The role of microsurgery in the management of hand injuries - abstract

The operating microscope was first used in clinical surgery in 1922 and, since then, major advances have been made in the field of microsurgery worldwide. The use of magnification has had a major impact on the development of hand surgery as a subspecialty. With the advent of modern microsurgery, many devastating hand injuries can now be successfully treated and, in many instances, satisfactory hand function restored. For example: (1) amputated digits and hands can be successfully replanted in some situations; and (2) post-traumatic reconstructive surgery of the hand can be performed, using microvascular techniques (e.g., toe-to-hand transfer for thumb reconstruction). It is feasible to develop microsurgery in the Caribbean. The basic method involved in training is quite simple. A microsurgical laboratory could be established at the Mona Campus of the University of the West Indies. Former medical students of the UWI would assist with the development and cost of maintenance of the technology. A successful microsurgery programme would be feasible (AU)

Industrial accidents at a bauxite mining community Linden, Guyana - abstract

The objectives of this prospective, 4-month study were to determine the incidence and types of injuries at Guymine (a bauxite mining company) and evaluate the factors which predispose to injuries at the work site. From June 1 to September 30, 1991, 86.5 percent (77) of all full-time employees referred for involvement in an industrial accident were seen by one of the investigators and information on the injury was collected, using a designed questionaire. There were 69 males and 8 females and most of the injured were in the age ranges 20-24 and 35-44 years. The incidence rate (IR) in males was 29.5/1,000 and 8/1,000 in females. The IR was highest in labourers (220/1,000), increased with increasing work experience and was highest in the mines (58.4/1,000). Most accidents occurred during the day-light hours and injuries most frequently involved the hands and fingers. Hazardous practices by workers and defective agencies were the main predisposing factors. Forty-four point four per cent of work sites were in a poor condition. About one year of work time was lost due to injuries during the study (AU)

Successful replantation of severed limbs

Two cases of successful limb replantation are reported. The advantages of a team approach and the basic requirements for beginning a replant programme are outlined (AU)

Hands

One hundred and sixty cases of sepsis and trauma seen in the first six months of the Hand Clinic of the University College Hospital of the West Indies have been described. The details of techniques which have been found to contribute to success include the use of a tournique on the arm and regional local anaesthesia. Methods of skin cover for finger-tip injuries are discussed. Reasons are given for performing primary tendon suture on all cut flexor tendons. An incision turning down the pulp as a flap has been used for those severe terminal pulp infestions complicated by osteomyelitis of the phalanx. Finally, some good results from early penicillin irrigation of tendon sheath infections are recorded. (AU)

Hand infections in Jamaica

Empirical antibiotic treatment for hand infections is changing to single antibiotic therapy against Staphylococcus aureus in immunocompetent patients. Fifty-one patients treated surgically for hand infections were reviewed to assess the nature of infection in terms of site, organism, mechanism of injury, and antibiotic sensitivity of organisms. Twenty-three percent of patients had diabetes mellitus and were noted to be older than non-diabetics. Eighty-four percent of non-diabetic patients had single organism infections, 59 percent involving S aureus. Fifty percent of diabetic patients had multi-organism infection caused by gram positive and gram negative organisms. Patients stuck with a piece of wood also had multi-organism infections. Double antiobiotic therapy is therefore advocated for patients with diabetes mellitus and all patients who had hand infections as a result of being stuck with a piece of wood. All others should have single antibiotic therapy with amoxycillin and clavulanic acid. (AU)