scholarly journals ANALIZA WSKAZAŃ DO I OCENA WYNIKÓW PO WTÓRNYCH OPERACJACH PO PIERWOTNYM ZAOPATRZENIU URAZÓW W OBRĘBIE KOŃCZYNY GÓRNEJ

2016 ◽  
Vol 60 (2) ◽  
Author(s):  
Andrzej Żyluk ◽  
Agnieszka Mazur
Keyword(s):  
Upper Limb ◽  
Primary Repair ◽  
Hand Function ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Finger Movement ◽  
Tertiary Institution ◽  
Secondary Interventions ◽  
Limb Injuries ◽  
Medical University

Introduction: The objective of the study was the analysis of the indications for, and assessment of the outcomes of secondary interventions after primary repair of injuries within the upper limb in the authors’ institution – Department of General and Hand Surgery of the Pomeranian Medical University in Szczecin (a tertiary care unit).Material and methods: Answers on questionnaires (including DASH) mailed to 33 patients were the subject of the analysis. The group consisted of 27 men and 6 women, mean age 36 years, in whom secondary interventions were performed at a mean of 8 months after primary surgery.Results: Injuries were grouped in five categories: tendon lacerations, hand or finger amputations, nerve sections, complex tissue injuries, and isolated finger fractures. The most common cause of secondary intervention was incomplete finger movement and lack of opposition of the thumb. The most common operations included tenolysis, arthrolysis and opponensplasty. The outcomes of secondary surgery from patients’ perspective were overall good: 13 (39%) patients reported significant improvement, 16 (48%) moderate, and only 4 (13%) patients had no benefit. Twenty­‍‑five patients regained full, or almost full hand function (DASH scores 2–39), and 8 (24%) had moderately to severely impaired function (DASH 40–80). Twenty­‍‑eight patients returned to work.Conclusions: Primary repair of upper limb injuries (even severe) in the tertiary institution was adequate, and secondary interventions rarely necessary. The most common indication was incomplete finger movement caused by ineffective postoperative mobilization. The important role of rehabilitation for the final outcome of the treatment of hand injuries was emphasized.

scholarly journals Self-inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Joice Geo ◽  
Cyril Joseph ◽  
Chintu Sabu George ◽  
Roy Abraham Kallivayalil
Keyword(s):  
Plastic Surgery ◽  
Upper Limb ◽  
Tertiary Care ◽  
Psychiatric Evaluation ◽  
Limb Injuries

Common Congenital Hand Differences

2018 ◽  
Author(s):  
Francisco Soldado ◽  
Scott Kozin
Keyword(s):  
Genetic Counseling ◽  
Global Health ◽  
Upper Limb ◽  
Hand Function ◽  
Treatment Algorithm ◽  
Hand Surgery ◽  
Thumb Hypoplasia ◽  
Thumb Duplication ◽  
Hand Defects ◽  
Reoperation Rates

Congenital differences of the hand are common in a pediatric hand surgery practice. The child’s global health and genetic counseling should be addressed before focusing on the upper limb disorder. Appropriate referral is necessary to facilitate education about the congenital difference and its effect on subsequent generations. The physician must be comfortable and have a sound understanding of the diagnosis and treatment algorithm. Reoperation rates are high for even the most common congenital hand defects treated by experienced surgeons. Syndactyly, polydactyly, thumb hypoplasia, and symbrachydactyly are particularly commonplace and are discussed in this review. The main aim when treating these disorders is improving hand function; however, aesthetics must also be considered when planning surgery. This review contains 36 figures, 3 tables and 50 references  Key words: congenital hand differences, pediatric hand, symbrachydactyly, syndactyly, thumb duplication, thumb hypoplasia

Patient and Surgeon Reported Experiences of Locoregional Anesthesia in Hand Surgery

2020 ◽  
Author(s):  
Jonathan Ricky Li Qi Leow ◽  
Hannah Jia Hui Ng ◽  
Sanjay L. Bajaj ◽  
Chandra M. Kumar ◽  
Vaikunthan Rajaratnam
Keyword(s):  
Patient Satisfaction ◽  
Upper Limb ◽  
Hand Surgery ◽  
Likert Scale ◽  
Tertiary Institution ◽  
Upper Limb Surgery ◽  
Locoregional Anesthesia ◽  
Almost All ◽  
Satisfaction Rates

