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1.
Plast Reconstr Surg ; 146(4): 819-829, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970003

RESUMO

BACKGROUND: Multilevel dysvascular injury of the hand can be treated with replantation or revision amputation. The authors compared both modalities regarding functional outcomes, patient-reported outcomes, and required resources, as relevant studies are scarce. METHODS: In this retrospective review of consecutive case series (replantation, n = 8; revision amputation, n = 11), clinical results and functional outcomes (including grip strength, range of motion, sensory recovery, and grip or pinch ability) were assessed. Patient-reported outcomes, required hospital resources, and treatment cost until 1 year after surgery were compared between both groups. RESULTS: Six patients used passive prostheses, two used body-powered prostheses, and three did not use a prosthesis in the revision amputation group. All patients in the replantation group could grip objects and had restored hands, with protective sensory recovery and substantial wrist motion, whereas six patients in the revision amputation group were unable to grip or pinch objects. Replantation was associated with superior patient-reported outcomes, but required more hospital resources and treatment costs. CONCLUSIONS: This study suggests that in the treatment of multilevel dysvascular injury of the hand, the surgical method should be chosen on a case-by-case basis. For better functional and patient-reported outcomes, replantation is preferred. Revision amputation can be performed in the absence of sufficient hospital resources and to reduce treatment cost. These findings can aid in the preoperative counseling of patients with multilevel dysvascular injury of the hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/irrigação sanguínea , Mãos/cirurgia , Reoperação , Reimplante/métodos , Adulto , Idoso , Amputação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
J Am Acad Orthop Surg ; 28(15): e642-e650, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732655

RESUMO

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.


Assuntos
Procedimentos Ortopédicos/métodos , Dedo em Gatilho/cirurgia , Corticosteroides/administração & dosagem , Adulto , Anestesia Local/economia , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Redução de Custos , Mãos/cirurgia , Humanos , Imobilização/métodos , Injeções Intralesionais , Curva de Aprendizado , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/educação , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia
3.
J Am Acad Orthop Surg ; 28(15): 639-649, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732657

RESUMO

BACKGROUND: The purpose of this study was to identify the utilization rate and most common reasons for presentation to the emergency department (ED) after elective outpatient hand surgery and to determine preoperative risk factors for these ED visits. METHODS: Patients who underwent elective hand surgery at an ambulatory surgery center between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and manually stratified. Bivariate and multivariate analyses were performed to identify independent predictors of ED utilization. RESULTS: From 2014 to 2015, 212,506 procedures were identified; the 7- and 30-day ED visit rates were 1.8% and 4.4%, respectively. Postoperative pain was the most common cause of an ED visit after outpatient hand surgery at 7 days (25.4%) and 30 days (16.1%) postoperatively. Overall, 98% of patients presenting to the ED for postoperative pain were subsequently discharged home. After controlling for confounding, comorbid congestive heart failure, chronic lung disease, diabetes, renal failure, schizophrenia, and depression were independent risk factors for an ED visit at up to 30 days postoperatively. Those with Medicare insurance were 94% more likely to present to the ED within 30 days than those with private health insurance, whereas those with Medicaid were more than three times as likely to present to the ED as those with private insurance. DISCUSSION: ED utilization after outpatient hand surgery is low, with postoperative pain being the most common cause of an ED visit at all time points. Nearly 98% of patients presenting to the ED for postoperative pain are subsequently discharged home. LEVEL OF EVIDENCE: Level III, Retrospective Cohort.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mãos/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória , Estudos Retrospectivos , Fatores de Risco
4.
J Am Acad Orthop Surg ; 28(15): e670-e678, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732659

RESUMO

Outcomes research has historically been driven by single-center investigations. However, multicenter studies represent an opportunity to overcome challenges associated with single-center studies, including generalizability and adequate power. In hand surgery, most clinical trials are single-center studies, with few having randomized controls and blinding of both participants and assessors. This pervasive issue jeopardizes the integrity of evidence-based practice in the field. Because healthcare payers emphasize applying the best available evidence to justify medical services, multicenter research collaborations are increasingly recognized as an avenue for efficiently generating high-quality evidence. Although no study design is perfect, the potential advantages of multicenter trials include generalizability of the results, larger sample sizes, and a collaboration of experienced investigators poised to optimize protocol development and study conduct. As the era of single-center studies shifts toward investment in multicenter trials and clinical registries, investigators will inevitably be faced with the challenges of conducting or contributing to multicenter research collaborations. We present our experiences in conducting multicenter investigations to provide insight into this demanding and rewarding frontier of research.


