Management of patients with forearm and hand injuries

Background: Injuries to the hand and the forearm, particularly crush injuries have always been a major challenge to even the best of surgeons, whether it is a major case of a mangled hand by a high pressure injury or even a small case as an injury to the tip of the finger by getting squashed in a closing door. Any injuries in the forearm and the hand requires a very meticulous and thoughtful approach towards coverage with the aim of maximal restoration of function as well aesthetic appearance.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over the period of 12 months. Subjects were recruited from patients presenting in emergency/surgery OPD, HIMS, Dehradun with a primary diagnosis of soft tissue injuries in the forearm and the hand. A total of 114 patients were included in the study.Results: 39.5% (45 patients) were treated with combined modalities, including debridement, grafting & flap coverage. 14.1% (16 patients) required some form of orthopaedics intervention. 21.1% (24 patients) needed neurovascular or tendon repair surgery. 37.7% (43 patients) faced some sort of early or late complications.    Conclusions: Proper assessment and management of complex injuries of hand and forearm is mandatory for a good functional and aesthetic outcome.

Clinical profile of patients with forearm and hand injuries

Background: Hand injuries are among the most frequent injuries, constituting between 6.6% and 28.6% of all injuries. Hand and forearm injuries, however small or large they may be do have a significant impact on the society in terms of cost of treatment, hospital stay and costs of lost production and hence the importance of this study.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over the period of 12 months. Subjects were recruited from patients presenting in emergency/surgery OPD, HIMS, Dehradun with a primary diagnosis of soft tissue injuries in the forearm and the hand. A total of 114 patients were included in the study.Results: Overall mean age of the subjects in our study was 28.21±15.71. The highest incidence was in the age group of (20-40) years i.e. 62 (54.30%). Male to female ratio in our study was 6.6:1. Maximum injuries occurred as workplace and industrial injuries. This contributed to 34.2% (39 subjects) of overall injuries. 50% patients had crush injuries while lacerations, burn and avulsion were other form of injuries. 43 patients had bone and joint involvement,16 patients had neurovascular injuries and 20 patients had tendon injuries.   Conclusions: Hand and forearm injuries are more common in males and in the age group of 20 to 40 years leading to loss of productive working days causing a significant financial burden on the society.

An innovative device for creating tissue plane cleavage by hydro-dissection based on lever and ergonomic principle.

In the Third world countries, the occupational health of a Reconstructive Surgeon attracts due attention from the applied physiology fraternity, where the massive amount of surgical workload causes chronic fatigue and repeated stress and injury. The knowledge of human physiology and the science of ergonomics analyze these challenges and formulate guidelines for creating a work environment that is safe and comfortable for its operators. Presented here is an innovative, cost effective, sterilizable, manually controlled hydrodissection instrument for surgery. This easy to make Syringe Pressure Gun (SPG), has revolutionized the face of cleft palate surgery reducing the surgical time to 50% and the palatal fistula rate from 3% to Zero percent. The effects were studied on patients and the operating surgeon both. The experimental group comprising of 1500 cleft palate patients in whom the gun was used during surgery as compared to 500 controls showed statistically highly significant results in terms of reduction in average bleeding in millilitres (P<0.05), average operating time in minutes (P<0.001), palatal fistula formation (P<0.005) and reduction in surgical complications like flap necrosis. The results in the operating surgeon (self control) on using the instrument, showed highly statistically significant fall in the muscle strain induced by tedious surgical manoeuvres, as studied by EMG (P<0.005), subjective hand grip pain and tiredness on a scale of 0-10, high convenience in flap dissection and therefore work performance improved in spite of the high volume of surgery. This ergonomic innovation will provide clues for future inventions based on physiological principles for improving the occupational health of the doctors and outcome of the patients.

Effect of 1 week ‘61-points relaxation training’ on cold pressor test induced stress in premenstrual syndrome.

