Use of Prophylactic Antibiotics in Hand Surgeries in Colombia.

PURPOSE: The aim of the investigation was to determine the rate of prophylactic antibiotic use in hand surgeries and the factors related to their use in a group of Colombian patients. METHODS: This was a descriptive study of patients undergoing hand surgery between January 2021 and December 2022. Sociodemographic, clinical, and pharmacological variables were analyzed. The use of prophylactic antibiotics in clean wounds was considered inappropriate except in those who needed placement of an internal fixation implant. Variables related to inappropriate use of prophylactic antibiotics were analyzed. RESULTS: A total of 523 patients were reviewed, with an average age of 44.3 years; 51.2% were men. Most of the patients had a diagnosis of hand fracture (28.7%), trigger finger (24.5%), or ganglion (18.5%). The surgical wound was considered clean in 79.0% of cases. A total of 91.0% received prophylactic antibiotics, mostly cefazolin (63.3%). Some 55.7% were considered inappropriate by our criteria. Women (odds ratio [OR], 3.19; 95% confidence interval [CI], 1.85-5.47), middle-low to high socioeconomic status (OR, 1.88; 95% CI, 1.05-3.38), treatment in clinic #1 (OR, 9.67; 95% CI, 4.81-19.43), history of diabetes mellitus (OR, 2.90; 95% CI, 1.07-7.86), and diagnosis of trigger finger (OR, 19.92; 95% CI, 9.95-39.88), ganglion (OR, 24.53; 95% CI, 11.72-51.34), or tenosynovitis (OR, 19.61; 95% CI, 6.78-56.73) were associated with receiving inappropriate prophylactic antibiotics. At hospital discharge, 60.6% received prophylactic antibiotics. CONCLUSIONS: In a low-middle income country, the use of inappropriate antibiotics in hand surgical procedures is as common as in higher-income countries. The causes appear multifactorial, including the characteristics of the health systems, doctors, and patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study.

BACKGROUND: Occupational hand and wrist injuries (OHWIs) account for 25% of work-related accidents in low- and middle-income countries. In Colombia, more than 500000 occupational accidents occurred in 2021, and although the rate declined to less than 5% in 2020 and 2021, at least one in four accidents involved a hand or wrist injury. AIM: To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia. METHODS: An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital, between June, 2020 and May, 2021. The overall frequency of OHWIs, as well as their distribution by sociodemographic, clinical, and occupational variables, are described. Furthermore, association patterns between sex, anatomical area (fingers, hand, wrist), and type of job were analyzed by correspondence analysis (CA). RESULTS: There were 2.101 workers treated for occupational accidents, 423 (20.3%) were cases of OHWIs, which mainly affected men (93.9%) with a median age of 31 years and who worked mainly in mining (75.9%). OHWIs were more common in the right upper extremity (55.3%) and comprised different types of injuries, such as contusion (42.1%), laceration (27.9%), fracture (18.7%), and crush injury (15.6%). They primarily affected the phalanges (95.2%), especially those of the first finger (25.7%). The CAs showed associations between the injured anatomical area and the worker's job that differed in men and women (explained variance > 90%). CONCLUSION: One out of five workers who suffered occupational accidents in Cundinamarca, Columbia had an OHWI, affecting mainly males employed in mining. This occupational profile is likely to lead to prolonged rehabilitation, and permanent functional limitations. Our results might be useful for adjusting preventive measures in cluster risk groups.

Analysis of Surgical Procedures on the Forearm and Hand and Their Relationship with Complex Regional Pain Syndrome: A Cross-sectional Study / Análise dos procedimentos cirúrgicos no antebraço e na mão e sua relação com a síndrome da dor regional complexa: Um estudo transversal

Abstract Objective Complex regional pain syndrome (CRPS) requires further understanding. Thus, the present study aimed to analyze if pre- and intraoperative factors may be related to the development of CRPS in the postoperative period. Methods We reviewed 1,183 medical records of patients undergoing forearm and hand surgeries from 2015 to 2021. The data of interest, that is, diagnosis, incisions, synthesis material, and anesthesia, were collected, tabulated, and statistically analyzed, with subsequent calculation of the odds ratios. Results Most patients were female, aged between 30 and 59 years, and sought the service electively (67% of the cases). The diagnoses included soft tissue trauma (43%), bone trauma (31.6%), and compressive syndromes (25.5%). During this period, 45 (3.8%) subjects developed CRPS. The statistical analysis showed that the chance of developing CRPS is twice as high in patients with compressive syndrome, especially carpal tunnel syndrome (CTS), which represented most surgeries performed in our service (24%). Two or more incisions occurred in 7.6% of the cases, which tripled the chance of developing postoperative CRPS. Gender, age, use pf synthetic material, type of anesthesia type did not statistically increase the risk of developing postoperative CRPS. Conclusion In short, the incidence of CRPS is low; however, it is critical to know and recognize the risk factors for prevention and active screening in the postoperative period.

