Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release.

UNLABELLED: The purpose of this study was to determine if nerve conduction studies predict time to resolution of symptoms after carpal tunnel release. A total of 56 patients undergoing open carpal tunnel release were prospectively enrolled. Pre-operative presence of nocturnal symptoms and daytime numbness/tingling were documented. Pre-operative nerve conduction studies were reviewed and classified as mild, moderate, or severe. After open carpal tunnel release, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. This study found that patients with mild or moderate carpal tunnel syndrome experience a faster time to resolution of daytime numbness and tingling when compared with patients with severe carpal tunnel syndrome. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of nerve conduction studies in predicting post-operative functional and subjective outcomes. LEVEL OF EVIDENCE: IV.

Assisted closure of fasciotomy wounds: A descriptive series and caution in patients with vascular injury.

INTRODUCTION: Negative pressure wound therapy (NPWT) and vessel loop assisted closure are two common methods used to assist with the closure of fasciotomy wounds. This retrospective review compares these two methods using a primary outcome measurement of skin graft requirement. METHODS: A retrospective search was performed to identify patients who underwent fasciotomy at our institution. Patient demographics, location of the fasciotomy, type of assisted closure, injury characteristics, need for skin graft, length of stay and evidence of infection within 90 days were recorded. RESULTS: A total of 56 patients met the inclusion criteria. Of these, 49 underwent vessel loop closure and seven underwent NPWT assisted closure. Patients who underwent NPWT assisted closure were at higher risk for requiring skin grafting than patients who underwent vessel loop closure, with an odds ratio of 5.9 (95% confidence interval 1.11 to 31.24). There was no difference in the rate of infection or length of stay between the two groups. Demographic factors such as age, gender, fracture mechanism, location of fasciotomy and presence of open fracture were not predictive of the need for skin grafting. CONCLUSION: This retrospective descriptive case series demonstrates an increased risk of skin grafting in patients who underwent fasciotomy and were treated with NPWT assisted wound closure. In our series, vessel loop closure was protective against the need for skin grafting. Due to the small sample size in the NPWT group, caution should be taken when generalising these results. Further research is needed to determine if NPWT assisted closure of fasciotomy wounds truly leads to an increased requirement for skin grafting, or if the vascular injury is the main risk factor.

Viral infections.

This article has concentrated on the etiology, pathogenesis, diagnosis, and treatment of viral infections of the hand. Some of these entities are quite common, but are often misdiagnosed. Herpes simplex appears to be the most common viral infection involving the hand. These and other viral infections can have much graver consequences in immunosuppressed patients. Recurrent episodes are common in herpetic and other viral infections. Health care workers have long been at risk, but improved compliance with prophylactic measures would seem to be decreasing the number of cases in this population. A plea has been made to disregard the term herpetic whitlow because it is an inaccurate description of the lesion and implies that an inappropriate type of treatment is required. Bacterial whitlows or felons require incision and drainage of the deep pulp space. Herpetic infections in this area do not. Less common infections such as cowpox, pseudocowpox (milkers nodules), ORF, and coxsackievirus (HFMD) infection of the hand have been brought to the attention of the reader. The bothersome warts caused by the human papillomavirus have been described and the systemic ramifications of hand-to-hand contact and hand injury causing more serious viral problems has been mentioned. A common thread in the care of the patient with these types of diseases is that an adequate history and physical remain invaluable in arriving at the correct diagnosis. With this correct diagnosis all of us, as physicians, then can easily abide by one of our basic principles Primum non nocere, "Let me help--but first let me do no harm."

Two replantations of severed ear parts.

Two successful cases of replantation of part of an ear are presented; both were done by simple suture. The larger of these replants consisted of a 13 x 43 mm segment of the superior helix and concha. Both were vascularized beofre 48 hours. The greatest problem was venous congestion. In the larger replant we made multiple puncture wounds daily on both sides of the graft with an 18-gauge needle to help relieve this.