Variability in local pressures under digital tourniquets

The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study

OBJECTIVE

To investigate the effect of proprioceptive training on hand function and activity limitation in patients undergoing open carpal tunnel release surgery.

DESIGN

Randomized controlled study.

SETTING

A university hospital.

PARTICIPANTS

Thirty patients were included in the study and randomized to proprioceptive training (PT) and conventional rehabilitation (CR) groups.

INTERVENTION

One week after surgery, both groups received CR for 6 weeks. All participants were asked to perform home-based exercises daily in 3 sets with 10 repetitions. For the PT group, a 6-step PT program was conducted starting from Week 6. Both groups received face-to-face interventions twice a week for 12 weeks.

MAIN OUTCOME MEASURES

The outcome measures included the Purdue Pegboard Test (PPT), the joint position sense test (JPST), the Boston Carpal Tunnel Questionnaire, and the Patient-Specific Functional Scale. In total, 3 assessments were performed (at 1, 6 and 12 weeks postoperatively).

RESULTS

In the PT group, the results for PPT were statistically significant (P<.05). Although there was a greater decrease in the absolute angular error value (JPST) of the PT group compared to the CR group, the difference was nonsignificant (P>.05). Similar reductions in activity limitation were seen in both groups (PT: 176%, CR: 175%). Symptom severity decreased by 40% in the PT group vs 32% in the CR group. The effect sizes were larger for the changes between the second and third assessments in the PT group compared to the CR group in all parameters tested.

CONCLUSION

When applied after carpal tunnel release surgery, PT may potentially to improve hand functions, reduce activity limitation, increase participation in activities of daily living, and thus improve quality of life.

Smart Insole Based on Flexi Force and Flex Sensor for Monitoring Different Body Postures

This study aims to fabricate smart insoles using wireless Flexi force and bend sensing technology. Polyvinyl chloride (PVC) film was chosen as the substrate to hold all the sensors. The developed smart insole has a three-layer structure (insole-PVC layer-fabric layer) and is calibrated in an isolation laboratory to evaluate its measurement performance. One male volunteer subject exhibited four different body postures, namely tree pose, forward-leaning, squatting, and forward folding pose. Changes in pressure distribution were considered to be similar for the forward, squat, and forward-folded positions. When subjects performed a full squat, the flex sensor exhibited maximum flexion during the squat position, and the flex sensor response against the squat pose was found to be higher by about 18.18% than in the forward lean, respectively. The tree pose has the highest error rate at the first metatarsal, about 18.6%, of which the maximum absolute relative error of the sensor is less than 5%. Plantar pressure distribution and body posture measurements were successfully validated using Flexi force and flex sensors embedded in the smart insole. The smart insole proposed in this research work has broader prospects for clinical application.

Validation of digital tourniquet pressures: An experimental comparison of T-RingTM and conventional surgical glove in human volunteers

Digital tourniquets are widely used for the management of digital injuries in emergency departments or outpatient clinics. This study is focused on the pressure analysis of digital tourniquets on some points not covered in the existing literature.A total of thirty volunteers were enrolled in this study. Instantaneous surface pressure was measured at the thumbs, index fingers, and little fingers. We investigated the pressure according to the circumference of digits, tourniquet types, and measurement sites (dorsal and mid lateral volar sides) above the digital vessels. Continuous pressure was measured in artificial silicone models to determine the change of pressure over 2 hours.The average pressure measured on the mid lateral volar side of volunteers fingers were 154.3 ± 54.9 mm Hg by T-Ring and 162.6 ± 61.0 mm Hg by surgical glove. The pressure on the dorsal side were 224.7 ± 57.7 mm Hg by T-Ring and 228.8 ± 66.0 mm Hg by surgical glove, each significantly higher than the mid lateral volar side. The circumference of digits did not significantly affect the surface pressure. The pressure pattern did not change significantly over 2 hours in both tourniquet types.The surface pressure of the mid lateral volar side was significantly lower than that of the dorsal side. However, there was no significant pressure difference according to the circumference of digits. Time dependent pressure change were not significantly different between 2 tourniquets.

Digital revascularization and replantation using the wide-awake hand surgery technique

The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the 'wide-awake' anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis. Four cases had minor superficial soft tissue necrosis that healed secondarily. We conclude that digital revascularization and replantation can be performed under local anaesthesia with use of adrenaline and without detriment to the traumatized digit provided careful patient selection and adequate operator experience are available.

LEVEL OF EVIDENCE

IV.