Assuntos
Amputação , Artrite Reumatoide/cirurgia , Artroplastia/métodos , Medicina Baseada em Evidências , Dedos/cirurgia , Dedos/transplante , Mãos/cirurgia , Colaboração Intersetorial , Estudos Multicêntricos como Assunto , Satisfação Pessoal , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Reimplante , Silicones , Nervo Ulnar/cirurgia , Traumatismos do Punho/cirurgia , Humanos , Resultado do Tratamento
5.
J Am Acad Orthop Surg ; 28(16): e686-e695, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769717

RESUMO

Scleroderma is derived from Latin meaning hard skin. It is an uncommon, noninflammatory connective tissue disorder characterized by increased fibrosis of the skin and in certain variants, multiple other organ systems. Scleroderma involves a spectrum of pathologic changes and anatomic involvement. It can be divided into localized and systemic scleroderma. Hand involvement is common and can include calcium deposits within the soft tissues, digital ischemia, and joint contracture. Nonsurgical management consists of lifestyle modifications, biofeedback, therapy for digital stiffness/contracture, and various pharmacologic medications. When nonsurgical measures are unsuccessful, certain surgical options may be indicated, each with their inherent advantages and pitfalls. Patients with scleroderma who are undergoing surgical intervention pose unique difficulties because of their poorly vascularized tissue and deficient soft-tissue envelopes, thus increasing their susceptibility to wound healing complications and infection. Some subgroups of patients are frequently systemically ill, and specific perioperative measures should be considered to reduce their surgical risk. The spectrum of hand manifestations seen in patients with scleroderma will be reviewed with the focus on evaluation and management.


Assuntos
Mãos , Procedimentos Ortopédicos/métodos , Esclerodermia Localizada/cirurgia , Escleroderma Sistêmico/cirurgia , Calcinose , Mãos/patologia , Mãos/cirurgia , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/patologia , Esclerodermia Localizada/terapia , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/terapia
6.
PLoS One ; 15(8): e0237798, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822396

RESUMO

BACKGROUND: Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. MATERIAL & METHODS: Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. RESULTS: The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes). CONCLUSION: Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.


Assuntos
Procedimentos Endovasculares/métodos , Mãos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(31): e21519, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756192

RESUMO

RATIONALE: Pilar cyst mainly occurs on the scalp, but pilar cyst on the dorsum of hand has not been reported. Herein, we provide information to improve the clinical cognition of pilar cyst location. PATIENTS CONCERNS: A 76-year-old man presented with a round nodule on the opisthenar of his right hand for two months without any subjective symptoms. DIAGNOSES: Histological features of the lesion biopsy indicated the diagnosis of pilar cyst. INTERVENTIONS: Surgical resection was made under local anesthesia. OUTCOMES: Complete recovery was achieved after surgery. CONCLUSION: Pilar cyst rarely occurs on the dorsum of hand and its diagnosis depends on histopathological examinations. Surgical resection is the only way to treat it.


Assuntos
Cisto Epidérmico/patologia , Mãos/patologia , Idoso , Cisto Epidérmico/cirurgia , Mãos/cirurgia , Humanos , Masculino
8.
Zentralbl Chir ; 145(5): 421-424, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32702765

RESUMO

OBJECTIVE: This video is a step-by-step description of thoracoscopic sympathectomy. INDICATION: Sweating is essential for thermoregulation. Hyperhidrosis is a condition of excess sweating from the eccrine glands and is associated with severe suffering for patients of all ages. It often worsens during adolescence. A generalised and focal type of hyperhidrosis which affects mainly the face, armpits, hands and feet can be distinguished from the focal variant. Thoracic sympathectomy has become the standard treatment for palmar and axillary hyperhidrosis worldwide. METHODS: The procedure is performed in the supine position with the upper body elevated about 30° in an adolescent patient. Both arms are abducted at 90° and single tube endotracheal ventilation is employed. A 3 mm trocar is placed in the anterior axillary line for a 3 mm 30° optic. A 5 mm trocar placed on the anterior axillary line (or breast fold in female patients) of the 4th or 5th intercostal space is used for the bipolar forceps. The sympathetic trunk and ganglia T 2 - 4 are identified and coagulated over the heads of ribs. CONCLUSION: The thoracoscopic approach to focal palmar and axillary hyperhidrosis allows clear identification of the sympathetic structures on each side. Under direct vision, selective ablation of the ganglia and sympathetic trunk provides long-term benefit for patients.