Abstract Introduction Locoregional anesthesia techniques have been increasingly adopted for use in hand surgery in recent years. However, locoregional anesthesia techniques may place patients under significant psychological stress, and there has been limited evaluation of acceptance and satisfaction rates of these techniques. Materials and Methods An observational study was conducted in a single tertiary institution. Data were collected from patients undergoing upper limb surgery procedures with locoregional anesthesia. After completion of surgery, a questionnaire adapted from Evaluation du Vecu de l’Anesthesie LocoRegionale (EVAN-LR), with scores from 1 to 5 on the Likert scale, was conducted on the same day to evaluate patient satisfaction. Responses were also obtained from the operating surgeon to assess satisfaction. Results A total of 101 patients were evaluated as part of the study. All EVAN-LR domains received a mean score >4.5. Responses from surgeons also showed good acceptance of locoregional anesthesia techniques with almost all giving scores ≥4 on the Likert scale. Conclusion The results of this study showed good satisfaction and acceptance of locoregional anesthesia among patients for upper limb procedures. This provides reassurance regarding the quality of care with locoregional anesthesia techniques. It remains important to be aware of potential sources of discomfort such as tourniquet pain to minimize discomfort and maximize patient satisfaction.

The assessment of grip strength after upper limb injuries in medico-legal practice

2016 ◽  
Vol 85 (1) ◽  
pp. 23-32 ◽  
Author(s):  
HJCR Belcher
Keyword(s):  
Upper Limb ◽  
Significant Relationship ◽  
Normative Data ◽  
Hand Function ◽  
Legal Practice ◽  
New Approach ◽  
Specific Effects ◽  
Percentage Loss ◽  
Limb Injuries ◽  
Injury Causes

Four hundred adult claimants underwent medico-legal assessment following upper limb injuries. Dynamometry was performed on each using the Jamar five handle-position test. Injury causes loss of power and there is a significant relationship between the percentage loss of power and the measured whole limb impairment. This paper presents a new approach for the analysis of the tests. The normal physiological length–tension pattern of muscle is maintained in the majority of claimants albeit with modifications due to the specific effects of injury on hand function. This paper provides normative data for the analysis of dynamometry in this population and makes recommendations for parameters that suggest that a test is a true reflection of capacity and thus useable in court.

Mangling upper limb injuries in industry

Injury ◽  
1999 ◽  
Vol 30 ◽  
pp. S
Author(s):  
D RING
Keyword(s):  
Upper Limb ◽  
Limb Injuries

Prescribing trends of antidiabetic drugs in diabetic and hypertensive diabetic patients in an urban tertiary care hospital of Bangladesh

2017 ◽  
Vol 3 (3) ◽  
pp. 338-343
Author(s):  
Mohammad Didar Khan ◽  
Md. Ibrahim ◽  
Md. Mizanur Rahman Moghal ◽  
Dipti debnath ◽  
Asma Kabir ◽  
...  
Keyword(s):  
Urban Areas ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Age Group ◽  
Microsoft Excel ◽  
Patient Profile ◽  
Prescribing Trends ◽  
Medical University ◽  
Insight Into

Objective: The present epidemiological study was conducted with the objectives of providing an insight into the current use of antidiabetic medications to diabetics and hypertensive diabetics in urban areas and determining how the patient factors influence the prescribing of antidiabetic medications. Methodology: Data of patients of past two years were collected from Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh. The details were entered in the structured patient profile form. Data were statistically analyzed using the Microsoft Excel 2007 software. Result: A total of 958 patient’s data were collected and analyzed of which 632 (65.97 %) were males and 326 (34.03 %) were females. These patients were further categorized based on their age. 330 patients (34.45 %) belonged to the age group 20 – 44 years, 504 (52.61 %) to the age group 45 – 65 years and 124 (12.94 %) to the age group 65 – 80 years. 684 (71.4%) patients out of the 958 patients studied were suffering from coexisting hypertension. Co-existing hypertension was found to be more prevalent in the age group 45 – 65 years (67.69%) and was found more in females (84.04%). Conclusion: Metformin was the oral hypoglycemic which was the highest prescribed. In hypertensive diabetics Metformin and Pioglitazone were most frequently prescribed drugs. Biguanides and Insulin were the most commonly prescribed antidiabetics. A combination of two or more drugs of different classes was prescribed to hypertensive diabetics. It is necessary to have an improved understanding of the etiology and pathophysiology of diabetes to focus on research efforts appropriately.

Development and Usability Testing of a Web-Based and Therapist-Assisted Coping Skills Program for Managing Psychosocial Problems in Individuals With Hand and Upper Limb Injuries: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Folarin Omoniyi Babatunde ◽  
Joy MacDermid ◽  
Ruby Grewal ◽  
Luciana Macedo ◽  
Mike Szekeres
Keyword(s):  
Upper Limb ◽  
Coping Skills ◽  
Usability Testing ◽  
Psychosocial Problems ◽  
Skills Training ◽  
Hand Therapy ◽  
Web Based ◽  
Coping Skills Training ◽  
Limb Injuries ◽  
Prolonged Pain

BACKGROUND Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. OBJECTIVE This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. METHODS The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. RESULTS In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. CONCLUSIONS We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

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