Thumb Reconstruction

Chapter 9 of Volume 1, Hand & Upper Limb. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

23 viva questions in this chapter

1. Describe these photographs and tell me what you would do.
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2. What are your indications and contraindications?
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3. How is the part transported, and how do you organise the operation?
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4. How do you manage this patient post-operatively?
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5. At 6 hours the digit is blue, tense and bleeds briskly dark blood. What now?
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6. This hand has been degloved in a roller. How do you assess viability?
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7. And a closed degloving injury?
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8. Classify this ring avulsion injury.
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9. When does this wound need covering?
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10. The thumb replant has failed at day 4. What now?
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11. The thumb is now amputated at the IP joint and the head of the proximal phalanx is exposed. What do you do?
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12. What are you trying to achieve, and how do you decide?
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13. A 1.5 cm volar pulp defect of the thumb with exposed bone. What are your options?
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14. Why would you not use the kite flap for the pulp in this 25-year-old carpenter?
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15. Total loss of the distal thumb through the distal phalanx. What decides your reconstruction?
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16. What can you offer without microsurgery?
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17. Take me through a toe transfer.
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18. Which toe, and what will you tell the patient about the foot?
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19. Which toe for which level?
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20. When would you pollicise, and what would you tell the patient?
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21. Talk me through what becomes what.
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22. What would you counsel before you start?
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23. How is this service organised in the UK?
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