Evaluation of the COVID-19 Infection Rate in the Perioperative Period of Elective Surgeries of the Hand and Microsurgery.

BACKGROUND: After the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease 2019 [COVID-19]), the world started reducing the number of elective surgeries to reduce the transmission of the coronavirus. Some priority elective surgeries were performed, and there was no increase in contagion rates due to safety protocols and protection measures. The study aims to present the coronavirus infection rate of elective hand surgeries and microsurgery performed during pandemics. METHODS: A retrospective study evaluating 188 patients submitted to elective surgical procedures. The exclusion criteria were patients infected by COVID-19 before the surgery and patients who submitted to trauma surgery. Only 108 patients were eligible for this study. The mean age was 47.8 years (range: 15 days-81 years). There were 63 females and 45 males. They were divided into 2 groups: outpatient (n = 49) and inpatient (n = 59) procedures. RESULTS: The overall COVID infection rate was 6.48%. The outpatient infection rate was 2.08%, whereas the inpatient infection rate was 10.17% (Student t test: P = .089). The main factor correlated with infection in the postoperative period was the number of postoperative outpatient visits (Student t test: P = .089). No statistical differences were observed between the variables studied, but there was a tendency for patients who submitted to inpatient surgery to get infected by COVID-19 (P = .089). The statistical power was 0.8 (Cohen's d test), showing that large samples are needed to analyze the correlation better. CONCLUSION: We concluded that the safety of performing elective hand surgery during the pandemic remains unclear, and more studies with larger samples are needed.

Isolated Compression of the Recurrent Motor Branch of the Median Nerve: A Case Report.

Isolated compression of the recurrent motor branch of the median nerve is an uncommon condition encontered in the daily life of the hand surgeon. Its early identification and correction can optimize functional outcomes. Among the few causes described, there are only 2 case reports of compression by fascial bands. We present a case of isolated compression of the recurrent motor branch of the median nerve secondary to anomalous fascial bands in a 34-year-old male patient, with significant atrophy of the thenar musculature of the right hand. Electroneuromyography showed isolated involvement of abductor pollicis brevis, with no sensory changes. The patient underwent exploration and decompression, recovering opposition and thumb function in 6 months.

Supercharged End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer for Hirayama Disease: A Case Report.

Hirayama disease is a rare condition of cervical myelopathy. Its early identification and correction can optimize functional outcomes. However, late presentation and some more severe cases may be associated with loss of hand function. Among the cases described, there are no reports of nerve transfers for this condition. We presented the first case report of a Hirayama disease of isolated ulnar nerve impairment managed with nerve transfer. Electroneuromyography showed isolated preganglionic involvement of C7, C8, and T1, with no sensory changes. The patient underwent nerve transfer with anterior interosseous nerve to ulnar nerve supercharge end-to-side, recovering hand function in 7 months.