Resumo Objetivo A síndrome da dor regional complexa (SDRC) precisa ser mais bem compreendida. Assim, este estudo objetiva analisar se fatores pré e intraoperatórios poderiam estar relacionados ao desenvolvimento de SDRC no pós-operatório. Métodos Foram revisados 1.183 prontuários de pacientes submetidos a cirurgias no antebraço e na mão entre 2015 e 2021. Os dados de interesse, como diagnóstico, incisões, material de síntese e anestesia realizada, foram coletados, tabulados e submetidos a testes estatísticos com posterior cálculo da razão de chances. Resultados A maioria dos pacientes era do gênero feminino, com idade entre 30 e 59 anos, que buscaram o serviço de forma eletiva (67% dos casos). Os diagnósticos agrupados de forma geral foram: traumas de partes moles (43%), traumas ósseos (31,6%) e síndromes compressivas (25,5%). Durante esse período, 45 pacientes (3,8%) evoluíram com SDRC. A análise estatística mostrou que a chance de desenvolver SDRC é duas vezes maior em pacientes com síndrome compressiva, especialmente a síndrome do túnel do carpo (STC), que representou a maioria dos cirurgias realizadas em nosso serviço (24%). Em 7,6% dos casos, foram realizadas duas ou mais incisões, o que triplicou a possibilidade de SDRC pósoperatória. Gênero, idade, uso de material de síntese, ou tipo de anestesia não aumentaram estatisticamente o risco de SDRC no pós-operatório. Conclusão Em suma, a incidência de SDRC é baixa, mas é importante conhecer e reconhecer os fatores de risco para a prevenção e a busca ativa no pós-operatório.

Analysis of Surgical Procedures on the Forearm and Hand and Their Relationship with Complex Regional Pain Syndrome: A Cross-sectional Study.

Objective Complex regional pain syndrome (CRPS) requires further understanding. Thus, the present study aimed to analyze if pre- and intraoperative factors may be related to the development of CRPS in the postoperative period. Methods We reviewed 1,183 medical records of patients undergoing forearm and hand surgeries from 2015 to 2021. The data of interest, that is, diagnosis, incisions, synthesis material, and anesthesia, were collected, tabulated, and statistically analyzed, with subsequent calculation of the odds ratios. Results Most patients were female, aged between 30 and 59 years, and sought the service electively (67% of the cases). The diagnoses included soft tissue trauma (43%), bone trauma (31.6%), and compressive syndromes (25.5%). During this period, 45 (3.8%) subjects developed CRPS. The statistical analysis showed that the chance of developing CRPS is twice as high in patients with compressive syndrome, especially carpal tunnel syndrome (CTS), which represented most surgeries performed in our service (24%). Two or more incisions occurred in 7.6% of the cases, which tripled the chance of developing postoperative CRPS. Gender, age, use pf synthetic material, type of anesthesia type did not statistically increase the risk of developing postoperative CRPS. Conclusion In short, the incidence of CRPS is low; however, it is critical to know and recognize the risk factors for prevention and active screening in the postoperative period.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

Burnt hand outcomes tool: Translation, adaptation and validation into Brazilian Portuguese.

INTRODUCTION: In burn trauma, hands are often injured due to defensive action or proximity to the causative agent, leading to significant morbidity during a patients work and social rehabilitation process. In this context, the use of patient-reported outcome measures is a first step in measuring and improving these outcomes. The Burned Hand Outcome Tool (BHOT) is a specific questionnaire for adults with burned hands aimed at quantifying outcomes related to this trauma. OBJECTIVE: To translate, culturally adapt, and validate the BHOT into Brazilian Portuguese. METHODS: Following established standards in the literature, the original English questionnaire was translated, back translated, and analyzed by a panel of experts in the field. Cultural adaptation of the translation was carried out with a sample of target patients. The questionnaire was validated concurrently with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire translated into Portuguese, at three time points (0 h, 2 h, 48 h), with two different evaluators. RESULTS: The cultural adaptation was conducted on a sample of 30 adult patients with hand burns without the need for reassessment of the translated items. The questionnaire validation was carried out on a sample of 100 adult patients with hand burns. The Cronbach's Alpha found at the first time point was 0.936. The correlations between the questionnaires varied from 0.656 to 0.915. CONCLUSION: The Burned Hand Outcome Tool has been translated, culturally adapted, and validated for a target population in Brazilian Portuguese.

Proprioceptive rehabilitation strategies in posttraumatic wrist injuries. Scoping review / Estrategias de rehabilitación propioceptiva en lesiones postraumáticas de muñeca. Revisión de alcance

Abstract Background: The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality. Objective: To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries. Methods: A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated. Results: After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates. Conclusion: Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.

Resumen Antecedentes: El enfoque propioceptivo puede mejorar de manera efectiva la fuerza, la movilidad, la reducción del edema y la disminución del dolor; lo que a su vez tiene un impacto positivo en la funcionalidad. Objetivo: Identificar las estrategias de rehabilitación propioceptiva reportadas en la literatura, en adultos con lesiones traumáticas de muñeca. Metódos: Se efectuó una revisión de alcance siguiendo los parámetros de la estrategia Prisma ScR. Se incluyeron investigaciones con pacientes adultos, diagnóstico de lesión postraumática de muñeca, que utilizaron rehabilitación propioceptiva. Se evaluó el dolor, la funcionalidad, la fuerza, los rangos de movilidad articular y el edema. Resultados: Se incluyeron seis artículos, que involucraron 125 pacientes al aplicar los criterios de exclusión. Se han generado protocolos de rehabilitación basados en facilitación neuromuscular propioceptiva y el uso de herramientas sensoriomotoras que promueven la recuperación de la muñeca. Además, se han establecido otros abordajes como la imaginería motora, que genera un trabajo de identificación y organización del movimiento, mejorando el dolor y la función manual. Faltan seguimientos de mayor tiempo, estandarización de los instrumentos utilizados durante la intervención propioceptiva y aumentar la población observada para generar una recomendación de intervención temprana y estimaciones entre el costo y el beneficio. Conclusión: La rehabilitación propioceptiva ha demostrado beneficios en la recuperación del miembro inferior y la cadera o espalda. Para la rehabilitación de las lesiones traumáticas de muñeca, es un pendiente de la investigación. La información bien descrita y los diseños de buena calidad son necesarios para proponer rutinariamente esta estrategia en la clínica.

