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Ciudad P, Escandón JM, Manrique OJ, Escobar H, Pejerrey Mago B, Arredondo Malca A. Efficacy of Combined Spinal-Epidural Anesthesia for Lower Extremity Microvascular Reconstruction. J Surg Res 2023; 291:700-710. [PMID: 37562232 DOI: 10.1016/j.jss.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Some surgeons have raised concerns regarding the sympathectomy-like effect of epidural anesthesia during lower limb microvascular reconstruction. The combined spinal-epidural (CSE) anesthetic technique incorporates several benefits of spinal and epidural techniques in a single approach. The aim of this study was to analyze the postoperative outcomes of patients undergoing soft-tissue reconstruction of the lower limb by implementing the CSE anesthesia approach. METHODS We reviewed medical records from patients who underwent lower limb reconstructive procedures under CSE anesthesia with free tissue transfer from January 2017 to December 2020. We evaluated the postoperative outcomes. RESULTS Thirty-eight patients underwent microvascular reconstructive procedures of the lower extremity over the study period. The average age and BMI were 38.4-year and 28 kg/m2. All patients only had one postoperative rescue dose with epidural anesthesia. The most common type of flap used was the anterolateral thigh flap (53%). The average splinting time and length of stay (LoS) were 8.4 days and 18.4 days, respectively. Donor-site complications included wound dehiscence (3%) and surgical site infection (3%). Recipient-site complications included partial flap loss (8%) and total flap loss (10%). No pro re nata morphine analgesia was used. Tramadol and/or ketoprofen were administered for postoperative analgesia. The average time to start physiotherapy and to resume daily activities were 10 days and 29 days, respectively. CONCLUSIONS The CSE anesthesia for microvascular reconstruction of the lower limb demonstrated a similar success rate compared to historical records. CSE provided adequate pain management and none of the patients required postoperative monitoring in the ICU.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
| | - Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Hugo Escobar
- Department of Anesthesiology and Perioperative Medicine, Arzobispo Loayza National Hospital, Lima, Peru
| | - Bertha Pejerrey Mago
- Department of Anesthesiology and Perioperative Medicine, Arzobispo Loayza National Hospital, Lima, Peru
| | - Aida Arredondo Malca
- Department of Anesthesiology and Perioperative Medicine, Arzobispo Loayza National Hospital, Lima, Peru
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"Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, With a Focus on Free Tissue Transfer.". Plast Reconstr Surg 2022; 150:406e-415e. [PMID: 35674517 DOI: 10.1097/prs.0000000000009325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer, and use it to develop evidence-based care guidelines. METHODS A systematic review was conducted in Pubmed, Embase, Scopus, and Cochrane Library databases. Since a preliminary search of the pediatric microsurgical literature yielded scant data with low level of evidence (LOE), pediatric anesthesia guidelines for healthy children undergoing major surgeries were also included. Exclusion criteria included: vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. RESULTS 204 articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High quality data was found for anesthesia, analgesia, fluid administration / blood transfusion, and anticoagulation (LOE 1). Lower quality evidence was identified for patient temperature (LOE 3) and vasodilator use (LOE 4). Key recommendations include: administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin < 7 g/dl unless patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high risk patients. CONCLUSIONS Pediatric-specific guidelines are important as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
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Park JY, Suh HP, Kwon JG, Yu J, Lee J, Hwang JH, Hong JP, Kim YK. Epidural Anesthesia and Arterial Maximal Flow Velocity of Free Flap in Patients Having Microvascular Lower Extremity Reconstruction: A Randomized Controlled Trial. Plast Reconstr Surg 2021; 149:496-505. [PMID: 34898523 DOI: 10.1097/prs.0000000000008764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND One of the critical factors for free flap survival is to maintain adequate perfusion. The authors evaluated the effect of epidural anesthesia on arterial maximal flow velocity of the free flap in microvascular lower extremity reconstruction. METHODS This is a prospective randomized study where patients were allocated to receive either combined general-epidural anesthesia (epidural group, n = 26) or general anesthesia alone (control group, n = 26). After injecting epidural ropivacaine 10 ml in the epidural group, the effect on arterial maximal flow velocity