Assuntos
Hiperidrose , Adolescente , Axila , Feminino , Mãos/cirurgia , Humanos , Hiperidrose/cirurgia , Sudorese , Simpatectomia , Toracoscopia , Resultado do Tratamento
9.
Plast Reconstr Surg ; 146(1): 54e-60e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590653

RESUMO

BACKGROUND: The wide-awake local anesthesia no tourniquet (WALANT) technique in hand surgery is gaining popularity. The authors aimed to prospectively analyze the frequency and type of arrhythmias in patients undergoing hand surgery under local anesthesia and to examine whether the addition of adrenaline affects their incidence. METHODS: Adult patients undergoing hand surgery under local anesthesia were randomized into two groups: group 1, local anesthesia with lidocaine and tourniquet; and group 2, local anesthesia with lidocaine and adrenaline (WALANT). Patients with a history of arrhythmias were excluded. Patients were connected to Holter electrocardiographic monitoring before surgery and up until discharge. The records were blindly compared between the groups regarding types of arrhythmias, and frequency and timing relative to injection and tourniquet inflation. RESULTS: One hundred two patients were included between August of 2018 and August of 2019 (age, 59.7 ± 13.6 years; 71 percent women; 51 in each group). No major arrhythmia (ventricular tachycardia, ventricular fibrillation, atrial fibrillation) or arrhythmia-related symptoms were recorded for either group. Minor arrhythmias (including atrial premature beats, ventricular premature beats, and atrial tachycardia) were recorded in 68 patients (66.6 percent), with no statistical difference between the groups. There were three patients with minor arrhythmias during inflation of the tourniquet. Patients in the adrenaline group had 2 percent sinus tachycardia during injection and 4 percent asymptomatic bradyarrhythmias. These findings do not require any further treatment. CONCLUSIONS: The authors' results show that hand operations using WALANT technique in patients with no history of arrhythmia are safe and are not arrhythmogenic; therefore, there is no need for routine perioperative continuous electrocardiographic monitoring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Anestesia Local/métodos , Arritmias Cardíacas , Epinefrina/efeitos adversos , Mãos/cirurgia , Vasoconstritores/efeitos adversos , Adulto , Idoso , Anestesia Local/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Plast Reconstr Surg ; 146(4): 430e-438e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32590525

RESUMO

BACKGROUND: Although hand surgery is generally safe and effective, some patients experience complications or poor outcomes prompting them to seek compensation. This study reviews malpractice claims in hand surgery using a national data set to assess reasons for litigation and identify predictors of outcome. METHODS: The Westlaw database was queried for cases related to hand surgery and medical malpractice between 1989 and 2018. Jury verdicts and settlements were reviewed for relevance, and variables including plaintiff and defendant demographics, diagnosis, alleged reason for malpractice, verdicts, and payouts were recorded. RESULTS: Four hundred thirty relevant claims were identified. Distal radius fractures (21 percent), carpal tunnel syndrome (14 percent), and tendon lacerations (6 percent) were the most common diagnoses. Alleged reasons for malpractice included failure to diagnose/treat (34 percent), surgical negligence (29 percent), and improper procedure/treatment (19 percent). Thirty-six cases (8 percent) resolved in settlement for a mean payout of $551,957. A plaintiff verdict was reached in 98 cases (25 percent of trials), with a mean payout of $832,258. The remaining 296 cases (75 percent of trials) resulted in defendant verdicts (no payout). Plaintiff age, plaintiff sex, defendant sex, and defendant degree had no impact on trial outcome. Cases involving surgeons without subspecialty certification in hand surgery were significantly more likely to result in plaintiff verdicts (27 percent versus 7 percent with hand subspecialization; p = 0.003). CONCLUSIONS: This study reviews malpractice claims in hand surgery over the past 30 years. Providing timely diagnoses, managing expectations, and reducing procedural error may decrease the risk of litigation.


Assuntos
Mãos/cirurgia , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Especialidades Cirúrgicas/legislação & jurisprudência , Humanos , Fatores de Tempo , Estados Unidos
11.
Medicine (Baltimore) ; 99(23): e20504, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501996