The posterior interosseous nerve at the proximal forearm: anatomical study and clinical correlation / El nervio interóseo posterior en el antebrazo proximal: estudio anatómico y correlación clínica

SUMMARY: The deep branch of the radial nerve (DBRN) runs through the radial tunnel, which is a muscle-aponeurotic structure that extends from the humeral lateral epicondyle to the distal margin of the supinator muscle (SM). The Posterior Interosseous Nerve (PIN) originates as a direct continuation of the DBRN as it emerges from the SM and supplies most of the muscles of the posterior compartment of the forearm. The PIN can be affected by compressive neuropathies, especially at the "Arcade of Frohse". Its preservation is of special interest in surgical approaches to proximal radius fractures and in compressive syndromes release, for which surgeons must have an adequate anatomical knowledge of its course. This descriptive cross-sectional study evaluated 40 upper limbs of fresh cadavers. The diameters of the DBRN, the length of the radial tunnel, and the distances to the supinator arch, PIN emergence and PIN bifurcation were measured. The deep branch of the radial nerve (DBRN) has a course of 23.8 ± 3.7 mm from its origin to the supinator arch, presenting a diameter of 2.2 ± 0.3 mm at that level. The length of the radial tunnel was 42.2 ± 4 mm. The PIN originated 70.7 ± 3.5 mm distal to the lateral epicondyle. Type I corresponds to the division of the PIN during its journey through the radial tunnel, presenting in 35 % of cases, and Type II corresponds to the division of the PIN distal to its emergence from the radial tunnel presenting in the remaining 65 %. This study enriches the knowledge of the PIN and provides useful reference information on a Latin American mestizo sample. We propose the division pattern of the PIN into two types. Future studies may use this classification not only as a qualitative variable, but also include quantitative morphometric measurements.

El ramo profundo del nervio radial (RPNR) discurre por el túnel radial, que es una estructura músculo- aponeurótica que se extiende desde el epicóndilo lateral del húmero humeral hasta el margen distal del músculo supinador (MS). El nervio interóseo Posterior (NIP) se origina como una continuación directa del RPNR cuando emerge del MS e inerva la mayoría de los músculos del compartimiento posterior del antebrazo. El NIP puede verse afectado por neuropatías compresivas, especialmente en la "Arcada de Frohse". Su conservación es de especial interés en los abordajes quirúrgicos de las fracturas proximales de radio y en la liberación de síndromes compresivos, para lo cual los cirujanos deben tener un adecuado conocimiento anatómico de su curso. Este estudio descriptivo transversal evaluó 40 miembros superiores de cadáveres frescos. Se midieron los diámetros de la RPNR, la longitud del túnel radial y las distancias al arco supinador, la emergencia del NIP y la bifurcación del NIP. El RPNR tenía un recorrido de 23,8 ± 3,7 mm desde su origen hasta el arco supinador, presentando un diámetro de 2,2 ± 0,3 mm a ese nivel. La longitud del túnel radial fue de 42,2 ± 4 mm. El NIP se originó 70,7 ± 3,5 mm distal al epicóndilo lateral. El tipo I corresponde a la división del NIP durante su recorrido por el túnel radial presentándose en el 35 % de los casos, y el tipo II corresponde a la división del NIP distal a su salida del túnel radial presentándose en el 65 % restante. Este estudio enriquece el conocimiento del NIP y proporciona información de referencia útil sobre una muestra de mestizos latinoamericanos. Proponemos el patrón de división del NIP en dos tipos. Futuros estudios pueden utilizar esta clasificación no solo como una variable cualitativa, sino también incluir medidas morfométricas cuantitativas.

Proprioceptive rehabilitation strategies in posttraumatic wrist injuries. Scoping review.

Background: The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality. Objective: To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries. Methods: A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated. Results: After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates. Conclusion: Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.

Antecedentes: El enfoque propioceptivo puede mejorar de manera efectiva la fuerza, la movilidad, la reducción del edema y la disminución del dolor; lo que a su vez tiene un impacto positivo en la funcionalidad. Objetivo: Identificar las estrategias de rehabilitación propioceptiva reportadas en la literatura, en adultos con lesiones traumáticas de muñeca. Metódos: Se efectuó una revisión de alcance siguiendo los parámetros de la estrategia Prisma ScR. Se incluyeron investigaciones con pacientes adultos, diagnóstico de lesión postraumática de muñeca, que utilizaron rehabilitación propioceptiva. Se evaluó el dolor, la funcionalidad, la fuerza, los rangos de movilidad articular y el edema. Resultados: Se incluyeron seis artículos, que involucraron 125 pacientes al aplicar los criterios de exclusión. Se han generado protocolos de rehabilitación basados en facilitación neuromuscular propioceptiva y el uso de herramientas sensoriomotoras que promueven la recuperación de la muñeca. Además, se han establecido otros abordajes como la imaginería motora, que genera un trabajo de identificación y organización del movimiento, mejorando el dolor y la función manual. Faltan seguimientos de mayor tiempo, estandarización de los instrumentos utilizados durante la intervención propioceptiva y aumentar la población observada para generar una recomendación de intervención temprana y estimaciones entre el costo y el beneficio. Conclusión: La rehabilitación propioceptiva ha demostrado beneficios en la recuperación del miembro inferior y la cadera o espalda. Para la rehabilitación de las lesiones traumáticas de muñeca, es un pendiente de la investigación. La información bien descrita y los diseños de buena calidad son necesarios para proponer rutinariamente esta estrategia en la clínica.