The present study was conducted on 50 clinically healthy women volunteers who were in their reproductive age group and in their premenstrual period. Thirty women having premenstrual syndrome (PMS) were compared with 20 control women to evaluate 1 week training of 61- points relaxation (61-PR) yogic exercise. In both the groups cold pressor test (CPT) was performed; and systolic blood pressure (SBP; mmHg), diastolic blood pressure (DBP; mmHg) and heart rate (HR/min) were measured. Basal SBP, DBP and HR of women with PMS was significantly higher than the control subjects with P value 1.2E-05, 0.000583 and 0.005707 respectively, suggesting the presence of stress in women with PMS. Immediately after CPT, the said parameters were statistically significantly more raised in PMS group than control group (P = 6.14E-05, 2.78E-06, 0.003799) respectively. Following 1 week of 61-PR training, the control group showed a significant decline in SBP, DBP & HR (P = 0.00769384, 0.00852894, 0.62316217) respectively. However, the PMS group showed a statistically highly significant reduction in SBP, DBP & HR (P = 2.55E-07, 4.35E-07 and 6.4904E-06) respectively immediately after CPT. These results suggest a reduction in sympathetic activity by 61-PR training and it can be used as an effective relaxation tool during premenstrual stress.

Effect of '61-points relaxation technique' on stress parameters in premenstrual syndrome.

Premenstrual Syndrome is a psychoneuroendocrine stress related disorder and more than 300 treatment modalities for PMS show that the existing remedies have not provided satisfactory help to relieve PMS. 61-points relaxation exercise (61-PR), a relatively less known hatha yoga technique, is a successful means of stress relaxation and is expected to relieve PMS as well. The present study was conducted on 50 clinically healthy women volunteers who were in their reproductive age group and in their premenstrual period, from which a control group (n = 20) and a PMS group (n = 30) based on the symptoms were identified. In both groups basal heart rate (HR/min), systolic (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), electromyogram (EMG; mV), electrodermal galvanic activity (EDG; microv), respiratory rate (RR/min) and peripheral temperature (T; degrees F) were recorded and the subjects were taken through a guided 61-PR. The symptoms and parameters were re-recorded after the 61-PR. In control group, the basal HR was 82.06 +/- 8.07, SBP 111.95 +/- 8.23, DBP 76.8 +/- 6.42, EMG 4.08 +/- 2.99, EDG 9.77 +/- 3.29, RR 15.60 +/- 3.77 and T was 97.86 +/- 0.63. After 10 minutes of 61-PR, HR (77.27 +/-10.85, P < 0.05), SBP (107.35 +/- 7.41, P < 0.05), DBP (75.25 +/-7.57, P < 0.05), EMG (2.07 +/- 1.90, P < 0.05), EDG (8.06 +/- 2.87, P < 0.05), RR (16.00 +/- 4.12, P < 0.05) fell significantly and T (97.97 +/- 0.64, P > 0.05) rose significantly. In the PMS group, the basal HR was 90.61 +/- 8.46, SBP 122.5 +/- 11.52, DBP 83.53 +/- 8.26, EMG 5.79 +/-2.75, EDG 13.14 +/- 6.54, RR 19.13 +/- 3.76 and T was 93.43 -/+ 5.29. After 10 minutes of 61-PR, HR (75.58 +/- 10.11, P < 0.0001), SBP (114.53 +/- 9.70, p < 0.0001), DBP (77.46 +/- 8.68, P < 0.0001), EMG (2.56 +/- 1.77, P < 0.0001), EDG (10.64 +/- 5.72, P < 0.0001), and RR (16.13 +/- 3.76, P < 0.0001) declined to a much greater extent and T (93.49 +/- 5.28, P < 0.0001) rose more significantly. These results suggest a reduction in sympathetic activity by 61-PR, also the high basal sympathetic tone present in subjects of PMS group due to stress is considerably reduced by relaxation. 61-PR is effective in providing relief from PMS and may be a useful adjuvant to medical therapy of PMS and other stress disorders.

Omental cyst--a rare entity.

A case of omental cyst in a young girl who presented with distension and a lump in abdomen and having difficulty in micturition is reported. Pre-operative diagnosis was achieved by ultrasonography. An exploratory laparotomy with excision of cyst was done and histopathologic examination of the specimen confirmed the diagnosis. The postoperative course was uneventful. The aetiopathogenesis, special features of the disease and review of literature is discussed.

Unusual frontal bone injury.

A 12-year old girl presented 6 months after a forehead injury due to fall from height. She had a deformed forehead with a rectangular bone defect and a rectangular bicortical bone fragment impacted into the lower edge of the defect. There was no obvious skin or dural injury. The deformed forehead was exposed through a bi-coronal scalp flap. The bone fragment was reposited back into the defect. The forehead of the patient healed with a smooth contour.