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1.
Plast Reconstr Surg ; 145(2): 459-467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
2.
Plast Reconstr Surg ; 145(2): 471-481, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985644

RESUMO

BACKGROUND: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings. METHODS: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit. RESULTS: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach. CONCLUSIONS: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.


Assuntos
Países em Desenvolvimento/economia , Deformidades Congênitas da Mão/economia , Traumatismos da Mão/economia , Mãos/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise Custo-Benefício , Assistência à Saúde/economia , Feminino , Deformidades Congênitas da Mão/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Masculino , Turismo Médico/economia , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Gravidez , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Viagem/economia , Viagem/estatística & dados numéricos , Adulto Jovem
3.
Medicine (Baltimore) ; 98(52): e18434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876722

RESUMO

RATIONALE: Although lipomas are the most common benign form of soft tissue tumor in the body, giant lipomas of the hand, defined as >5 cm in diameter, are extremely rare. PATIENT CONCERNS: A 49-year-old man presented with a soft and fixed lump in the left hypothenar area. The mass was not tender, but it was associated with symptoms of tingling sensation and paresthesia in the left ring and little fingers that had lasted for 4 years. DIAGNOSES: Preoperative image studies revealed an encapsulated and multilobulated mass, which measured 8 cm × 5 cm × 2 cm. Basic histologic examination identified the specimen as a lipoma and further immunohistochemical studies ruled out the possibility of malignancy. INTERVENTIONS: To enable a complete excision of the mass, the palmar digital branch of the ulnar nerve for the little finger passing through the mass was temporarily transected. After complete excision of the mass, the branch was coapted again under microscopy. OUTCOMES: Complete sensory recovery was achieved 6 months after surgery, without any sign of recurrence. LESSONS: Although giant lipomas in the hand can extend to vital components such as neurovascular structures, muscles, and tendons, meticulous en bloc resection can provide excellent results without any complications.


Assuntos
Mãos , Lipoma/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Mãos/diagnóstico por imagem , Mãos/patologia , Mãos/cirurgia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios X
4.
Acta Chir Orthop Traumatol Cech ; 86(5): 313-319, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748104

RESUMO

Rheumatosurgery is a discipline managing the symptoms of rheumatoid arthritis of the musculoskeletal system. In a vast number of patients this disease starts in the wrist and hand. The portfolio of surgical procedures performed on the skeleton and soft tissues in these regions can be divided into two groups that, however, often times overlap in practice. Commonly, a combination of these surgical interventions is used. The surgical management should commence with prophylactic interventions that aim to slow down the development of rheumatoid deformities. These are followed by reconstructive surgery which shall manage the already developed rheumatoid deformities and their complications. The prophylactic interventions include early and late synovectomy, peritenosynovectomy, tenodeses, tendon transpositions and limited arthrodeses. The reconstructive surgery procedures comprise osteotomy, resection procedures, alloplasties, total arthrodesis and tendon reconstructions. Key words: rheumatoid arthritis, rheumatosurgery, hand, wrist.


Assuntos
Artrite Reumatoide/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Articulação da Mão/cirurgia , Mãos/cirurgia , Artrite Reumatoide/complicações , Artrodese , Deformidades Adquiridas da Mão/etiologia , Humanos , Sinovectomia , Tendões/cirurgia
5.
Handchir Mikrochir Plast Chir ; 51(6): 509, 2019 12.
Artigo em Alemão | MEDLINE | ID: mdl-31698494
6.
Medicine (Baltimore) ; 98(44): e17726, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689814

RESUMO

The purpose of this study was to assess the efficacy and safety of Pelnac and split-thickness skin graft for management of complex wound with underlying bone/tendon exposure at forearm and hand.This is a prospective study, beginning from March 2013 up to May 2017. There were 13 patients, with age of 31.2 years. All of them underwent the staged Pelnac and split-thickness skin graft to manage the complex wound with bone/tendon. Postoperatively, scheduled follow-up was conducted.The average follow-up was 15 months. There were no infections, wound necrosis, hematoma, or seroma during the phase when Pelnac was applied. There was 100% "take" of the Pelnac in 12/13 patients. In 11 patients, there was complete skin graft "take". Patients' satisfaction for the esthetic appearance of the grafted area was 75.0 ±â€Š8.5/100. The VSS value was 2.9 ±â€Š2.5. Regarding the sensory recovery, the response of "normal or near normal" could be obtained in 7/13 patients, "slight loss" in 5 patients and "significant loss" in 1 case. The average DASH score was 27.2 ±â€Š18.5, and most patients (12/13) could obtain an acceptable ability to perform the daily activities.Pelnac dermal template is a favorable alternative to flap reconstruction in the treatment of complex wound with underlying tissues exposure.