AN ALTERNATIVE MODEL FOR TEACHING TENDON REPAIR AND SURGICAL TECHNIQUE IN HAND SURGERY.

Introduction: At the beginning of the medical career, the orthopedic surgeon in academic training needs valid methodologies for training complex surgeries in tissues that simulate real situations. With training in animal tissue, adapted to approach human tissue, it is possible to simulate procedures and decisions that will be necessary in real situations. Objective: This study consists in presenting a simple and reproducible simulation model for surgical repair of tendons by training on fresh tendons fixed on a wooden frame. Methodology: The model construction consists of a flat piece of Medium Density Fiberboard (MDF) and two threaded hooks were used on the board, to which Nylon threads are attached to tie the tendon, allowing a satisfactory simulation of a human tendon. Conclusion: This is a simple, inexpensive, and effective method for tendon suturing training, through which the trainee can develop repair techniques and basic surgical principles, such as instrument handling, safety, and sharps disposal. This approach aims to improve the trainee's skills and dexterity when placed in live surgery. The surgical techniques developed include the modified Kessler and Bunnel sutures. Level of Evidence IV, Descriptive Study .

Introdução: No início da carreira médica, o ortopedista em formação acadêmica necessita de metodologias válidas para o treinamento de cirurgias complexas em tecidos que simulem situações reais. Com o treinamento em tecido animal, adaptado para abordar o tecido humano, é possível simular procedimentos e decisões que serão necessários em situações reais. Objetivo: Este estudo consiste na apresentação de um modelo de simulação simples e reprodutível para reparo cirúrgico de tendões por meio do treinamento em tendões frescos fixados em estrutura de madeira. Metodologia: A construção do modelo consiste em uma peça plana de Fibra de Média Densidade (MDF) e foram utilizados dois ganchos roscados na prancha, aos quais são fixados fios de Nylon para amarrar o tendão, permitindo uma simulação satisfatória de um tendão humano. Conslusão: É um método simples, barato e eficaz para o treinamento de suturas tendíneas, por meio do qual o trainee poderá desenvolver técnicas de reparo e princípios cirúrgicos básicos, como manuseio de instrumentos, segurança e descarte de objetos cortantes. Este método visa melhorar as habilidades e destreza do trainee quando colocado em cirurgias ao vivo. As técnicas cirúrgicas desenvolvidas incluem as suturas Kessler e Bunnel modificadas. Nível de Evidência IV, Estudo Descritivo .

Colgajo adipofascial de flujo reverso del dorso del antebrazo para reconstrucción de la mano y muñeca: nuestra experiencia clínica / Back Forearm Reverse Flow Adipofascial Flap for hand and wrist reconstruction: our clinical experience

Los defectos cutáneos de la mano pueden ser difíciles de resolver. La cobertura cutánea es esencial para proveer una protección adecuada y permitir el funcionamiento correcto de las estructuras subyacentes. El objetivo de este estudio es reportar nuestra experiencia con el uso del colgajo adipofascial de flujo reverso del dorso del antebrazo para cobertura del dorso de la mano, dedos y muñeca en pacientes tratados en la ciudad de San Cristóbal, Estado Táchira, desde mayo de 2015 hasta enero de 2018. Se realizó un estudio longitudinal, descriptivo y prospectivo en pacientes con pérdidas cutáneas extensas de la mano, que fueron cubiertas con el colgajo adipofascial reverso del dorso del antebrazo. Se incluyeron 10 pacientes. 90% de sexo masculino. La edad promedio fue 41±12,32(13-69). La etiología de los defectos fue: 40% traumatismos de alta energía, 30% mano diabética tropical, 10% secuela de quemadura de segundo grado, 10% herida por arma de fuego artesanal, 10% carcinoma primario de piel. 100% de los colgajos sobrevivieron, logrando buena cobertura y cicatrización sin necesidad de otros procedimientos quirúrgicos y con mínimas complicaciones de la zona dadora. La función de la mano y muñeca se recuperó en todos los pacientes. En conclusión, el colgajo adipofascial de flujo reverso del antebrazo es un procedimiento útil, versátil y sencillo para la reconstrucción del dorso de la mano, dedos y cara volar de muñeca en pacientes de distintas edades(AU)

Hand skin defects can be difficult to resolve. Skin coverage is essential to provide adequate protection and allow proper function of the underlying structures. The objective of this study is to report our experience with the use of the Back Forearm Reverse Flow Adipofascial Flap to cover the back of the hand, fingers and wrist in patients treated in the city of San Cristóbal, Táchira State, since may 2015 to january 2018. A longitudinal, descriptive and prospective study was made in patients with extensive skin losses of the hand, which were covered with the Back Forearm Reverse Flow Adipofascial Flap. 10 patients were included. 90,0% male. Mean age 41±12.32(13-69) years. The etiology of the defects was: 40,0% high-energy trauma, 30,0% tropical diabetic hand, 10,0% second degree burn sequel, 10,0% handcrafted firearm wound, 10,0% primary skin carcinoma. 100,0% of the flaps survived, achieving good coverage and healing without the need for other surgical procedures and with minimal complications in the donor area. Hand and wrist function recovered in all patients. In conclusion, the reverse flow adipoascial flap of the forearm is a useful, versatile and simple procedure for the reconstruction of the back of the hand, fingers and volar face of the wrist in patients of different ages(AU)

