Hs07
comparison of Betadine Paint and Plastic Bag Immersion Techniques for Surgical Site Skin Preparation in Hand Surgery

Abstract

The first published successful clinical replantation of the upper limb was first described by Malt and McKhan in 1962. Together with the refinement of reconstructive microsurgical technique, replantation of the upper limb at various levels has progressed at an astonishing rate and is now widely prac ticed worldwide. The vast majority of research into replantation of upper limb focuses on the digit. At the level of the wrist, the problems of failure of microsurgical anastomosis and tendon adhesions to pulley systems are less pronounced. However functional impairment as a result of the laceration of all tendons and nerves to the hand and bony misalignment is more marked. We outline theses issues with a case report of a 33 years old man who, in a self harm attempt amputated his left hand with a saw. He underwent a primary surgery to replant his hand, and subsequent surgery to improve function to his hand. In particular, we describe the dilemma of tendon transfer to improve opposition of the thumb, vital to fine pincer grip.Purpose: Cavitary type scaphoid nonunions represent a difficult treatment challenge as they exhibit bone loss, scaphoid shortening, flexion ("hump back") deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. We present our technique for these problematic cavitary nonunions and discuss its rationale. Methodology: A retrospective analysis was undertaken on a consecutive cohort of 19 patients that were treated by the relatively simple method of (1) excising the nonunion via a volar approach (2) packing the volar defect with cancellous autograft, harvested from the ipsilateral distal radius and (3) holding it out to length with two Kirschner wires and a plaster cast. Wires are removed at 10-12 weeks. Results: Union was achieved in (18/19) 95% of cases, with no compli cations, in an average of 9.7 (range 8-12) weeks. Carpal mechanics were restored, with an average carpal height index of 1.52 ± 0.07 and an average scapholunate angle of 46 ± 10 degrees. Average follow up was 2.2 years. Conclusion: In this subset of patients we believe this technique is less technically demanding than the use of either corticocancellous grafts or various compression screws. Our success equals that of other published tech niques, with all patients enjoying a full return to work even in occupations demanding heavy labour. We believe this may also be due to the ability of cancellous grafts to restore carpal height and normal carpal angles, thereby producing a better functional outcome.Purpose: Most textbooks, including "Terminology for Surgery of the Hand" name this ligament. Ingenious diagrams demonstrate its role in stabiliz ing the wrist in extreme ulnar deviation. The present study aims to verify this assumption.Methods: Eight embalmed cadaveric specimens, dissected to expose the fibrous apparatus on the radial side of the wrist joint were fixed to a stand by the radius and ulna. Const...