Evaluation of uncertainty in colony forming units on the disinfected skin of nurses in operation room / 现代临床护理

Objective To develop a feasible method for evaluating uncertainty in colony forming units(CFU)on the disinfected skin of nurses of operation room.Methods A nurse of operation room in a hospital involved the study.Ten spots on her disinfected hand skin were selected for evaluation of uncertainty in the acquired data and analysis of reliability of the evaluation methods,according to Technical Norms for Monitoring the Disinfection and Sterilization Quality in Hospitals in Jiangsu Province and JJF1059-1999 Evaluation and Expression of Uncertainty in Measurement.Results The CFU on the disinfected skin of nurse was(4±2)cfu/cm2, which indicated that the disinfection of the nurse's hands was not qualified.Conclusion The evaluation method by our study is reliable for evaluating the uncertainty in CFU on nurse’s disinfected hand skin.It is simple and fitful for the uncertainty evaluation of hospital disinfection effect.

Combined with the hand skin defect of the thumb and finger reconstruction / 中华显微外科杂志

Objective To determine the surgical approaches and evaluate the clinical efficacy of skin defects of the emergency thumb, finger reconstruction.Methods Emergency in 11 cases complicated skin defect of the thumb and the hand, fingers missing injured patients by using the method of combined of toenail flap of biped dorsalis pedis flap or the second toe.The implantation of thumbnail flap of dorsalis pedis flap combined with the second toenail flap was applied on 5 cases.3 cases had received the implantation of thumbnail flap of dorsalis pedis flap combined with the second toe and 3 cases with combined repair of the second toe of biped dorsal flap.Of all the cases, reconstruction of 3 fingers in 1 case, reconstruction of 2 fingers in 10 cases,5 cases with reconstruction by means of implantation of toenail flap of same pediele splitting flap or the second toe, 6 cases with repair of toenail flap of dorsalis pedis flap or second toe.Results Except for 1 necrosis occurred in 1 finger in 1 case of 3 fingers reconstruction, the rest of tissue flaps and fingers all survived.The primary healing was achieved postoperatively.The patients were followed up for 5-24 months.The functions such as grabbing, grasping, nipping were basically restored after the repair.The appearance of hand was also restored to a certain degree.Sensory recovery S2-S4 of reconstruction finger and flap was achieved.Healing was satisfying in the donor area, no obvious cicatricial contracture was seen, while the walk function was not affected.Conclusion The application of combined implantation of toenail flap of biped dorsalis pedis flap or the second toe in the repair of overall hand skin degloving injury could restore the function and appearance of the injured hands to a certain degree.It is proved to be an effective treatment method.

Use of 2-Octylcyanoacrylate (Dermabond(r)) for Repair of Hand Trauma

Dermabond(r) (2-Octylcyanoacrylate) has an eight-carbon alkyl derivative that is less inflammative and stronger than its short chain derivatives (i.e. 2-Butylcyanoacrylate, Histoacryl(r)). This study is to compare a tissue adhesive, 2-octylcyanoacrylate (Dermabond(r)), with conventional wound closure techniques for hand trauma. Thirty-eight patients presenting to Asan Medical Center Emergency Department with hand trauma from March 2003 to June 2003 were enrolled into this prospective clinical trial study. These patients were randomly assigned to treatment with either 2-octylcyanoacrylate or 5-0 monofilament sutures. The two groups were similar in both clinical and demographic characteristics. Photography taken at three months after treatment was rated by two plastic surgeons blinded to the method of closure. There was no difference between the two groups for appearance scores based on a visual analog scale (73.3mm for 2-octylcyanoacrylate versus 69.9mm for 5-0 monofilament sutures). The length of time for skin repair was similar between these two groups. (9.2 minutes for 2-octylcyanoacrylate versus 8.9 minutes for 5-0 monofilament sutures) Moreover, the use of 2-octylcyanoacrylate obviates the need for suture removal. In conclusion, the use of 2-octylcyanoacrylate for hand skin repair is an acceptable alternative, which includes many advantages to conventional suturing with a comparable cosmetic outcome.

Bilateral chest navel flaps with nerves for repairing the avulsion injury of total hand skin / 中华创伤骨科杂志

Objective To explore a therapeutic method for repairing the avulsion injury of total hand skin. Methods Bilateral chest navel flaps with nerves were used to repair the avulsion injury of total hand skin. Two nerves of the right lateral flap were anastomosed with the first and third common palmar digital nerves respectively; two nerves of the left lateral flap were anastomosed with the dorsum manus of ulnar nerve and cutaneous branch of radial nerve respectively. Results Postoperative follow up of 12 to 15 months showed that two cases were successful. The injured hands regained thalposis and thigmesthesia; the ulnar hand had sensitive thigmesthesia when touching a table; and the grasping function of the hand recovered partially. Conclusion Bilateral chest navel flaps with nerves are recommendable to all kinds of hospitals for repairing the avulsion injury of total hand skin.