Estudio de las heridas por amoladora tratadas en el Hospital de Clínicas y Hospital Pasteur, Montevideo, Uruguay / Grinder injuries treated at the Clínicas and Pasteur Hospital of Montevideo, Uruguay / Estudo das lesões por esmerilhadeira tratadas no Hospital de Clínicas e Hospital Pasteur, Montevidéu, Uruguai

Resumen: Introducción: las heridas causadas por amoladora representan una consulta frecuente al cirujano plástico en nuestro país. Los objetivos del presente trabajo fueron conocer la epidemiología de los pacientes que consultaban con estas lesiones, conocer las circunstancias del accidente y estudiar si existía relación entre las condiciones de uso de la herramienta y la gravedad de las lesiones. Material y método: se realizó un estudio descriptivo, transversal, donde se recabaron los datos de los pacientes que consultaban por heridas por amoladora en las puertas de emergencia de Hospital Pasteur y Hospital de Clínicas en un período de 6 meses. Resultados: un total de 76 pacientes fueron incluidos en el estudio, la mayoría de sexo masculino, en edad laboral activa (39 a 58 años) dedicados a la realización de trabajos temporales o tareas de construcción, con bajo nivel de instrucción. El 84% de las heridas fueron graves. El 61% de los pacientes no utilizó los elementos de seguridad de la herramienta al momento del accidente. La mayoría de las lesiones se produjeron fuera del ambiente laboral. Conclusiones: en base a nuestro trabajo pudimos establecer el perfil epidemiológico de la población más susceptible de sufrir estas lesiones. Comprobamos que las heridas producidas por amoladora son en su mayoría graves y requieren procedimientos complejos para su resolución.

Summary: Introduction: grinder injuries represent a large number of consultations for plastic surgeons in our country. This study aims to learn about the epidemiological characteristics of patients who consulted for these lesions and the circumstances of the accidents, and to analyze whether there is a relationship between the conditions for tool use and the severity of lesions. Methodology: we conducted a retrospective, descriptive, transversal study where we collected data from the patients who consulted for grinder injuries at the emergency departments of Pasteur and Clínicas Hospital during a 6-month period. Results: seventy-six patients were included in the study, most of which were male working adults (between 39 and 58 years-old) who had temporary jobs or were performing construction works and had low levels of education. 84% of lesions were severe. 61% of patients did not respect safety regulations at the time of the accident. Most lesions occurred out of working hours. Conclusions: based on our study, we could identify the epidemiological profile of the most vulnerable population for this kind of lesions. We proved that most grinder lesions are severe and their management requires complex procedures.

Resumo: Introdução: as lesões causadas por esmerilhadeira são causa frequente de consulta ao cirurgião plástico no Uruguai. Os objetivos do presente trabalho foram conhecer as características dos pacientes que consultaram com essas lesões, conhecer as circunstâncias do acidente e analisar a possível relação entre as condições de uso da ferramenta e a gravidade das lesões. Metodologia: foi realizado um estudo descritivo, transversal, onde foram coletados dados de pacientes que consultaram por lesões de esmerilhadeira no pronto-socorro do Hospital Pasteur e Hospital de Clínicas durante um período de 6 meses. Resultados: foram incluídos no estudo 76 pacientes, a maioria do sexo masculino, em idade ativa para trabalhar (39 a 58 anos) dedicados à realização de trabalhos temporários ou trabalhos na construção civil, com baixo nível de escolaridade. 84% dos ferimentos foram graves. 61% dos pacientes não utilizaram os elementos de segurança da ferramenta no momento do acidente. A maioria das lesões ocorreu fora do ambiente de trabalho. Conclusões: com base em nosso trabalho conseguimos estabelecer o perfil da população mais suscetível a esses agravos. Constatamos que a maioria das lesões causadas por esmerilhadeiras são graves, exigindo procedimentos complexos para sua resolução.

Evaluation of Circular Saw Injuries in a Reference Center in Microsurgery and Reimplantation.

Objective To evaluate the epidemiologic profile, the time until care, and the type of conduct taken regarding patients who are victims of accidents with circular saws and their resulting injuries, and to make a comparison with the literature. Methods A cross-sectional descriptive study reviewing the medical records of patients cared for from April to December 2018, analyzing age, gender, injured side, affected fingers, month and time of the accident, type of injuries, procedures performed in the emergency room, time elapsed between trauma and admission to the operating room, and reapproach during hospitalization. Results A total of 54 male patients aged between 15 and 72 years were care for. The left side was more affected, and the most frequent type of lesion involved the thumb, which had to be amputated in many cases. In total, 23 patients underwent reimplantation, 3 of which were macroreimplantations. Regarding the time of trauma, 26 cases occurred between noon and 4 p.m., and the time elapsed between the accident and the admission to the operating room was ≥ 6 hours in 84% of the patients. Conclusion Circular saw lesions are predominantly severe, with a potential for leaving permanent sequelae, and they affect mainly the thumb. The characterization of the type of injury and the initial care conditions obtained in the present study may contribute to the policy of prevention and care of patients who are victims of circular saw injuries. Level of Evidence IV; Case Series.