Assuntos
Traumatismos do Braço/cirurgia , Regeneração Tecidual Guiada/métodos , Traumatismos da Mão/cirurgia , Transplante de Pele/métodos , Tendões/cirurgia , Adolescente , Adulto , Traumatismos do Braço/fisiopatologia , Derme/fisiopatologia , Derme/cirurgia , Feminino , Seguimentos , Antebraço/cirurgia , Mãos/cirurgia , Traumatismos da Mão/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Cicatrização/fisiologia , Adulto Jovem
9.
J Ayub Med Coll Abbottabad ; 31(3): 320-325, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535498

RESUMO

BACKGROUND: The long-disputed issue of rehabilitation of extensor tendon repairs in zones V-VII has been treated with either complete immobilization or mobilization within the constraints of splint. In recent times, most authors have preferred some mobilization. Many studies have shown good results with early mobilization techniques; however, these studies have limitations. Most of these are retrospective observations. Some prospective studies are without proper controls. This study was conductive to compare the functional outcome of early active mobilization versus immobilization following repair of extensor tendons in zone V-VII. METHODS: Functional outcome was determined by total active motion, pain and complications during rehabilitation. Total active motion (TAM) was graded by scores of the American Society for Surgery of Hand as TAM=total active flexion (MCP+PIP+DIP)-total extension deficit (MCP+PIP+DIP). A randomized control trial was conducted including 50 subjects of with extensor tendon injury exclusively in zone V-VII. Patients were divided randomly in two groups. All extensor tendon repairs (zone V to VII) were performed with modified Kessler's method. The pain and TAM was assessed during all visits in both groups except TAM in group B that was assessed after four weeks. RESULTS: We found that outcome of 12% cases in Group A as excellent and no patient fell in category of fair results. While, in comparison, there was no case of excellent result in Group B. 4% cases showed fair results that were treated with immobilization. The pain score at the end of treatment, i.e., at 12 weeks were same in both the groups but, generally the score remained higher in group of EAM. There was significant difference in adhesion formation that was more in patients of immobilization group. The overall suture dehiscence was insignificant and was only 8% in each group. CONCLUSIONS: EAM has better outcome in terms of pain and range of motion.


Assuntos
Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões , Tendões/cirurgia , Mãos/cirurgia , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/cirurgia
10.
Zhonghua Shao Shang Za Zhi ; 35(8): 604-607, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474041

RESUMO

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.


Assuntos
Retalhos de Tecido Biológico/transplante , Mãos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Adulto , Braço , Feminino , Humanos , Masculino , Transplante de Pele , Cicatrização , Adulto Jovem
11.
Rev. bras. cir. plást ; 34(3): 423-427, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047173

RESUMO

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.


Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.


Assuntos
Humanos , Masculino , Adulto , História do Século XXI , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Retalhos Cirúrgicos , Ferimentos e Lesões , Queimaduras , Queimaduras por Corrente Elétrica , Técnicas de Fechamento de Ferimentos , Antebraço , Traumatismos do Antebraço , Mãos , Traumatismos da Mão , Complicações Intraoperatórias , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/reabilitação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/reabilitação , Retalhos Cirúrgicos/efeitos adversos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/reabilitação , Queimaduras por Corrente Elétrica/cirurgia , Queimaduras por Corrente Elétrica/complicações , Técnicas e Procedimentos Diagnósticos , Técnicas de Fechamento de Ferimentos/reabilitação , Antebraço/cirurgia , Traumatismos do Antebraço/cirurgia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/reabilitação , Mãos/cirurgia , Traumatismos da Mão/cirurgia
12.
Plast Reconstr Surg ; 144(2): 395-407, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348350

RESUMO

BACKGROUND: Decision analysis allows clinicians to apply evidence-based medicine to guide objective decisions in uncertain scenarios. There is no comprehensive review summarizing the various decision analysis tools used. The authors aimed to appraise and review the decision analytic models used in hand surgery. METHODS: A search of English articles on the PubMed, Ovid, and Embase databases was performed. All articles, regardless of date of publishing, were considered. Two reviewers, based on strict inclusion criteria, independently assessed each article. RESULTS: The search resulted in 5525 abstracts, which yielded 30 studies that met inclusion criteria. Included studies were grouped according to medical indications, with scaphoid fractures (n = 6) and carpal tunnel syndrome (n = 5) being the most commonly reported. Included articles used decision analysis (n = 15) and/or economic analyses (n = 23) to discuss diagnostic strategies or compare treatments. The three most common outcomes reported were utility (n = 12), cost per quality-adjusted life-year (n = 16), and quality-adjusted life-years (n = 16). The decision analysis models compared diagnostic strategies, management options, and novel treatments. CONCLUSIONS: Decision analysis is increasingly popular in hand surgery. It is useful for comparing surgical strategies through evaluation of quality-of-life outcomes and costing data. The most common model was a simple decision tree. The quality of decision analysis models can be improved with the addition of sensitivity analysis. Surgeons should be familiar with the principles of decision analysis, so that complex decisions can be evaluated using rigorous probabilistic models that combine risks and benefits of multiple strategies.