RESUMO

RATIONALE: Acute compartment syndrome (ACS) is a feared complication following traumatic injuries. We describe the occurrence of silent ACS of the hand in a 2-year old patient with atypical symptoms. PATIENT CONCERNS: Our patient experienced massive swelling but minimal pain of the hand after a heavy bistro table with a stone tabletop had fallen on the right hand. DIAGNOSIS: After monitoring the development of ACS for 1 night, we noted increased firmness of the swelling and impaired perfusion of the skin covering the palm and dorsum of the hand. Notably, the patient held the hand in an intrinsic minus position but did not complain of pain after administration of only a single (weight-matched) dose of ibuprofen. Our suspicion of ACS was confirmed intraoperatively because of the elevated intramuscular pressure (up to 60 mm Hg) in several hand compartments. INTERVENTIONS: We performed surgical fasciotomy of all hand compartments, followed by temporary coverage of the wounds with Epigard synthetic skin substitute. The wounds were closed stepwise after 2 and 7 days, and occupational therapy was initiated after 3 weeks. OUTCOMES: At the 1-year follow-up, we noted unrestricted wrist and finger functions of the patient. The parents reported that there was no difference in the use of the 2 hands during daily activities. LESSONS: The possible development of ACS should be borne in mind even in the absence of marked pain. Although the 3 A's (i.e., anxiety, agitation, and increased analgesic requirements) in the diagnosis of ACS in children are well established, some patients may experience only minimal pain. This challenges the correct and timely diagnosis of ACS in children, particularly if they are very young.


Assuntos
Síndromes Compartimentais/etiologia , Lesões por Esmagamento/complicações , Pré-Escolar , Síndromes Compartimentais/cirurgia , Fasciotomia/métodos , Feminino , Mãos/cirurgia , Traumatismos da Mão/complicações , Traumatismos da Mão/cirurgia , Humanos , Pediatria/métodos , Suíça
12.
J Plast Reconstr Aesthet Surg ; 73(8): 1413-1423, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32499185

RESUMO

INTRODUCTION: Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non-emergency surgery, although such reviews excluded upper limb procedures and represents the rationale for this review. METHODS: The literature was systematically searched for studies concerning the outcomes of adult hand or wrist surgery on patients receiving anticoagulation or antiplatelet agents in direct comparison to controls (no anticoagulation or antiplatelet agents, or interruption of either). The primary outcome was reoperation for any complication related to postoperative bleeding, within 30 postoperative days. RESULTS: Nine cohort studies (3628 individuals; 3863 operations) were included. Based on very low-quality evidence, anticoagulation did not affect the risk of reoperation for bleeding (RR 2.4 [95% CI 0.1, 57]; 3 studies, n=443) or bruising (RR 2.5 [95% CI 1.0, 6.3]; n=124; I2=0%). Based on low quality evidence, antiplatelet agents did not affect the risk of reoperation for bleeding (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=1885; I2=0%) or bruising (RR 3.2 [95% CI 0.2, 44]; n=571; I2=66%). A sensitivity analysis showed that carpal tunnel decompression on patients receiving anticoagulants or antiplatelets appeared to be safe (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=2077; I2=0%). CONCLUSIONS: Given the sparsity of events (bleeding and bruising) and low-quality of the literature, no firm conclusions can be drawn. The decision to interrupt antiplatelets or anticoagulants should be made jointly with expert physicians and the patient. Registration: PROSPERO ID CRD42018087755.


Assuntos
Anticoagulantes/administração & dosagem , Mãos/cirurgia , Inibidores da Agregação de Plaquetas/administração & dosagem , Punho/cirurgia , Hemorragia/prevenção & controle , Hemorragia/cirurgia , Humanos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Reoperação
14.
Occup Ther Int ; 2020: 9573950, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565758

RESUMO

Purpose: To examine the content validity of the Danish version of the Canadian Occupational Performance Measure (COPM-DK). Materials and Methods: This cross-sectional study was performed in a hospital and a community rehabilitation centre. The content validity of the COPM was assessed by relating the clients' prioritized occupational performance issues (OPIs) to the conceptual model of the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the levels of the Taxonomic Code of Occupational Performance (TCOP). Six occupational therapy lecturers participated in classifying the OPIs using the TCOP. Results: A total of 112 clients from a regional and community-based rehabilitation participated. The 56% regional participants came from a hospital's hand and knee surgery department. The remaining 44% participants came from a community-based rehabilitation centre with in- and outpatient departments. There were 44% males, with a mean age of 65.2 years. They prioritized 495 OPIs, of which 40% concerned self-care, 32% productivity, and 28% leisure. The prioritized OPIs were divided into a total of 224 different OPIs. There were significant differences in which areas were prioritized in the various population groups. Of the OPIs, 64.3% could be classified into the TCOP levels of occupation and activity, i.e., 1/3 of the OPIs were related to tasks and actions, and thus beyond the scope of the COPM. The interrater agreement of the OPI classification was only fair (kappa 0.3). Conclusion: The content validity of the COPM seems to depend on how and with which clients it is administered. Caution must be taken to secure OPIs on the higher levels of the TCOP, while maintaining the clients' right to nominate OPI preferences. Therefore, an introductory course and on-going support are recommendable. Bearing this in mind, the COPM seems useful to identify individual clients' prioritized OPIs in a Danish context.