Evaluation of Circular Saw Injuries in a Reference Center in Microsurgery and Reimplantation / Avaliação de lesões por serra circular em um centro de referência em microcirurgia e reimplantes

Abstract Objective To evaluate the epidemiologic profile, the time until care, and the type of conduct taken regarding patients who are victims of accidents with circular saws and their resulting injuries, and to make a comparison with the literature. Methods A cross-sectional descriptive study reviewing the medical records of patients cared for from April to December 2018, analyzing age, gender, injured side, affected fingers, month and time of the accident, type of injuries, procedures performed in the emergency room, time elapsed between trauma and admission to the operating room, and reapproach during hospitalization. Results A total of 54 male patients aged between 15 and 72 years were care for. The left side was more affected, and the most frequent type of lesion involved the thumb, which had to be amputated in many cases. In total, 23 patients underwent reimplantation, 3 of which were macroreimplantations. Regarding the time of trauma, 26 cases occurred between noon and 4 p.m., and the time elapsed between the accident and the admission to the operating room was ≥ 6 hours in 84% of the patients. Conclusion Circular saw lesions are predominantly severe, with a potential for leaving permanent sequelae, and they affect mainly the thumb. The characterization of the type of injury and the initial care conditions obtained in the present study may contribute to the policy of prevention and care of patients who are victims of circular saw injuries. Level of Evidence IV; Case Series.

Resumo Objetivo Avaliar o perfil epidemiológico, o tempo até o atendimento, e o tipo de conduta tomada em pacientes vítimas de acidentes com serra circular e lesões decorrentes, e fazer uma comparação com a literatura. Métodos Estudo descritivo transversal, com revisão do prontuário de pacientes atendidos de abril a dezembro de 2018, analisando idade, sexo, lado lesado, dedos acometidos, mês e horário do acidente, tipo de lesões, procedimentos realizados na urgência, tempo decorrido entre o trauma e entrada em sala cirúrgica, e reabordagem durante a internação. Resultados Foram atendidos 54 pacientes do sexo masculino com idade entre 15 e 72 anos. O lado esquerdo foi o mais acometido, e o tipo de lesão mais frequente, a amputação, envolvendo principalmente o polegar. No total, 23 pacientes foram submetidos a reimplante, e, entre eles, 3 macrorreimplantes. Quanto ao horário do trauma, 26 ocorreram entre 12h e 16h, e o tempo decorrido entre o acidente e a entrada em sala cirúrgica foi ≥ 6 horas em 84% dos pacientes. Conclusão As lesões por serra circular são predominantemente graves, com potencial de deixar sequelas permanentes, e acometem principalmente o polegar. A caracterização do tipo de lesão e as condições de atendimento inicial obtidas neste trabalho poderão ajudar na política de prevenção e atendimento a pacientes vítimas de ferimentos por serra circular. Nível de Evidência IV; Série de Casos.

SERRATUS ANTERIOR MUSCLE FLAP FOR RECONSTRUCTION OF EXTREMITY INJURIES.

Objective: To report the use of the serratus anterior free tissue transfer in the treatment of traumatic injuries. Methods: Twenty-six free flaps or serratus pedicled flaps were performed for reconstruction of traumatic extremity injuries. Results: Complete flap survival was recorded in 20 limbs and 3 patients had circulatory complications. Even with the review of vascular anastomoses, partial flap necrosis could not be prevented and required a skin graft after debridement in the necrotic area. Another flap also required reexploration as a result of heavy congestion due to impaired venous return. Superficial wound infection was found in three patients and treated with conservative measures. Regarding the donor area, seroma formation was found in 8 cases; drainage was necessary in 2, and the others were resolved spontaneously. In 2, bruises formed and were later drained. In 1 limb there was long thoracic nerve injury and scapular winging. Conclusion: According to this study, the serratus anterior muscle flap is an excellent tool for treating small complex lesions in the extremities. Level of Evidence IV; Case series .

Objetivo: Relatar o uso da transferência de retalho livre do serrátil anterior no tratamento de lesões traumáticas. Métodos: Vinte e seis retalhos livres ou pediculados do serrátil anterior foram realizados para reconstrução de lesões traumáticas de extremidades. Resultados: A sobrevida completa do retalho foi registrada em 20 membros e 3 pacientes tiveram complicações circulatórias. Mesmo com a revisão das anastomoses vasculares, a necrose parcial do retalho não pôde ser prevenida e exigiu enxerto de pele após desbridamento da área necrótica. Outro retalho também necessitou reexploração em decorrência de forte congestão por dificuldade de retorno venoso. Infecção de ferida superficial foi encontrada em três pacientes, tratados com medidas conservadoras. Em relação à área doadora, a formação de seroma foi encontrada em 8 casos; em 2 foi necessária drenagem e os demais foram resolvidos espontaneamente. Em 2 houve formação de hematomas, que foram drenados. Em um membro havia lesão longa do nervo torácico e deformidade do tipo escapula alada. Conclusão: De acordo com este estudo, o retalho do músculo serrátil anterior é uma excelente ferramenta para o tratamento de lesões complexas e pouco extensas nas extremidades. Nível de Evidência IV; Série de casos .

[Reinsertion to the work in workers with partially permanent disability for hand injury]. / Reinserción laboral en trabajadores con incapacidad permanente parcial por lesiones de mano.

Background: Hand injuries resulting from accidents at work are one of the main causes of disability in workers. Every worker ruled with Partial Permanent Disability must legally be reinstated to the same workplace. Objective: To know the prevalence of reintegration and causes of non-reintegration into workers with Partial Permanent Disability due to hand injuries. Material and methods: A descriptive, observational, and retrospective study, which included 100% of the opinions of Parcial Permanent Disability due to hand injuries, generated from 2012 to 2016 at UMF 61 of Veracruz. Results: 143 cases were analyzed, 127 (88.8%) were men and 16 (11.2%) women, with a mean age of 37.3 ± 11.6 years. Labor reintegration in the same company occurred in 60 (42%) of the cases, 50 (35%) were reinstated in another company and 33 (23.1%) were not reinstated to work. Regarding work termination: 51 (35.7%) workers were laid off after their ruling, 13 (9.1%) resigned, 12 (8.4%) terminated their contract, and 7 (4.9%) were retired. Currently 72 (50.3%) workers continue to perform physical work and 18 (12.6%) did not return to work. Conclusions: Labor reintegration occurred in less than half of the cases ruled. The main cause of the non-reintegration was the unjustified dismissal by the company where the accident occurred. Not reintegrating into the same workplace has: legal, economic, medical and social implications to the worker.