Assuntos
Técnicas de Apoio para a Decisão , Mãos/cirurgia , Tratamento Conservador/economia , Análise Custo-Benefício , Humanos , Procedimentos Ortopédicos/economia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Terapias em Estudo/economia
13.
Plast Reconstr Surg ; 144(2): 408-414, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348351

RESUMO

Wide-awake local anesthesia no tourniquet surgery has been shown to decrease cost and hospital length of stay. The authors studied the use of virtual reality during wide-awake local anesthesia no tourniquet outpatient upper extremity surgery to assess its effect on patient pain, anxiety and fun. Patients undergoing wide-awake local anesthesia no tourniquet surgery were randomized to use (virtual reality) or not use (non-virtual reality) virtual reality during their procedures. Pain, fun, and anxiety were measured with a Likert scale at several time points, as were blood pressure and heart rate. A postoperative questionnaire was used to assess overall satisfaction. Virtual reality patients exhibited lower anxiety scores during injection, during the procedure, and at the end of the procedure. There were no differences in blood pressure, heart rate, or pain scores. Compared with non-virtual reality patients, virtual reality patients' fun scores were higher. Virtual reality patients felt the experience helped them to relax, and they would recommend virtual reality-assisted wide-awake local anesthesia no tourniquet surgery. Among patients with self-reported preexisting anxiety, virtual reality patients had lower pain and anxiety scores during injection of local anesthesia compared with non-virtual reality patients. This study demonstrates that readily available virtual reality hardware and software can provide a virtual reality experience that reduces patient anxiety both during the injection of local anesthesia and during the surgical procedure. (Plast. Reconstr. Surg. 144: 408, 2019.) CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, II.


Assuntos
Anestesia Local/métodos , Mãos/cirurgia , Realidade Virtual , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Feminino , Felicidade , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Dor/prevenção & controle , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Método Simples-Cego , Torniquetes , Vigília , Adulto Jovem
14.
Khirurgiia (Mosk) ; (6): 111-116, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317950

RESUMO

We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Embolização Terapêutica/métodos , Mãos/irrigação sanguínea , Isquemia/cirurgia , Insuficiência Venosa/cirurgia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Mãos/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Diálise Renal/instrumentação , Veias/diagnóstico por imagem , Insuficiência Venosa/etiologia
15.
Acta Chir Orthop Traumatol Cech ; 86(3): 193-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333183

RESUMO

PURPOSE OF THE STUDY To evaluate hand function deficiency in patients with Dupuytren's disease (DD) in addition to assessing the improvement of function after palmar fasciectomy by using different hand-related questionnaires. MATERIAL AND METHODS A total of 121 hands (95 patients) underwent surgery. Disease severity was designated using Tubiana's Staging System. The Tendency of changes of Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Patient Evaluation Measure (PEM), and Hand Function Score (HFS) scores of patients with DD undergoing palmar fasciectomy were assessed prior to, 3 months after, and 1 year after the operation. Moreover, total loss of extension (TLoE) was evaluated using a goniometer in the same time intervals. Repeated measure ANOVA Friedman's test were used. Responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS The results showed statistically significant improvement of the originally obtained questionnaire results after 3 months for DASH and HFS and 12 months for all forms; only the PEM and DASH score significantly changed between 3 and 12 months. TLoE before surgery was 144.1 o ±99.6 o ; 3-month and 1-year after surgery: 14.3 o ±58.0 o and 19.3 o ±34.7 o respectively. SRMs for 1 year after surgery was large for PEM (1.11) and medium for DASH (0.7) and HFS (0.79). CONCLUSIONS DASH, PEM, and HFS are valuable tools to monitor the hand function of patients with DD after surgery. Key words:hand function, Dupuytren's disease, palmar fasciectomy.


