PURPOSE: The purpose of this study was to identify the effects of heating on the non-affected hand on blood flow velocity, wound healing, and pain for hand microsurgery patients. METHODS: This study was designed using the nonequivalent control group pretest-posttest design. Thirty-nine patients were assigned either to the experimental group (20 patients) or control group (19 patients). Data were analyzed with chi2-test, Fisher's exact test, t-test, and repeated measure ANOVA using SPSS/WIN 17.0 program. RESULTS: After treatment in this program, blood flow velocity (F=5.13, p=.008) and wound healing (F=4.11, p=.020) improved significantly in the experimental group compared to the control group. But there was no significant improvement in pain in the experimental group compared to the control group (F=2.40, p=.097). CONCLUSION: Based upon these results, the non-affected side hand heating was recommended as an independent nursing intervention for the patients who need improvement in blood flow velocity and wound healing such as patients who have microsurgery. As the heating was effective even when applied on the non-affected side, it is the applicable to patients who cannot tolerate any therapy on affected side.
Adult ; Blood Flow Velocity/*physiology ; Female ; Hand Injuries/surgery/*therapy ; Humans ; Hyperthermia, Induced ; Male ; *Pain Measurement ; Time Factors ; Wound Healing/*physiology

OBJECTIVETo study the impacts of tetramethylpyrazine (TMP) intervention on hemorheology and blood coagulation before and after free skin flap transplantation, in order to provide new clues of applying Chinese drugs for activating blood circulation and removing stasis in microsurgery.

METHODSSixty patients undergoing free skin flap transplantation were randomly and equally assigned to two groups, the treatment group administered with tetramethylpyrazine, the control group with low molecular dextran, both were treated for 7 days. The survival rate of transplanted flap, hemorrheologic parameters and four blood coagulation associated indices (prothrombin time, thrombin time, activated prothrombin time and fibrinogen) were detected before and after treatment.

RESULTSComparisons of clinical efficacy and hemorrheologic indices showed no significant difference between the two groups (P > 0.05), but TMP showed less impacts on the four blood coagulation associated indices at the 24, 48 and 72 h after operation (P < 0.05).

CONCLUSIONTMP could prevent blood vessel crisis after free skin flap transplantation, so it is valuable in microsurgical clinical application.

Adult ; Female ; Hand Injuries ; drug therapy ; surgery ; Hemorheology ; drug effects ; Humans ; Male ; Microsurgery ; methods ; Middle Aged ; Perioperative Period ; Phytotherapy ; Pyrazines ; therapeutic use ; Surgical Flaps ; transplantation ; Young Adult

OBJECTIVETo analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively.

METHODSA total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test.

RESULTSTwenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001).

CONCLUSIONSSingle application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

Burns ; rehabilitation ; therapy ; Cicatrix ; therapy ; Contracture ; surgery ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Metacarpus ; Orthotic Devices ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin ; Skin Transplantation ; Tendons ; Time ; Traction ; Treatment Outcome

INTRODUCTIONHand infections in patients with end-stage renal failure (ESRF) are more diffi cult to treat and have had the worse outcomes. This paper examines the epidemiology, bacteriology and outcomes of surgically managed upper limb infections in these vulnerable patients.

MATERIALS AND METHODSAll patients from a single centre with surgically-managed upper limb infections between 2001 and 2007 were reviewed. We collected epidemiological data on demographics, type and site of infection, bacteriology, surgical treatment, complications and mortality.

RESULTSForty-seven out of 803 (6%) patients with surgically managed upper limb infections in the study period had ESRF. The average age was 59 years. ESRF was secondary to diabetes in 88% of cases. Patients presented on average 7 days after onset of symptoms. Abscesses (34%), wet gangrene (26%) and osteomyelitis (11%) were the commonest infections. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest pathogen (29%), occurring either in isolation or with other organisms. Eighteen percent of single organisms cultured were gram-negative. Multiple organisms occurred in 29%. A median of 2 operations were required. Thirty-six percent of all cases required amputation. Twenty-fi ve percent of patients had a life-threatening event (myocardial infarction or septic shock) during treatment.

CONCLUSIONSESRF patients present late with severe upper limb infections. Nosocomial infections are common. Initial empirical antibiotic treatment should cover MRSA and gram-negative bacteria. Immediate referral to a hand surgery unit is recommended. Multi-disciplinary management of the patient with input from physicians and anaesthetists or intensivists in the perioperative period is necessary to optimise the patient for surgery and to manage active medical comorbidities and complications after surgery.

Adult ; Aged ; Aged, 80 and over ; Amputation ; Diabetes Complications ; Epidemiologic Studies ; Female ; Hand ; surgery ; Hand Injuries ; epidemiology ; etiology ; surgery ; Humans ; Kidney Failure, Chronic ; complications ; epidemiology ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Surgical Wound Infection ; drug therapy ; epidemiology ; etiology