of the free flap was analyzed using ultrasonography. The primary outcome measurement was the arterial maximal flow velocity 30 minutes after establishing the baseline. Intraoperative hemodynamics and postoperative outcomes such as postoperative pain, opioid requirements, surgical complications, intensive care unit admission, and hospital length of stay were also assessed. RESULTS The arterial maximal flow velocity 30 minutes after the baseline measurement was significantly higher in the epidural group (35.3 ± 13.9 cm/second versus 23.5 ± 8.4 cm/second; p = 0.001). The pain score at1 hour postoperatively and opioid requirements at 1 and 6 hours postoperatively were significantly lower in the epidural group [3.0 (interquartile range, 2.0 to 5.0) versus 5.0 (interquartile range, 3.0 to 6.0), p = 0.019; 0.0 μg (interquartile range, 0.0 to 50.0 μg) versus 50.0 μg (interquartile range, 0.0 to 100 μg), p = 0.005; and 46.9 μg (interquartile range, 0.0 to 66.5 μg) versus 96.9 μg (interquartile range, 41.7 to 100.0 μg), p = 0.014, respectively]. There were no significant differences in intraoperative hemodynamics or other postoperative outcomes between the two groups. CONCLUSION Epidural anesthesia increased the arterial maximal flow velocity of the free flap and decreased postoperative pain and opioid requirements in microvascular lower extremity reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Affiliation(s)
- Jun-Young Park
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyunsuk Peter Suh
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Geun Kwon
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jihion Yu
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joonho Lee
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jai-Hyun Hwang
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Pio Hong
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Young-Kug Kim
- From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Cesur S, Aksu C, Yaşar EK, Kus A. Popliteal block combined with continuous adductor canal block for pediatric free-flap surgery. Anaesthesist 2021; 71:159-161. [PMID: 34529094 DOI: 10.1007/s00101-021-01038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sevim Cesur
- Department of Anesthesiology and Reanimation, Kocaeli University of Medical Faculty, Umuttepe/Kocaeli, Turkey.
| | - Can Aksu
- Department of Anesthesiology and Reanimation, Kocaeli University of Medical Faculty, Umuttepe/Kocaeli, Turkey
| | | | - Alparslan Kus
- Department of Anesthesiology and Reanimation, Kocaeli University of Medical Faculty, Umuttepe/Kocaeli, Turkey
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Galitzine S, Wilson K, Edington M, Burumdayal A, McNally M. Patients' reported experiences and outcomes following surgical excision of lower limb osteomyelitis and microvascular free tissue reconstruction under 'awake' epidural anaesthesia and sedation. Surgeon 2021; 19:193-199. [PMID: 32616367 PMCID: PMC7323658 DOI: 10.1016/j.surge.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Orthoplastic operations for lower limb osteomyelitis (LLOM) involving microvascular free tissue reconstructions ("free-flaps") are usually performed under general anaesthesia (GA), with or without epidural anaesthesia (EA) due to concerns about the discomfort associated with prolonged surgery. However, our clinical experience supports "awake" epidural anaesthesia with sedation (EA + Sed) rather than EA + GA as a technique of choice for this type of surgery. METHODS We used a standardised postoperative questionnaire to formally assess the experiences and outcomes for 50 patients who underwent free-flaps for LLOM under EA + Sed. FINDINGS The mean duration of surgery was 522 min (8.7 h), range 240-875 min. There were no ITU admissions or flap failures. Postoperatively, fifty patients completed a standardised questionnaire about their experiences before the operation, in the anaesthetic room and theatre. 80% were aware of the procedure at least "some of the time". 72.5% patients and 75% respectively, did not have any concerns in the anaesthetic room and theatre. Concerns expressed by the remaining patients were manageable. 97.5% of those patients who recalled their operation reported their overall experience as "comfortable" or "very comfortable". 92% of respondents had undergone previous lower limb surgery under GA ± EA. In this subgroup, 91.3% reported the recovery after EA + Sed as "quicker" than GA, and 89.4% reported their experience with EA + Sed as "better". All fifty patients (100%) were "satisfied" or "very satisfied" with their experience and all but one (98%) would recommend this technique to others. CONCLUSIONS Our study showed that despite prolonged duration, the patients' reported experiences and outcomes were excellent when EA + Sed was used for orthoplastic operations involving free-flaps for LLOM. We recommend EA + Sed as the anaesthetic technique of choice for such patients.
