A simple dressing technique for full thickness skin grafting of the digit after dermofasciectomy was described in 2015. This is an alternative to tie over dressings, saving time in theatre and clinic and minimising discomfort for the patient.

The results of a simple wrap around dressing for full thickness skin grafting following dermofasciectomy in Dupuytren’s disease are presented.

A defatted, fenestrated, graft is secured with interrupted 5.0 absorbable sutures. On top of this is placed a layer of non-adherent Mepitel (Mölnlycke Healthcare). Guaze swabs are added for pressure and exudate management. Wool wrap secures this then buddies it to the next digit before a volar slab is applied in extension for 1 week. Thermoplastic splinting and hand therapy are then commenced with fresh mepitel covered by a Premierpore dressing (Shermond, UK) until full healing.

22 cases were identified from operative records. 20 were primary cases and 2 were revisions. One patient had 2 full thickness skin grafts to different digits. All grafts took successfully. There were no post-operative haematomas. 1 patient had loss of under 1cm of graft which healed fully by granulation and 2 patients had a small area of over-granulation which had silver nitrate cautery in clinic and healed fully.

This technique offers a simple and effective alternative to the traditional tie over dressings saving time in theatre and clinic and avoiding discomfort for the patient.

INTRODUCTION: Side effects related to collagenase treatment for Dupuytren's disease is controversial issue due to the large number of minor adverse effects presented according to the opinion of the treating physician. OBJECTIVES: To assess the number of complications perceived by patients, find the degree of concordance patient-surgeon, and their relationship with short-term satisfaction. METHODS: Prospective observational study. Complications were listed using a 4-item Linkert-type questionnaire. Satisfaction with the result was assessed with a 5-point Linkert scale reconverted to a dichotomous variable to facilitate statistical analysis. Change on clinical status was carried out using the BriefMHQ questionnaire and satisfaction with the care process through the first part of the PEM questionnaire. RESULTS: Complications perceived by the patients were 1.48 and 2.18 by the surgeon on average. There was no concordance with what was perceived as a secondary effect with the surgeon and the patient, except for skin breakdown (very weak, k = 0.257) (hematoma k=0.031, local pain k=0.061, arm pain k=0.196 and allergic reaction k=0.000). Brief-MHQ improvement was 12.1 SD 10.8 (p <0,001). Positive patient’s satisfaction with the procedure was 88%. Eighty-nine of the patients would repeat this kind of treatment. CONCLUSIONS: Complications are not perceived by patients in the same way as surgeons and consider them as minor or with little impact. The concordance of what is perceived as a secondary effect after infiltration with CCH between the patient and the surgeon is nil. Only the presence of skin laceration has minimal agreement and affects short-term satisfaction.

INTRODUCTION: Treatment success in Dupuytren´s disease has traditionally been assessed by clinical examination and physical measures but, based on patient orientation, patient-reported outcome measures (PROMs) can be used to quantify treatment impacts and health-related quality of life from the patient’s perspective. OBJECTIVE: To compare the most widely used PROMS in Dupuytren´s disease, their psychometric properties, and their association with objectively measured hand function. METHODS:
Prospective study based on administration of two disease specific questionnaires —the Unité Rhumatologique des Affections de la Main (URAM) scale and the Southampton Dupuytren’s Scoring Scheme (SDSS) —and two hand specific questionnaires—the Brief Michigan Hand Outcomes Questionnaire (briefMHQ), and the Patient Evaluation Measure (PEM). Psychometric properties were calculated for all the questionnaires. RESULTS: Ninety-two completed both sets of questionnaires. Pre- and post-treatment scores was strongly correlated (Spearman rho >0.6) for all questionnaires. High internal consistency (Cronbach alpha >0.88) was observed for all the questionnaires. Test-retest reliability was also significant, with an ICC of >0.50 in all cases. The MCID was similar for three of the questionnaires (URAM, 11.528/45=0.256; SDSS, 5.079/20=0.254; and PEM, 21.542/77=0.215) and somewhat lower for the briefMHQ (10.617/60=0.177). No correlations were observed between treatment outcome and hand (r = 0.107; p = 0.31), joint (r = 0.163; p = 0.12), or finger (r = -0.151; p = 0.15) treated. CONCLUSION: We did not find that any one questionnaire performed better than the others in detecting perceived changes in health status among patients with Dupuytren´s disease.

Postoperative dressing protocols after clean surgery without implant vary widely. The purpose of this study was to elucidate whether early postoperative dressing removal is a valid option, as compared to untouched dressing or twice-weekly dressing change approach. A prospective randomized study was conducted on patients who underwent carpal tunnel release (CTR) or trigger finger release (TFR) between January and November 2020. Patients were randomly distributed into 3 groups: surgical dressing untouched until first follow up (SDU); surgical dressing changed twice a week in a health maintenance organization (HMO); and surgical dressing removed at first postoperative day (SDR). Data collected included patient characteristics, pre-and post-operative functional (QuickDASH) and autonomy (Instrumental Activities of Daily Living performance (IADL)) scores, Vancouver scar scale (VSS) and potential complications. Eighty-four patients were included: 28 (33.3%), 29 (34.5%) and 27 (32.1%) in the SDU, HMO and SDR groups, respectively. Deterioration in mean IADL score at 2-week follow-up was statistically significant in the HMO group (mean delta 3.35, p = 0.008). Quick DASH score improved significantly between preoperative and 2-week follow-up values only in the SDU group (mean delta 9.12, p = 0.012). Other parameters, including wound complications, did not differ significantly between groups. Early removal of postoperative dressing and immediate wound exposure was a safe option after CTR and TFR. An untouched bulky dressing correlated with early functional improvement. Finally, iterative dressing change in HMO showed no benefit and led to significant deterioration in early postoperative autonomy.

