this is Aaron frelich and the following
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video shows the technique for a rate
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reception of the index finger we begin
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by marking out our flaps full fully
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endorsed Lee and planning our incision
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to ensure that once the Ray has been
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deleted that we have adequate as well as
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cosmetic closure and a good contour to
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the hand the rate can be palpated and
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the incision extended dorsally directly
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over that ray to allow good exposure and
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visualization
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you begin by creating our flats with
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care being taken to ensure that these
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are full thickness so that we have good
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coverage once these are closed
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the dissection has continued dorsally
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along the extension mechanism and the
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Ray that is about to be deleted by port
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cautery can use for hemostasis and here
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you can see that the extension mechanism
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has identified and then incised full
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thickness flaps are created to allow
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good tissue for later closure once the
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entire metacarpal has been removed from
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the hand and this dissection is
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continued through the extensor mechanism
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and distally the mCP joint again full
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thickness when sizing through the
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collateral ligaments we then turned our
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attention to bull early and in this case
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the digital nerve active bundles need to
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be identified so that they can be cut
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and cauterized if the digital nerve is
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not cut and allowed to retract a neuroma
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can result in addition you need to
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ensure that the adjacent digital nerve
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is protected as not violated when doing
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this the same is done on the opposite
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side attention squad the nerve and then
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it's cut for a blue friend
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nice action fun continued electrons
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identified and cut and dissections
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continued circumferentially once again
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the elegant and full thickness flats or
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later closure this is the proximal
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extent and our bony resection here we've
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used a saw and the cut is beveled to
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provide appropriate contour to the hand
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and after removing the remaining soft
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tissue attachments the metacarpal and
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then subsequently the remainder of the
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Ray can be removed and its entirety here
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you can see the flexor tendon with a
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cutting light retract the final
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attachments through the collaterals are
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incised removing the finger the proximal
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stump should be contoured and any sharp
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edges removed with either saw or Lunger
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and then the deep tissues including the
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periosteum as well as any intrinsic or
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in American metacarpal ligaments can
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then be closed this is especially
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important with internal rays of the
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finger rather than the border rays the
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tourniquet was then deflated and
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hemostasis as well perfusion early date
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citation digit is ensured and then the
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skin is closed with interrupted
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non-absorbable suture we begin by in
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setting the flaps here and then the
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dorsal incision is completely closed
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and any remaining additional skin can be
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excised if necessary to give a good
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cosmetic closure
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here's the final result because your
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closure a very cosmetic result