Assuntos
Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Deformidades Adquiridas da Mão/cirurgia , Mãos/cirurgia , Avaliação da Deficiência , Contratura de Dupuytren/reabilitação , Fasciotomia/reabilitação , Deformidades Adquiridas da Mão/reabilitação , Pesquisas sobre Serviços de Saúde , Indicadores Básicos de Saúde , Humanos , Recuperação de Função Fisiológica
16.
Oper Orthop Traumatol ; 31(5): 372-383, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31359070

RESUMO

OBJECTIVE: Accessibility of any anatomical structure of the hand via surgical approach. INDICATIONS: Any surgical treatment of the hand. CONTRAINDICATIONS: Any contraindication to surgical treatment of the hand. SURGICAL TECHNIQUE: Skin incision at the hand with access to any anatomical structure. POSTOPERATIVE MANAGEMENT: Postoperative treatment depends on the disease and hand surgery performed.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/cirurgia , Humanos , Resultado do Tratamento
17.
Handchir Mikrochir Plast Chir ; 51(3): 177-184, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31167278

RESUMO

BACKGROUND: Mobile X-ray imaging systems are standard in the operating theatre. Mini-C-arms are the prevailing technology in hand surgery. Unfortunately, the exposure to Mini-C-arm radiation is often underestimated. METHODS: For one year, the intraoperative radiation dose delivered by an OrthoScan High Definition Mini-C-arm with a flat panel detector was measured using headband and finger ring dosimeters in all hand and wrist surgeries performed by three experienced hand surgeons. RESULTS: Two hundred and thirteen patients underwent surgical treatment involving the use of an OrthoScan High Definition Mini-C-arm. The total radiation dose administered by all three hand surgeons over 12 months was 9033.39 mGy with a total irradiation time of 376:38 min. A radiation exposure of 2.0 mSv was detected on both finger ring dosimeters of one surgeon during one month. For all other dosimeters, the monthly radiation exposure was below the detection limit of < 0.3 mSv. CONCLUSION: The radiation exposure reached during about 100 surgeries/surgeon/year involving the use of an OrthoScan Mini-C-arm does not exceed the annual occupational exposure limits of 50 mSv for the hand and 20 mSv for the lens of the eye. Only at an X-ray exposure of 800-1000 mGy/month can radiation exposure be detected with a finger ring dosimeter (measuring range 0.3 mSv-10 Sv) in a hand surgeon. Due to the potential health risk posed by stochastic radiation effects, all possible safeguards including behavioural measures should be observed.


Assuntos
Mãos , Exposição Ocupacional , Exposição à Radiação , Lesões por Radiação , Fluoroscopia , Mãos/diagnóstico por imagem , Mãos/cirurgia , Humanos , Doses de Radiação
18.
Handchir Mikrochir Plast Chir ; 51(3): 193-198, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31167280

RESUMO

BACKGROUND: The national competency-based catalogue of learning objectives in surgery (NKLC) for undergraduate surgical education in Germany consists of 230 objectives and defines competence levels for each objective. These levels range from "competence level 1: factual knowledge" to "competence level 3: independent action". The German second state examination is not based on these objectives, although it is known that assessment drives learning. This study analyses the proportion of hand surgery-based learning objectives in the NKLC and compares the results with the hand surgery questions of the German second medical licensing examination compiled by the Central German Institute for Medical and Pharmaceutical Examinations (IMPP). METHODS: Hand surgery teaching objectives in the NKLC were identified by five hand surgeons. All exam questions addressing these objectives were identified in the German second medical licensing examinations held from autumn 2009 through autumn 2014 (n = 11). The analysis included the number of hand surgery questions for each examination, the number of learning objectives and the different levels of competence. RESULTS: Forty-seven learning objectives of the NKLC were identified as "hand surgery-related" (20.4 % of all NKLC learning objectives). Nine of them were classified as learning objectives that were "only covered by hand surgery" (3.9 % of all NKLC learning objectives). Two hundred and twenty questions (6.3 % of the total number of 3480 questions) addressed hand surgery-related objectives. Per exam, an average of 20 ± 8.2 questions (minimum: 9; maximum: 37) addressed a hand surgery-related learning objective. An average of 0.5 ± 0.7 questions per exam were related to objectives that only covered hand surgery (minimum: 0; maximum: 2). During the study period, 16 learning objectives were not tested at all (13.7 % of all NKLC learning objectives). These untested objectives included 5 objectives of competence level 1 (10.6 % of all NKLC learning objectives). Six of the 9 objectives that are only covered by hand surgery were not assessed at all. CONCLUSIONS: The number of hand surgery-based learning objectives in the NKLC appears to be high. However, many of these learning objectives are not addressed in the second medical licensing examination. We recommend better adjustments between the state examinations and the NKLC.