Introducción: las lesiones de mano derivadas de accidentes de trabajo constituyen una de las principales causas de discapacidad en los trabajadores. Todo trabajador dictaminado con Incapacidad Permanente Parcial (IPP), jurídicamente debe ser reinsertado a su mismo centro de trabajo. Objetivo: conocer la prevalencia de reinserción y causas de no reinserción laboral en trabajadores con IPP por lesiones de mano. Material y Métodos: estudio descriptivo, observacional y retrospectivo, que incluyó el 100% de los dictámenes de IPP por lesiones de mano, generados del 2012 al 2016 en la UMF 61 de Veracruz. Resultados: se analizaron 143 casos, 127 (88.8%) fueron hombres y 16 (11.2%) mujeres, con edad media 37.3 ± 11.6 años. La reinserción laboral en la misma empresa se presentó en 60 (42%) de los casos, 50 (35%) se reinsertaron en otra empresa y 33 (23.1%) no se reinsertaron al trabajo. Respecto de la terminación laboral: 51 (35.7%) trabajadores fueron despedidos posterior a su dictaminación, 13 (9.1%) renunciaron, 12 (8.4%) finalizaron su contrato, y 7 (4.9%) fueron jubilados. Actualmente 72 (50.3%) trabajadores continúa realizando un trabajo físico y 18 (12.6%) no volvió a trabajar. Conclusiones: la reinserción laboral se presentó en menos de la mitad de los casos. La principal causa de no reinserción fue el despido injustificado por la empresa donde ocurrió el accidente. No reintegrarse al mismo centro de trabajo conlleva implicaciones: legales, económicas, médicas y sociales al trabajador.

Descriptive Study of Patients With Upper Limb Amputation As Possible Candidates for a Hand Transplant in Medellín, Colombia.

Introduction The amputation of the upper limb, especially of the hand, is a serious trauma with significant functional and psychological impact. Treatment options include adaptation to the stump, use of prostheses, and composite tissue transplantation. Unfortunately, in Colombia, to date, there are no epidemiological data that characterize the sociodemographic and clinical variables of patients with upper limb amputation. Objective To describe the clinical and epidemiological characteristics of patients with upper limb amputation in two hospital institutions in the city of Medellín during the period 2018-2019 as a basis for developing a hand transplant program in Colombia. Methods A descriptive cross-sectional study was carried out where a total of 443 medical records were reviewed, of which eight records that met the inclusion criteria were identified. Variables such as age, etiology of amputation, level of amputation, comorbidities, complications, and rehabilitation process were analyzed. The information was collected in the REDCap program, and a descriptive analysis was carried out with the data obtained. Results From a sample of 443 amputee patients, eight were selected that met the inclusion criteria. There were 7/8 men (87%) aged 43 years. A total of 75% came from rural areas. In 3/8 patients, there was amputation of the dominant limb. The most common mechanisms were shear trauma and crushing in the context of an occupational accident. A total of 50% had a complete extra-hospital amputation, and reimplantation was not attempted in any of the cases. The most frequent levels of amputation were the proximal and distal third of the forearm. The longest follow-up time was 12 months. Only two patients mentioned the possibility of using a prosthesis during rehabilitation. Conclusions Three young patients were identified, without comorbidities, with amputation of the dominant limb in the context of an occupational accident and without the possibility of rehabilitation with prostheses who benefit from a possible future hand transplant. However, it is necessary to implement a composite tissue transplantation program and public health policies that allow this procedure to be performed in Colombia.

Comparative Analysis of a Modified Secondary Healing Protocol for Fingertip Amputations and Non-microsurgical Reconstruction Techniques / Análise comparativa de um protocolo de cicatrização secundária modificado para amputações das pontas dos dedos e técnicas de reconstrução não microcirúrgicas

Abstract Objective To describe and compare the results obtained with a secondary healing protocol for fingertip amputations and their relationship to injury severity according to the Allen classification. Methods Medical records of 127 fingertip injuries were revised, and a retrospective, comparative, analytical study the amputations treated conservatively was performed. Injury characteristics, healing time, and complications were described and analyzed. Results Between April 2017 and May 2019, 127 fingertip injuries were treated conservatively. The average age of the sample was of 28.33 years. The average healing time was of 4.31 weeks. The complications during the follow-up were observed in 18.9% (n= 24) of the cases, but none require revision treatment. A statistically significant relationship between the development of complications and treatment revision according to the Allen classification was not found (p ≥ 0.05). Conclusion The proposed secondary healing protocol has shown to be safe and effective in types 1 to 3 fingertip amputations in the Allen classification, and it should be included as a therapeutic option even in injuries of greater extension than those that have traditionally been limited to.

