Hand Problems ============= þ Fingertip Avulsions - Wounds with an area less than 10 x 10 mm generally do not result in the loss of functional ability to palpate. [Clinical Procedures in Emergency Medicine (2nd ed) by Roberts and Hedges, p747.] þ Amputations - The temperature of the amputated part is the most important variable. Warm ischemia may be tolerated for 6 to 8 hours, but when cooled properly to 4 degrees centigrade, 12 to 24 hours of ischemia may be tolerated, depending on the body part. þ Hand and Wrist Fractures þ Horseshoe Abscess of Palm - A horseshoe abscess of the palm refers to a concurrent infection of the radial and ulnar bursae via a bursal communication in the palm of the hand (present in 50% of people). Treatment requires IV antibiotics and operative debridement. Ref: Rosen 3rd ed. p 553, 580 þ Discussion: which suture type for extensor tendon lacerations? - Date sent: Wed, 9 Jul 1997 15:08:32 -0500 From: "Jonathan A. Handler" At 11:14 AM 7/9/97 +0000, you wrote: >On 7 Jul 97 at 12:49, TANMAN wrote: > >> tendon 3.0 vicryl > >For hand tendons, I was taught (and do) repair them with 4-0 Prolene, >with the expectation that they will stay there permanently rather >than being absorbed like Vicryl. Of course, one wants to minimize >irritation so positioning and size of knots are important. Healing and remodeling occurs over several months, but once this process is completed, I had always thought that there was no advantage to continue to have a foreign body present in the tissue. If this is indeed the case, then wouldn't PDS (polydioxanone) be the suture of choice in these cases? It is very strong, very secure (much more so than prolene), minimally irritative, and if I am not mistaken, it takes a very long time to absorb (?5-6 months?). If correct, would it seem that this would be an ideal suture material for closing tendons? ----------------------------------- Date sent: Thu, 10 Jul 1997 14:10:41 -0400 From: Ricardo Tappan Just to reiterate what Jon said about PDS it has a tensile strenght of 100% for 30 days, 50% retention of 5-6 months. This makes ideal but less then perfect for high tension areas. Vicryl on the other hand has a tensile strenght of 14 days and 2-3 months. In addition due to it's wick like structure it has a tendency to saw through tissue if not used carefully. Personally most hand docs i have worked with strictly use non-absorbables. About two years ago I started to use a product called mersiline which is a non-absorbable, varient of nylon, but a lot smoother, flexible and very strong, most of the plastic hand people I know use this for tendon-hand injuries. While not a physician I did and still do work (part time) in a busy ED where techs do 99% of all suturing. Our training is about a year long and our results are impressive. There's a few ED docs on this list who I hlped instruct in the art of wound repair. Hi Jon send me an address and I'll be happy to send you a few of our wound management books we just published. Take care Rick Tappan, EMT/P MEDCOR Inc. George Washington University Dept. of Emergency Medicine ----------------------------------------