15018752330
发表时间:2015-12-08 浏览次数:538次
Unburied K-wires left projecting from the fingers after hand surgery can
lead to inadvertent injuries if left open, especially in children or
disoriented patients, particularly at the time of reversal of anesthesia
and in the immediate postoperative period. Different ways have been
described to circumvent this. Many surgeons twist the K-wire on itself
along with capping of the wire tip, but this requires considerable
twisting force on an already inserted K-wire, which can lead to
malalignment or even refracture. [1] Furthermore, the bent K-wire acts like a hook, catching onto dressing materials or clothes and subsequently may migrate out.
We
present a simple and effective way of preventing such mishaps caused by
unburied K-wire ends using silicone blocks. Silicone blocks are
routinely used in procedures like dorsal nasal augmentation and
interpositional arthroplasty for temporomandibular joint ankylosis. [2]
A small cuboid of silicone block is obtained from a solid silicone
block or from a left-over silicone block after sculpting for other
indications. The block is approximately 0.5 cm Χ 0.5 cm Χ 1.5 cm in size
and is inserted gently and with constant pressure over the K-wire end.
The
silicone block fits snugly over the K-wire and in our experience
spontaneous expulsion of the block from the K-wire tip has not occurred [Figure 1]. The chance of the deeper migration is also minimized.
Sterilization of the silicone block is not essential but is desired,
especially in the case of left-over blocks. Capping of the K-wire can
be done as the last step of hand surgery after dressing. However in
procedures where further operative steps are needed following K-wiring,
sterilization of the silicone is a must. This can be planned
preoperatively. Our theatre nurse routinely makes a sterilized block of
silicone available in all hand surgery cases where K-wiring is needed.
The
semi-rigid consistency of the silicone minimizes chances of penetrating
injuries to the patient or caretakers. However, patients are counseled
regarding proper precautions to prevent inadvertent injuries due to long
silicone blocks. Being inert, there is less chance of allergenicity as
well. One major advantage is the availability of silicone blocks in most
operation theatres.
Silicone block capping is a simple and effective way of preventing injury due to unburied K-wire tip.
References
1.Nicolaou M, Fleming A. A simple and cost-effective method of protecting unburied K-wire ends. Ann R Coll Surg Engl 2009;91:714-5.
2.Chuangsuwanich A, Lohsiriwat V. Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: a 15-year experience. Indian J Plast Surg 2013;46:533-7.