Resumo Objetivo Descrever e comparar os resultados obtidos com um protocolo de cicatrização secundária para amputações das pontas dos dedos e sua relação com a gravidade da lesão de acordo com a classificação de Allen. Métodos Foram revisados os prontuários clínicos de 127 lesões nas pontas dos dedos, e realizou-se um estudo retrospectivo, comparativo e analítico das amputações tratadas de forma conservadora. Foram descritas e analisadas as características da lesão, o tempo de cicatrização, e as complicações. Resultados Entre abril de 2017 e maio de 2019, foram tratadas de forma conservadora 127 lesões nas pontas dos dedos. A idade média da amostra era de 28,33 anos. O tempo médio de cicatrização foi de 4,31 semanas. As complicações apresentadas durante o acompanhamento afetaram 18,9% (n = 24) dos casos, porém nenhum exigiu tratamento de revisão. Não foi encontrada relação estatisticamente significativa entre o desenvolvimento das complicações e a revisão do tratamento de acordo com a classificação de Allen (p ≥ 0,05). Conclusão O protocolo de cicatrização secundária proposto mostrou-se seguro e eficaz nas amputações das pontas dos dedos conforme os tipos de 1 a 3 da classificação de Allen, e deve ser incluída como opção terapêutica mesmo em lesões de maior extensão do que aquelas tradicionalmente limitadas.

Serratus anterior muscle flap for reconstruction of extremity injuries / Retalho do músculo serrátil anterior para reconstrução de lesões em extremidades

ABSTRACT Objective: To report the use of the serratus anterior free tissue transfer in the treatment of traumatic injuries. Methods: Twenty-six free flaps or serratus pedicled flaps were performed for reconstruction of traumatic extremity injuries. Results: Complete flap survival was recorded in 20 limbs and 3 patients had circulatory complications. Even with the review of vascular anastomoses, partial flap necrosis could not be prevented and required a skin graft after debridement in the necrotic area. Another flap also required reexploration as a result of heavy congestion due to impaired venous return. Superficial wound infection was found in three patients and treated with conservative measures. Regarding the donor area, seroma formation was found in 8 cases; drainage was necessary in 2, and the others were resolved spontaneously. In 2, bruises formed and were later drained. In 1 limb there was long thoracic nerve injury and scapular winging. Conclusion: According to this study, the serratus anterior muscle flap is an excellent tool for treating small complex lesions in the extremities. Level of Evidence IV; Case series .

RESUMO Objetivo: Relatar o uso da transferência de retalho livre do serrátil anterior no tratamento de lesões traumáticas. Métodos: Vinte e seis retalhos livres ou pediculados do serrátil anterior foram realizados para reconstrução de lesões traumáticas de extremidades. Resultados: A sobrevida completa do retalho foi registrada em 20 membros e 3 pacientes tiveram complicações circulatórias. Mesmo com a revisão das anastomoses vasculares, a necrose parcial do retalho não pôde ser prevenida e exigiu enxerto de pele após desbridamento da área necrótica. Outro retalho também necessitou reexploração em decorrência de forte congestão por dificuldade de retorno venoso. Infecção de ferida superficial foi encontrada em três pacientes, tratados com medidas conservadoras. Em relação à área doadora, a formação de seroma foi encontrada em 8 casos; em 2 foi necessária drenagem e os demais foram resolvidos espontaneamente. Em 2 houve formação de hematomas, que foram drenados. Em um membro havia lesão longa do nervo torácico e deformidade do tipo escapula alada. Conclusão: De acordo com este estudo, o retalho do músculo serrátil anterior é uma excelente ferramenta para o tratamento de lesões complexas e pouco extensas nas extremidades. Nível de Evidência IV; Série de casos .

An alternative model for teaching tendon repair and surgical technique in hand surgery / Um modelo alternativo para o ensino de reparo tendíneo e a técnica cirúrgica em cirurgia da mão

ABSTRACT Introduction At the beginning of the medical career, the orthopedic surgeon in academic training needs valid methodologies for training complex surgeries in tissues that simulate real situations. With training in animal tissue, adapted to approach human tissue, it is possible to simulate procedures and decisions that will be necessary in real situations. Objective This study consists in presenting a simple and reproducible simulation model for surgical repair of tendons by training on fresh tendons fixed on a wooden frame. Methodology The model construction consists of a flat piece of Medium Density Fiberboard (MDF) and two threaded hooks were used on the board, to which Nylon threads are attached to tie the tendon, allowing a satisfactory simulation of a human tendon. Conclusion This is a simple, inexpensive, and effective method for tendon suturing training, through which the trainee can develop repair techniques and basic surgical principles, such as instrument handling, safety, and sharps disposal. This approach aims to improve the trainee's skills and dexterity when placed in live surgery. The surgical techniques developed include the modified Kessler and Bunnel sutures. Level of Evidence IV, Descriptive Study.

RESUMO Introdução No início da carreira médica, o ortopedista em formação acadêmica necessita de metodologias válidas para o treinamento de cirurgias complexas em tecidos que simulem situações reais. Com o treinamento em tecido animal, adaptado para abordar o tecido humano, é possível simular procedimentos e decisões que serão necessários em situações reais. Objetivo Este estudo consiste na apresentação de um modelo de simulação simples e reprodutível para reparo cirúrgico de tendões por meio do treinamento em tendões frescos fixados em estrutura de madeira. Metodologia A construção do modelo consiste em uma peça plana de Fibra de Média Densidade (MDF) e foram utilizados dois ganchos roscados na prancha, aos quais são fixados fios de Nylon para amarrar o tendão, permitindo uma simulação satisfatória de um tendão humano. Conslusão É um método simples, barato e eficaz para o treinamento de suturas tendíneas, por meio do qual o trainee poderá desenvolver técnicas de reparo e princípios cirúrgicos básicos, como manuseio de instrumentos, segurança e descarte de objetos cortantes. Este método visa melhorar as habilidades e destreza do trainee quando colocado em cirurgias ao vivo. As técnicas cirúrgicas desenvolvidas incluem as suturas Kessler e Bunnel modificadas. Nível de Evidência IV, Estudo Descritivo.