Assuntos
Currículo , Educação de Graduação em Medicina , Cirurgia Geral , Licenciamento , Competência Clínica , Cirurgia Geral/educação , Alemanha , Metas , Mãos/cirurgia , Humanos
19.
Rev. bras. ortop ; 54(3): 309-315, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1013731

RESUMO

Abstract Objective This study evaluates the conditions for microvascular procedures found by hand surgeons in Brazilian clinical practices. Methodology A prospective, observational, and analytical primary clinical research conducted during the 37th Brazilian Congress of Hand Surgery, from March 30th to April 1st, 2017, in Belo Horizonte, in which physicians answered 12 closed, objective, multiple-choice questions regarding their geographic region, type of institution (public or private), microsurgical training, time of experience, technical conditions, the availability of a standby team for emergencies and compensation. Results The study analyzed 143 hand surgeons; among them, 65.7% participants were based at the Southeast region, 13.3% in the Northeast region, 11.9% in the South region, 6.3% in the Central-West region and 2.8% in the North region. Regarding the time of experience, 43.4% of the hand surgeons had less than 5 years, 16.8% had 5 to 10 years, 23.8% 10 to 20 years, and 23% hadmore than 20 years of practice in microvascular surgery. Seven percent of the surgeons had no training in microvascular surgery; for 63.6%, training occurred during medical residency, whereas 30.8% were trained in another institution, and 7.7% in another country. Among these surgeons, 76.9% worked at both private and public hospitals, 14.7% at private hospitals and 5.6% at public hospitals. Regarding compensation, 1.8% of the surgeons considered it adequate, and 98.2%, inadequate in public hospitals, whereas 5.0% considered it adequate, and 95.0%, inadequate in private hospitals. Conclusion This research shows that most surgeons were trained in microsurgery, had never performed reattachments, and considered that compensation is inadequate; moreover, standby teams were not available. There are few, unevenly distributed hand surgeons with microsurgical ability in emergency settings, and their compensation is low.


Resumo Objetivo Avaliar quais as condições que o cirurgião de mão no Brasil tem encontrado na prática clínica para a realização de procedimentos microvasculares. Métodos Pesquisa clínica primária prospectiva, observacional, transversal e analítica; realizada no 37° Congresso Brasileiro de Cirurgia deMão, de 30 demarço a 1 de abril de 2017, em Belo Horizonte. Por meio de aplicação de questionário a médicos do Congresso, com 12 perguntas, respostas objetivas, fechadas ou de múltipla escolha; envolveram a região geográfica, o tipo de instituição, se pública e/ou privada, seu treinamento microcirúrgico, tempo de formação, condições técnicas, presença de equipe de retaguarda para urgências e remuneração. Resultados Um total de 143 médicos foram entrevistados, 65,7% atuavam na região sudeste;13,3% na região nordeste; 11,9% na região sul; 6,3% na região centro-oeste; e 2,8% na região norte. Do total de cirurgiões, 43,4%, atuavam há < 5 anos; 16,8% de 5 a 10 anos; 23,8% de 10 a 20 anos; e 23% há > 20 anos. Do total de cirurgiões, 7,0% não tiveram treinamento em cirurgias microvasculares; 63,6% realizaram treinamento na residência médica, 30,8% em outra instituição, e 7,7%, outro país. Do total de cirurgiões, 5,6% trabalhavam em hospitais públicos, 14,7% em hospitais privados, e 76,9% em ambos. Do total de cirurgiões, 1,8% consideravam adequada a remuneração nas instituições públicas e 5,0% nas instituições privadas; 98,2% consideraram inadequadas as remunerações nas instituições públicas e 95,0% nas instituições privadas. Conclusão A maioria obteve treinamento em microcirurgia, não fazia reimplantes, considerava a remuneração inadequada, e não dispunha de equipe de sobreaviso. Há escassez e má distribuição de cirurgiões de mão com habilidade microcirúrgica nas emergências e baixo valor de reembolso.


Assuntos
Reimplante , Fatores Socioeconômicos , Mãos/cirurgia
20.
Clin Plast Surg ; 46(3): 317-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103076

RESUMO

Tendinopathy and tendinitis are some of the most frequently encountered disorders in hand and upper extremity surgery. Patients often present with progressively increasing pain over a subacute or chronic period. In most cases it is a clinical diagnosis, with confirmation via advanced imaging. First-line treatment consists of conservative measures such as activity modification, splints, and injections. After a 3- to 6-month trial of nonoperative treatment, surgery usually involves decompression of the involved tendons and debridement of any inflammatory tissue. Patient and anatomic factors can affect the outcomes of both nonoperative and operative treatments.


Assuntos
Procedimentos Ortopédicos/métodos , Tendinopatia/terapia , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Contenções , Tendinopatia/cirurgia , Punho/cirurgia
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