Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery

Summary: There is currently no consensus on the optimal suture type for palmar skin closure following open carpal tunnel release and trigger finger release. We performed a retrospective analysis of patients in the Palo Alto Veterans Affairs (PAVA) Health Care System who underwent these procedures over a 2-year period to compare 30-day wound outcomes following closure with poliglecaprone 25 (Monocryl), nylon, and chromic gut suture. Out of 312 PAVA cases (133 carpal tunnel release, 179 trigger finger release), incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012). On multivariable logistic regression, suture type and diabetes were independent predictors of 30-day wound complications and extra encounters. At PAVA, compared with Monocryl, closures with nylon and chromic were significantly more likely to dehisce and/or become infected [nylon: odds ratio (OR), 5.0; 95% CI, 1.9–13.3 and chromic: OR, 9.3; 95% CI, 2.7–32.4; P = 0.002], and to be associated with an additional encounter (nylon: OR, 2.4; 95% CI, 1.1–5.3 and chromic: OR, 4.5; 95% CI, 1.6–12.9; P = 0.007). This has led to using Monocryl as the standard closure for these cases at PAVA.
Source: Plastic and Reconstructive Surgery Global Open - Category: Cosmetic Surgery Tags: Ideas and Innovations Source Type: research

Related Links:

The objective of this study was to assess the relationship between multiple TF and systemic or musculoskeletal disorders in a sample of young patients.Material and methodA retrospective study was performed of all patients with TF operated in our hospital between 2011 and 2015. Multiple or single TF diagnosis and pathologies such as diabetes mellitus (DM), thyroid dysfunction, carpal tunnel syndrome (CTS), epicondylalgia or DeQuervain's disease were collected. Statistical results included a bivariate analysis and a multiple logistic regression.ResultsTwo hundred and seventy-nine patients with a mean age of 48.45 years ...
Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research
AbstractPurposeAromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs.MethodsPostmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with...
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
Authors: Zochodne DW Abstract Peripheral neurons are targeted by a 'double hit' during diabetes mellitus. First, they are damaged directly; diabetic polyneuropathy is a progressive neurodegenerative disorder that involves sensory, autonomic and eventually motor neurons. The second 'hit' involves a profound impairment in the ability of peripheral axons to regenerate. This is important because the impairment impacts on how patients may recover from polyneuropathy. Moreover, diabetic patients also develop direct focal injures of peripheral nerves, such as carpal tunnel syndrome and ulnar neuropathy at the elbow. Their...
Source: Expert Review of Endocrinology and Metabolism - Category: Endocrinology Tags: Expert Rev Endocrinol Metab Source Type: research
ConclusionThere was no significant association between the patterns of electronic devices use and CTS symptoms. The high prevalence of CTS symptoms necessitates awareness programs, especially among the young population. Although this work did not prove the association, further studies with confirmatory clinical testing are recommended.
Source: The Egyptian Rheumatologist - Category: Rheumatology Source Type: research
AbstractIntroductionTo estimate lifetime prevalence of diabetes-related upper limb and non-acquired skin manifestations in a representative type 1 diabetes (T1D) population and to identify associations between these conditions and quality of life.MethodsA questionnaire on these complications and measures of quality of life (World Health Organization –Five Well-Being Index [WHO-5]), depression, and diabetes-specific burden (Problem Areas in Diabetes [PAID] scale) was sent to all T1D patients in a Danish clinic (N = 583).ResultsThe response rate was 68.6%. Lifetime prevalence of any upper limb soft tissue...
Source: Diabetes Therapy - Category: Endocrinology Source Type: research
Abstract Chikungunya (CHIK) has re-emerged as a potential neurotropic virus, with outbreaks recently being reported from many parts of India. The present study was conducted to study the spectrum and outcome of neurological complications in patients of CHIK during the 2016 outbreak in Delhi. A total of 42 cases seropositive for IgM CHIK antibodies by MAC-ELISA and developing neurological complications were enrolled. The male:female ratio was 1:2 (age range = 18-90 years). The neurological manifestations observed were encephalitis (n = 12), bulbar palsy (n = 3), acute disse...
Source: Tropical Doctor - Category: Tropical Medicine Authors: Tags: Trop Doct Source Type: research
Shri RamNeurology India 2019 67(7):55-61 Carpal tunnel syndrome (CTS) is a disease caused by compression of the median nerve passing through the wrist. Patients suffer from severe pain and paresthesis in the median nerve. Compression of the median nerve occurs, with prolonged working on keyboards (computer or laptop or music players) being one of the reasons along with others such as diabetes or rheumatoid arthritis. CTS research holds great promise for the patients as well as doctors for better medical treatment. The study has been carried out with an objective to analyze research progress based on the literature publish...
Source: Neurology India - Category: Neurology Authors: Source Type: research
De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus,...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
ConclusionsThenar atrophy and sensory loss were highly specific in CTS but had limited value in early detection. Due to their low specificity, provocative tests do not appear sufficient enough to establish a definite CTS diagnosis. Only Durkan’s test could possibly be considered initially as it has more balanced values. Diabetes, obesity, rheumatoid arthritis, hypothyroidism and gout significantly increase the risk of CTS.
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Background: Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes, especially in those with diabetic polyneuropathy. Our study aims were to investigate the validity of the Tinel sign in diagnosing tibial neuropathy and determine the prevalence of tibial nerve entrapment in both a diabetic and nondiabetic population. Methods: Two hundred forty nonneuropathic subjects with diabetes and 176 diabetic subjects with neuropathy participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy complaints were evaluated. All su...
Source: Plastic and Reconstructive Surgery - Category: Cosmetic Surgery Tags: Hand/Peripheral Nerve: Original Articles Source Type: research
More News: Carpal Tunnel Syndrome | Diabetes | Endocrinology | Health Management | Plastic Surgery | Skin