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Results of the Treatment of Major, Complex Hand Injuries

100%

Żyluk A., Janowski P.

Polish Journal of Surgery

2011

vol. 83

issue 2

87-94

Complex hand injuries are associated with serious consequences including long period off-work, permanent disability, inability to return to original profession or to work at all. As these injuries are common, they create considerable economical consequences and, therefore, it is desirable their treatment would be as perfect as possible to reduce potential loss of function.The aim of the study was analysis of the structure of complex, multi-structural hand injuries and evaluation of the outcomes of the treatment of these injuries in both medical (recovery of function) and economical (period of inability to work and costs of medical care) aspects.Material and methods. The study presents the results of treatment of 78 patients suffered from severe, major hand injuries, involving damage of at least two of four anatomical structures within the hand or wrist (bones, tendons, arteries or nerves) as well as severe injury involving at least two digits. Functional results were assessed at a mean of 10 months after the accident. Tendons were repaired in all 42 patients, bones were fixed in 29 (69%), nerves were repaired in 21 (50%), arteries in 14 (33%) and in two patients skin defect was covered by the flap (one local and one groin flap).Results. Total active motion of affected digits amounted 2/3 of normative active motion of the healthy digits and total grip strength approximated half of the grip strength of the unaffected hand. In patients with nerve injuries, a satisfactory recovery of sensation in the affected digits was obtained. Dexterity of the hand in daily activity was scored 30 points in DASH scale. Injury-related duration of sick leave in 31 patients worked at the time of the accident amounted 4.4 months in average (range 1-12). A total of 27 subjects (87% of worked) returned to work: 24 to their previous profession and three had to qualify for a new job. Total hospital costs of the treatment in the analysed group amounted a mean of 2600 PLN.Conclusion. The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.

A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

81%

Żyluk A., Puchalski P., Walaszek I., Janowski P.

Polish Journal of Surgery

2008

vol. 80

issue 11

615-620

Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.

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2 Polish Journal of Surgery

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2 Janowski P.

2 Żyluk A.

1 Puchalski P.

1 Walaszek I.

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Results of the Treatment of Major, Complex Hand Injuries

A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial