cực điều trị phẫu thuật của các vấn đề tay là một khu vực đặc biệt quan tâm đến phẫu thuật thẩm mỹ. Tay là một cơ quan duy nhất mà truyền cảm giác từ môi trường bên ngoài để chúng tôi cũng như cho phép chúng tôi sửa đổi và tương tác với môi trường bên ngoài. | CHAPTER 6 UPPER EXTREMITY The surgical treatment of hand problems is a specialized area of interest in plastic surgery. The hand is a unique organ which transmits sensations from the external environment to US as well as allowing us to modify and interact with the external environment. The hand is made up of many finely balanced structures. It must function with precision as in writing as well as with strength as in hammering. Since the hand is a major tool of interaction with others it is essential that it look as normal as possible as well as function well. I. HAND ANATOMY A. Surface Anatomy Knowledge of proper terminology is essential to communicate the location of injuries to others B. Nerves 1. Sensory median ulnar radial Fig. 6-1 2. Motor intrinsic muscles of hand a. Median nerve thenar muscles radial lumbricals b. Ulnar nerve interossei ulnar lumbricals hypothenar muscles Fig. 6-1 68 c. Muscles and tendons 1. Flexor system Fig. 6-2 a. Long flexors Flexor digitorum profundus attaches to distal phalanx and bends the DIP distal interphalangeal joint. Flexor digitorum superficialis attaches to middle phalanx and bends PIP proximal interphalangeal joint. b. Intrinsic flexors Lumbricals bend the MCP metacarpal-phalangeal joints EXT. DIGIT. COM. LUMBR F PROF SUPERF INTEROS TRIANG. UG LATER. BAND CLELLAND S UG. GRAYSON S UG. Fig. 6-2 2. Extensor system Fig. 6-3 a. Long extensors insert on base of middle phalanx b. Intrinsics interossei and lumbricals pass volar to the axis of the MCP joint where they act as flexors and move dorsal to the axis of the PIP joint to insert on the dorsal distal phalanx. They act as extensors to the PIP and DIP joints Fig. 6-3 69 D. Skeleton Fig. 6-4 see bibliography page 80 E. Wrist a large number of tendons nerves and vessels pass through a very small space and are vulnerable to injury Fig. 6-5 Anatomy ot the Wrist Extensor digitorum communis T. Extensor digitorum quinti t. Extensor carpi ulnaris t. Ulna Flexor carpi ulnaris t. Extensor