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Affiliation(s)
- Svetlana Galitzine
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.
| | - Katy Wilson
- Anaesthetic ST6, Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.
| | | | - Amisha Burumdayal
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.
| | - Martin McNally
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
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Bosselmann T, Kolbenschlag J, Goertz O, Zahn P, Prantl L, Lehnhardt M, Behr B, Sogorski A. Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking. J Clin Med 2021; 10:2114. [PMID: 34068862 PMCID: PMC8153641 DOI: 10.3390/jcm10102114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects in most peripheral vascular compartments is available. METHODS A total of 30 patients who were to receive axillary plexus blockade (APB) were included. Microcirculatory assessment of the dependent extremity was conducted utilizing combined laser-Doppler flowmetry and white light spectroscopy. Two probes (1-2 and 7-8 mm penetration depth) were used to assess changes in microcirculation. RESULTS APB resulted in significant changes to both superficial and deep cutaneous microcirculation. Changes in blood flow were most prominent in superficial layers with a maximum increase of +617% compared to baseline values. Significantly lower values of +292% were observed in deep measurements. Consecutively, a significant enhancement in tissue oxygen saturation was observed. Further analysis revealed a significant impairment of perfusion characteristics due to reported nicotine consumption (max Bf: +936% vs. +176%). CONCLUSION Cutaneous microcirculation is strongly affected by APB, with significant differences regarding microvascular anatomy and vascular physiology. Smoking significantly diminishes the elicited improvements in perfusion. Our findings could influence reconstructive strategies as well as dependent perioperative anesthetic management.
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Affiliation(s)
- Talia Bosselmann
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Ole Goertz
- Department of Plastic Surgery and Hand Surgery, Burn Center, BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (O.G.); (M.L.); (B.B.); (A.S.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital, 14193 Berlin, Germany
| | - Peter Zahn
- Department of Anesthesiology, Intensive Care Medicine, Palliative and Pain Medicine, BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany;
| | - Lukas Prantl
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | - Marcus Lehnhardt
- Department of Plastic Surgery and Hand Surgery, Burn Center, BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (O.G.); (M.L.); (B.B.); (A.S.)
| | - Björn Behr
- Department of Plastic Surgery and Hand Surgery, Burn Center, BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (O.G.); (M.L.); (B.B.); (A.S.)
| | - Alexander Sogorski
- Department of Plastic Surgery and Hand Surgery, Burn Center, BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (O.G.); (M.L.); (B.B.); (A.S.)
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Park EP, Le JM, Gigliotti J, Feinstein J, Ying YP, Morlandt AB. Does Supplemental Regional Anesthesia Decrease Length of Stay and Opioid Use for Patients Undergoing Head and Neck Microvascular Reconstruction? J Oral Maxillofac Surg 2020; 79:712-721. [PMID: 32976833 DOI: 10.1016/j.joms.2020.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare length of hospital stay and opioid usage among head and neck surgery (HNS) patients treated with and without regional anesthesia for microvascular free-flap donor sites. METHODS The authors performed a retrospective cohort study for HNS patients undergoing microvascular free-flap reconstruction. The control group received no regional anesthesia. The experimental group had a regional anesthesia nerve block performed immediately before surgery. The primary outcome variable was length of stay, and the secondary outcome variable was total morphine milliequivalents. The data were analyzed using Student t tests, analysis of variance, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and multiple linear regression. RESULTS The study sample was composed of 148 patients with a mean age of 58.1 years. The mean length of stay for the control group was 6.74 ± 1.57 days, compared with the experimental group at 5.84 ± 1.01 days (P < .0001). The mean morphine milliequivalent was 256.5 ± 164.6 mg for the control group and 208.9 ± 164.8 mg for the experimental group (P = .56). Importantly, the demographics, pathology spectrum, flap selection, duration of procedure, and complication rate were similar in both groups. CONCLUSIONS This study demonstrates that for HNS patients undergoing microvascular reconstruction, regional nerve block at the donor site is associated with significantly shorter hospital stays. Although there was a trend toward decreased opioid usage in the regional anesthesia group, these results did not reach statistical significance. Consideration should be given to incorporate regional anesthesia techniques into early recovery after surgery protocols for centers performing high-volume head and neck microvascular reconstruction.
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Affiliation(s)
- Earl Peter Park
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Science Center, New Orleans, LA.
