IMPACT OF THE COVID-19 PANDEMIC ON EMERGENCY UPPER LIMB SURGERIES IN A QUATERNARY HOSPITAL.

The COVID-19 pandemic has triggered a global crisis in health systems worldwide. Emergency care services have been overloaded, and there have been different changes in the patient's profile and the most frequent diagnoses. The aim of the study was to compare the number of emergency surgeries in the Hand and Microsurgery group of the quaternary hospital (IOT-FMUSP) from March 2020 to February 2022, the pandemic period, with the previous two years, March 2018 to February 2020.

REPLANTATION OF THE THUMB OR REVISION OF AMPUTATION: AN EPIDEMIOLOGICAL STUDY.

Objetive: This article presents a retrospective cohort study analyzing patients from IOT-FMUSP who underwent replantation or revision amputation procedures for traumatic thumb amputation between 2013 and 2020.

Methods: The study included 40 patients in the replanted group and 41 patients in the amputed group. The patients were divided according to the level of amputation and their medical records were analyzed.

CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION?

Unlabelled: We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries.

Objective: To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results.

Comparative Analysis of the Treatment of Skin Lesions of the Lower Limbs with Sural Flap versus Propeller Flap.

 The objective of the present study was to prospectively compare the sural and propeller flaps for soft-tissues coverage of the lower extremity. The following variables were evaluated: incidence of complete or partial flap loss and donor area morbidity (primary closure versus skin graft).  Prospective and randomized analysis of data collected from all patients presenting with soft tissue defects of the lower third of the leg and heel treated with reverse sural or propeller flaps.

Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults.

 Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit.

Evaluation of Circular Saw Injuries in a Reference Center in Microsurgery and Reimplantation.

 To evaluate the epidemiologic profile, the time until care, and the type of conduct taken regarding patients who are victims of accidents with circular saws and their resulting injuries, and to make a comparison with the literature.  A cross-sectional descriptive study reviewing the medical records of patients cared for from April to December 2018, analyzing age, gender, injured side, affected fingers, month and time of the accident, type of injuries, procedures performed in the emergency room, time elapsed between trauma and admission to the operating room, and reapproach during hospitalization.  A total of 54 male patients aged between 15 and 72 years were care for.

EFFECT OF HYPERBARIC OXYGEN THERAPY ON NERVE REGENERATION IN RATS.

Objective: To evaluate histological changes in peripheral nerves of rats after sciatic nerve neurorrhaphy, according to the time of exposure to hyperbaric oxygen chamber treatment.

Methods: Twenty-five Wistar rats were divided into 5 groups according to the amount of exposure to hyperbaric oxygen chamber treatment. Group 1 was the control and there was no use of hyperbaric oxygen chamber; group 2 received one week of therapy; group 3, two weeks; group 4, three weeks; and group 5, four weeks.

Transfer of Second Toe for the Treatment of Traumatic Thumb Amputation in a Four-year-old Child: A Case Report.

Microsurgical toe transfer for thumb reconstruction is a challenging procedure, considering the technical skills necessary to perform it, as well as the difficult postoperative evaluation of esthetical and functional aspects. The present is the report of the case of a 3-year-old child who suffered a traumatic thumb amputation. Thumb reconstruction was performed through microsurgical toe transfer months after replantation failure.

Structured evaluation of a comprehensive microsurgical training program.

Objectives: This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons.

Methods: The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs.

Orthoplastic reconstruction in children: are the risk factors similar to those observed in adults?

Free flaps in the pediatric population are less common and when indicated the expectations to avoid amputation are high. The objective of this study is to describe indications and results of free flaps for limb reconstruction. Patients undergoing microsurgical free flaps in an orthopedic hospital were consecutively included in this cross-sectional study, from 2014 to 2020.

Do technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

Introduction: The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion.

THE DESIGN OF THE ARTERIOVENOUS VASCULAR LOOP DOES NOT AFFECT ITS PATENCY: EXPERIMENTAL STUDY.

Objective: To evaluate the effect of the design of a femoral vascular loop with anastomosis in the femoral artery of rabbits on the presence of flow (patency) after seven days.

Methods: A total of 39 rabbits underwent arteriovenous microanastomosis using the microsurgical technique. Two loop designs were used: one circular and the other angled.

IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?

Objective: Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery.

LIFE QUALITY EVALUATION USING "TIME TRADE OFF" METHOD FOR RHEUMATOID HANDS.

Objective: Rheumatoid arthritis is a prevalent disease in the population (range 0.5% to 1%) and involves both orthopedic and rheumatologic treatment. The Time Trade-Off (TTO) technique, which determines the number of years the patient or the professional would be allowed before a successful procedure in terms of life expectancy and value of the procedure, has been gaining ground in clinical protocols.

ARTHROSCOPIC ASSESSMENT OF THE WRIST WITH KIENBÖCK'S DISEASE.

Objective: Treatment of Kienböck's disease is challenging and the variability of results, despite the surgical technique, shows that there must be other aspects that can influence outcomes. The objective of this study is determine, through arthroscopic approach, the pattern of impairment of the carpal bones in Lichtman stage III patients.

Method: Wrist arthroscopy was performed in patients with symptoms and evidence of lunate necrosis on x-rays, with signs of 3A and 3B stages.

USE OF MAGNETIC RESONANCE IMAGING TO DIAGNOSE BRACHIAL PLEXUS INJURIES.

Objective: To compare magnetic resonance imaging and intraoperative findings in patients diagnosed with traumatic injury to the brachial plexus.

Methods: Patients with a diagnosis of traumatic injury to the brachial plexus admitted to the hand and microsurgery outpatient consult of the Hospital das Clínicas at the University of São Paulo were selected during December 2016. A total of three adult patients with up to six months of injury who underwent surgical treatment were included in the study.

Reduction of Morbidity With a Reverse-Flow Sural Flap: A Two-Stage Technique.

The reverse sural flap has often been used for cutaneous coverage of the distal region of the leg and ankle. When the flap is performed in 2 stages, the vascular pedicle is exteriorized and later resected. Our goal was to assess the reverse sural flap performed in 2 stages regarding its viability and low morbidity along the flap-donor area.

A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: a prospective, randomized, non-inferiority trial.

Objectives: Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP) and the standard of care (vacuum-assisted closure, VAC).

Correlation between the elbow flexion and the hand and wrist flexion after neurotization of the fascicles of the ulnar nerve to the motor branch to the biceps.

Objective: Gain in elbow flexion in patients with brachial plexus injury is extremely important. The transfer of a fascicle from the ulnar nerve to the motor branch of the musculocutaneous nerve (Oberlin surgery) is a treatment option. However, in some patients, gain in elbow flexion is associated with wrist and finger flexion.

Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes.

Objective: This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims.

Method: This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered.

Treatment of Preiser disease with vascularized bone graft from the distal radius: a report of two cases.

The authors report two cases of women with Preiser disease treated with dorsal distal radius vascularized grafts. In the first case, after minor trauma, the patient had pain in the left wrist of insidious onset and evolution with significant worsening. The radiographic examination showed increased density of the proximal pole of the scaphoid, and magnetic resonance imaging (MRI) showed partial necrosis.

Prognostic factors on survival rate of fingers replantation.

Objective: To evaluate the factors that influence the survival rate of replantation and revascularization of the thumb and/or fingers.

Methods: We included fifty cases treated in our department from May 2012 to October 2013 with total or partial finger amputations, which had blood perfusion deficit and underwent vascular anastomosis. The parameters evaluated were: age, gender, comorbidities, trauma, time and type of ischemia, mechanism, the injured area, number of anastomosed vessels and use of vein grafts.