Since the beginning of Ambulatory Surgery in Portugal in the 90's, the activities in Ambulatory Surgery Units have quality and safety, so these Units have brought together the best conditions for the maintenance of scheduled surgical activity in the era of COVID-19.
Ambulatory Wrist and Hand Surgery offers a safe and economical option for a variety of surgical procedures.
Particularly at the time of Covid-19, the Wrist and Hand Group at our hospital maximized the number of patients undergoing outpatient surgical procedures, as well as their complexity.
During the period covering the last 3 months of 2020 (October-December), 192 patients were operated on in the context of outpatient surgery.
The potentiation of the Hand surgery was due to a greater availability of weekly rooms, analgesic optimization, possibility of overnight stay and referral of patients with traumatic injuries directly from the Emergency Department.
In the referred period, there were no complications in the postoperative period and the level of patient satisfaction was high.
In conclusion, Ambulatory Surgery during the Covid-19 pandemic, offers a safe and economical option for a variety of surgical procedures and has become the preferred choice over the Central Block for most procedures. Thus, in addition to becoming a field to continue to be explored in the future, it is also an example to be followed by other subgroups in the specialty.

Background:The pandemic of COVID-19, resulted in the UK entering lockdown,March-May 2020.This study evaluates the effect of the lockdown, on management of hand injures via our institution’s virtual fracture clinic(VFC).Methods:All patients referred with hand injuries via the Queen Alexandra Hospital, Portsmouth,VFC in April, May 2020 were included.Carpal and wrist injuries were excluded. Demographics, mechanism of injury,and management were recorded. Forming comparator groups for pre- and post-lockdown, equivalent data were collected for 50 patients before lockdown in December 2019, January 2020, and after restrictions in July,August 2020.Results:58 patients referred during the lockdown. Pre-lockdown 162 patients referred, and post-lockdown 181 patients referred (64% and 68% fewer, respectively). The mean age was similar for each period (pre = 36.1 years [SD 20.3], during = 36.3 years [22], post = 33.7 years [22.8]). Falls, punching, sporting and crush injuries were commonest pre-lockdown(32%, 20%, 20% and 18% respectively).Sporting and punching injuries reduced during lockdown (14.8% and 4.5% reduction, respectively), whereas falls and crush injuries (5.9% and 6.2% increase, respectively). Cycling injuries were highest during lockdown (6 during, none pre-, and 3 post-lockdown), as was direct discharge from VFC (65.5% during,34% pre-,47.2% post-lockdown).One patient was planned of surgery during the lockdown,did not attend, the remainder were treated non-operatively.No patients from any period re-attended with a complication.Conclusions:Lockdown imposition does not abolish the burden of hand trauma and certain injuries increase. This should be considered when planning service provision during future lockdown periods.The majority of hand injuries can be managed non-operatively, with a low rate of re-attendance and complications.

Purpose: To perform an analysis of electric scooter (e-scooter)-related upper limb fractures (ULF), the most common e-scooter-related injuries, which have increased dramatically in parallel with the rapid rise in the use of e-scooters and shared e-scooter services in recent years.
Methods: We retrospectively reviewed the medical charts of e-scooter-related emergency department (ED) visits between January 2017 to January 2020 in a level-I trauma center. All patients with ULF were included in the study, and their data were analyzed for demographics, fracture diagnosis (using the AO/OTA classification), associated injuries, and required surgical treatment.
Results: This study included 359 patients (49.3% males) with 461 ULF, of which 25 were open fractures (5.4%). The mean age of the cohort was 33 years (standard deviation 10.5). The most common mechanism of injury was rider fall (89.7%). The non-dominant hand was injured in 52.6% of cases, and 31.2% of all fractures were treated operatively. A total of 122 patients (34.0%) sustained more than 1 ipsilateral ULF, and 27 patients (7.5%) had a concomitant contralateral fracture. Radial head fracture was the most common fracture type (n = 123, 26.6%) of which 16 (13.0%) were bilateral. The 5th ray was injured most frequently (n = 33, 47.1%) among the metacarpal and phalange fractures. Most of the non-orthopedic-associated injuries were head and maxillofacial.
Conclusion: Physicians should be alert to and seek associated fractures during initial assessments of e-scooter-related upper limb injuries. The use of mandatory upper limb safety gear and its enforcement are of paramount importance.

Introduction: chronic tendinous mallet finger injuries are commonly treated with an open operative fixation.Aim: to evaluate a new technique of closed reduction and fixation using a percutaneous figure of 8 suture for treating closed tendinous mallet finger injury. Method: We conducted a retrospective analysis of prospectively collected data of 15 consecutive patients, undergoing percutaneous fixation of chronic mallet finger injuries. All patients had failed conservative splinting of duration 10.5 weeks (9-12 weeks) with a residual extensor lag of the distal interphalangeal joint greater than 30 degrees. Surgery was performed using a minimally invasive technique using a 3-0 proline suture in a percutaneous figure of 8 pattern, by going through the periosteum on both sides and providing rigid hyperextension. Patients were kept in a splint for 7 days followed by full mobilisation under supervision of hand therapists. Results: The average age of our cohort was 51 (40-62 years old). At an average of 6.2 months All patients achieved correction of deformity to less than10 degrees. The overall functional outcome was good to excellent in all patients with no incidence of recurrence at last follow up. There was no instance of skin necrosis or wound complications in any of the patients. Conclusion: The new figure of 8 percutaneous technique is an effective, safe and minimally invasive approach for closed tendinous mallet finger injures. This needs further validation by analysing outcomes in a larger cohort.