By H. R. Mittelbach M.D. (auth.)
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Additional resources for The Injured Hand: A Clinical Handbook for General Surgeons
Example text
The operator can best maintain a "steady hand" during the often lengthy operations if he and his assistants are seated while working. Any unnecessary contact with the wound surfaces must be avoided. For this reason all sutures are knotted by instrument. Holding sutures are better than hooks for maintaining operative exposure. " A bloodless operating field makes swabbing largely unnecessary. If swabbing cannot be avoided, it should be done only with moist swabs (Ringer's solution or physiological saline) to minimize tissue trauma.
Primary Suture As a rule, a cleanly excised wound is immediately sutured shut, if this can be done without tension (Figure 38a,b). Sutures that are tied too tight or are too closely spaced lead to necrosis by the pressure of the wound edema (Figure 39a,b). A slight gaping of the wound edges, on the other hand, has no adverse effect on the healing process or the appearance of the scar (Moberg) (Figure 40). The suturing technique (simple loop suture. Figure 41, or vertical mattress suture after Donati, Figure 42) plays only a minor role in this regard.
In the case of fractures, the same applies to injection of the anesthetic into the fracture hematoma. The local anesthetic chosen should meet the following requirements: Low toxicity. Good tissue tolerance. Rapid onset of action. Long duration of action. Anesthesia in Hand Surgery 31 Anesthetics that satisfy these requirements include mepivacaine, lidocaine, and, for lengthy operations, bupivacaine. Complications with generalized reactions may result from an intolerance to the anesthetic, inadvertant intravascular injection, a disregard of contraindications to epinephrine-containing solutions, or overdose.