debridement
  • Contaminated wound I
  • Contaminated wound II
  • Amputation
  • Arthrodesis in trauma, joint transfer
  • Mutilated hand
  • Paeditric mutilated hand
  • Nail bed injury
  • Fingertip injury
  • Skin grafts
  • Chemical, radiation, frostbite injuries
  • Electrical burns
  • Injection injuries
  • Farm injuries
 
 
Microsurgery:
  • Microvascular techniques
  • Cross and reverse cross finger flaps
  • Local regional flaps of the hand
  • Emergency free flaps
  • Dorsal hand reconstruction
  • Soft tissue coverage-traumatized limb
  • Thumb replantation/immediate pollicisation/immediate transfer
  • Replantation part preservation
  • Paediatric replantation
 
Tendons:
  • Scientific basis flexor tendon rehabilitation
  • Technical aspects of flexor repair
  • Postoperative management flexor injuries
  • Extensor repair I
  • Extensor repair II
  • Extensor injuries: bracing/splinting/therapy
  • Extrinsic, intrinsic tightness, quadregia, and lumbrical plus
  • History of flexor tendon repair
 
Bone:
  • Anatomy,/physiology of bone healing
  • Anatomy/physiology of cartilage
  • Kienbock/Preisers
  • Scapular and clavicular fractures
  • Shoulder fractures
  • Humerus (extraarticular) fractures
  • Elbow fractures
  • Forearm (extraarticular) fractures
  • Distal radius fractures
  • Distal radius malunion
  • Distal ulna fractures/dislocations DRUJ
  • Scaphoid fratures
  • Scaphoid nonunions/malunions
  • Carpal dislocation/fractures (not scaphoid)
  • Carpometacarpal, metacarpophalangeal joint dislocation without fractures
  • Metacarpal and proximal phalanx fractures
  • Middle phalanx fractures/proximal interphalangeal joint fracture dislocation
  • Distal phalanx fractures, fracture dislocation and bony mallet
  • Phalangeal/metacarpal malunions
  • External fixation
 
Arthroplasty:
  • Principles
  • Shoulder
  • Elbow
  • Wrist
 
Arthroscopy:
  • Shoulder
  • Elbow
  • Wrist
 
Therapy:
  • Hand therapy
  • Therapy open house
  • Orthotics
  • Tendon splinting and therapy
  • Prosthetics
 
Congenital:
  • Overview I
  • Overview II
  • Genesis
  • Examination of the congenital hand
  • Congenital radiology
  • Transverse absence/symbrachydactyly/phocomelia
  • Radial club hand
  • Radial deficiencies
  • Camptodactyly, clinodactyly, Kirner’s, delta phalanx
  • Syndactyly and thumb clasped and windblown hand
  • Polydactyly
  • Genetics counselling
  • Macrodactyl, constriction band syndrome, synostosis and brachydactyly
 
Infections:
  • Common infections (excluding tenosynovitis)
  • Atypical hand infections
  • Tenosynovitis
 
Dupuytren’s:
  • Anatomy and pathophysiology
  • Treatment
 
Arthritis:
  • Medical treatment
  • Non rheumatoid arthritis
  • Osteoarthritis wrist, including arthrodesis and arthroplasties
  • Osteoarthritis digits (not CMC)
  • Rheumatoid arthritis general principles
  • Swan neck/boutonierre
  • CMC except arthroplasty
  • CMC joint arthroplasty
 
Miscellaneous:
  • Tourniquet
  • Transplantion of the hand
  • Ulnar sided wrist pain
  • Elbow pathology (not neuropathy)
  • Shoulder pathology/treatment
  • Trigger digits
  • Compartment syndromes
  • Vascular disorders
  • Sport injuries
  • Hand problems in performing arts
  • Hand as a mirror of systemic disease
  • Getting the most from lab dissection
  • Workman’s complication
  • Photography: how to take OR hand pictures
 
 
 
Clinical Services
 
  • Elective and emergency service for all hand, wrist and forearm disorders/injuries
  • Hand Outpatient Clinic
  • A wide range of outpatient procedures
  • Hand Therapy Unit.
 
 
Some of hand operation performed in our centre
 
  • Neurotization for brachial plexus injury
  • Carpal Tunnel Release​
  • Exploration and release of neuroma​
  • Contracture release​
  • Tendon Transfer for BPI​
  • Exploration and Nerve Grafting​
  • Tendon adhesiolysis
  • Tendon Reconstruction​
  • Wound debridement and Island Pedicle flap finger​
  • Excision Biopsy​ tumour hand
  • Fixation hand fracture​
  • Nail bed Injury repair​
  • Fingertip injury repair​
  • Tendon injury repair​
  • Wound debridement hand infection​
  • Flap coverage soft tissue defect hand
  • Hand replantation
  • Forearm replantation
  • Arm replantation
  • Fixation scaphoid fracture