| | - John Minh Le
- Surgical Resident, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jordan Gigliotti
- Assistant Professor, Department of Oral & Maxillofacial Surgery, McGill University, Montreal, Canada
| | - Joel Feinstein
- Associate Professor and Director of Regional Anesthesia for University Hospitals, Department of Anesthesia and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yedeh P Ying
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Anthony B Morlandt
- Associate Professor and Section Chief of Oral Oncology and Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
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Lindsay KJ, Leonard DA, Higgins GC, Robertson E, Perks G. Invited editorial from the social media editor of JPRAS; Leadership in the time of COVID-19. J Plast Reconstr Aesthet Surg 2020; 73:1405-1408. [PMID: 32684344 PMCID: PMC7365634 DOI: 10.1016/j.bjps.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Free tissue transfer has become the standard in wound coverage and further refinements have given us newer flap donor sites or modifications of existing flaps to decrease morbidity; smaller vessels are being anastomosed, a direct spin-off following successful distal replantations. Younger children are presenting with traumatic defects similar to adults. Although there were apprehensions of free tissue transfer in children occasioned by smaller vessels, duration of procedure and concerns of growth following flap harvest, reports of small and large series have appeared in the literature with similar success. Pediatric-free tissue transfer is now an established entity. This article seeks to arrive at a consensus based on a review of the existing literature on free flaps for skin and soft-tissue coverage of lower limb trauma in children.
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Affiliation(s)
- R. Srikanth
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Jayaram K, Rao P, Gurajala I, Ramachandran G. Evaluation of the Effect of Regional Anaesthesia on Microvascular Free Flaps. Turk J Anaesthesiol Reanim 2018; 46:441-446. [PMID: 30505606 DOI: 10.5152/tjar.2018.91129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Multiple factors influence the success of microvascular free flap surgeries. Anaesthesia is an important factor to maximise the success rate of microvascular free flaps both by controlling haemodynamics and improving the perfusion of free vascularised tissue. The debate on the usefulness of regional and general anaesthesia for free tissue transfer is ongoing. This retrospective study was conducted to evaluate the effects of regional anaesthesia and other perioperative factors on outcomes of microvascular free flaps. Methods This retrospective observational study was conducted on 165 patients undergoing microvascular free flap surgeries between January 2014 and December 2015 after obtaining approval from the Institutional Ethics Committee (Nizams Institute Ethics Committee, Nizams Institute of Medical Sciences, India). Perioperative variables analysed included the type of surgery, indication, ASA physical status, type of anaesthesia, perioperative haemodynamics, fluids used, duration of surgery, re-explorations, blood transfusion and duration of hospital stay. The primary outcome measure was to assess the effect of regional anaesthesia on the success of free flap. Results Multivariate analysis identified the type of anaesthesia and preoperative haemodynamics as independent risk factors for predicting the failure of flap with an odds ratio of 0.208 and 7.469, respectively. A subgroup analysis of 55 acute trauma patients revealed preoperative haemodynamic instability as an individual independent risk factor for graft failure with an odds ratio of 11.90. Conclusion The results of this study emphasise the importance of the choice of anaesthesia and preoperative optimisation in improving the success of free flap surgeries.
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Affiliation(s)
- Kavitha Jayaram
- Department of Anaesthesia, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Prasad Rao
- Department of Anaesthesia, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Indira Gurajala
- Department of Anaesthesia, Nizam's Institute of Medical Sciences, Hyderabad, India
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Zhang X, Sun C, Bai X, Zhang Q. Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites. Head Neck 2018; 40:2670-2676. [PMID: 30387900 DOI: 10.1002/hed.25470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/20/2018] [Accepted: 08/22/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Xia Zhang
- Department of Anesthesiology, School and Hospital of StomatologyChina Medical University Shenyang People's Republic of China
| | - Changfu Sun
- Department of Oral and Maxillofacial Surgery, School and Hospital of StomatologyChina Medical University Shenyang People's Republic of China
| | - Xiaofeng Bai
- Department of Oral and Maxillofacial Surgery, School and Hospital of StomatologyChina Medical University Shenyang People's Republic of China
| | - Qian Zhang
- Department of Anesthesiology, School and Hospital of StomatologyChina Medical University Shenyang People's Republic of China
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Sabapathy SR, Bhardwaj P. Setting the Goals in the Management of Mutilated Injuries of the Hand-Impressions Based on the Ganga Hospital Experience. Hand Clin 2016; 32:435-441. [PMID: 27712746 DOI: 10.1016/j.hcl.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mutilated injuries need to be treated aggressively and appropriately to avoid amputation or severe disability in the individual. Assessment of the management of these injuries on a global level reveals that there is a gap between the need and availability of the skilled manpower to manage these injuries. There is also a gap in the utilization of the available services. These gaps need to be covered or narrowed as far as possible. Although some measures need policy changes and improvement of health care delivery infrastructure, simpler measures taken at the final health care delivery level can significantly improve the final outcome.
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Affiliation(s)
- S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
| | - Praveen Bhardwaj
- Hand & Wrist Surgery and Reconstructive Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
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