Assuntos
Avaliação da Deficiência , Terapia Ocupacional , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Dinamarca , Feminino , Mãos/cirurgia , Humanos , Joelho/cirurgia , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
15.
Jt Dis Relat Surg ; 31(2): 267-272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584724

RESUMO

OBJECTIVES: This study aims to evaluate the surgical and clinical outcomes of reversed cross-finger subcutaneous flaps applied to patients with dorsal digital defects. PATIENTS AND METHODS: Between January 2015 and September 2018, 25 (22 males, 3 females; mean age 35.6±11.6 years; range, 19 to 65 years) out of 27 patients under prospective follow-up with finger dorsal digital defect were retrospectively screened and included in the study. The data, obtained by the same two surgeons at six months postoperatively in patients who had undergone reversed cross-finger subcutaneous flaps surgery, concerned cold intolerance, a static two-point separation test, and functional results using range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scoring. RESULTS: The majority of the patients presented with occupational injury (64%), most commonly to the dominant hand (76%) and the fourth finger (36%) most frequently. Seven patients with extensor tendon defects underwent reconstruction with a palmaris longus autograft. At the six-week postoperative follow-up, all flaps were live, the donor site had no morbidity, and no additional intervention was performed. There was no statistically significant difference in finger joint ROM (p>0.05). Cold intolerance was observed in 14 patients (56%). The mean dynamic two-point distinction was 6.0±0.7 mm and the QuickDASH score was 22.3±5.0. CONCLUSION: Due to reasons such as minimal donor site morbidity, satisfactory functional finger outcomes, and easy applicability, reversed cross-finger subcutaneous flap is a good option for reconstruction of defects in the dorsal aspect of the finger with or without extensor mechanism defects.


Assuntos
Traumatismos dos Dedos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/fisiopatologia , Traumatismos dos Dedos/cirurgia , Mãos/cirurgia , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
16.
J Hand Surg Am ; 45(6): 536-541, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-141759

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Mãos/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Medição de Risco , Singapura , Resultado do Tratamento
17.
J Hand Surg Am ; 45(6): 536-541, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387156

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Mãos/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Medição de Risco , Singapura , Resultado do Tratamento
18.
J Nippon Med Sch ; 87(4): 184-190, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32350187

RESUMO

This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.


Assuntos
Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Mãos/cirurgia , Procedimentos Ortopédicos/métodos , Quimioterapia Adjuvante , Expressão Gênica , Tumor de Células Gigantes de Bainha Tendinosa/diagnóstico por imagem , Tumor de Células Gigantes de Bainha Tendinosa/genética , Tumor de Células Gigantes de Bainha Tendinosa/patologia , Humanos , Mesilato de Imatinib/administração & dosagem , Fator Estimulador de Colônias de Macrófagos/metabolismo , Recidiva Local de Neoplasia , Resultado do Tratamento
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(3): 374-375, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32386007

RESUMO

Upper limb injury is a common disease in hand surgery. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. In clinic, clothes or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Therefore, the upper limb raising pad for assisting the raising of the affected limb is specially designed. The device is composed of shell, mounting plate, strut, elastic band and spring. The position of the strut is adjusted by squeezing or lifting the spring, so as to change the inclination angle of the mounting plate and to adjust the raising height of the upper limb. After the height is determined, the affected limb is placed comfortably and then fixed with the elastic band. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied.


Assuntos
Mãos/cirurgia , Extremidade Superior , Humanos , Equipamentos Cirúrgicos
20.
Handchir Mikrochir Plast Chir ; 52(3): 233-241, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: covidwho-599532

RESUMO

The first case of a SARS-Cov-2 virus infection was confirmed on January 27th in Munich. For both, plastic and hand surgeons it is crucial to act responsible, minimize the transmission of the virus and aid in reasonable and adequate allocation of resources for the treatment of affected patients during this pandemia. This article aims to provide an overview over the latest developments and insights that affect plastic and hand surgeons. At the same time plastic and hand surgeons are required to participate actively in the discussion of new regulatory measures that on one hand aim to ensure a proper medical care of COVID-19 patients and on the other hand need to guarantee coverage of all other patients. Furthermore exit - strategies after the pandemia need to be discussed by our societies. Naturally, this manuscript provides insight into the current situation, which might undergo changes due to the swift progression of the pandemia.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Mãos/cirurgia , Pandemias , Pneumonia Viral , Cirurgia Plástica , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Cirurgia Plástica/tendências
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