RESUMO
BACKGROUND: High infection rates have been reported in hand procedures using the wide-awake local anesthesia no tourniquet (WALANT) method, causing some to question the validity of this approach. However, little evidence exists surrounding the direct use of WALANT compared with monitored anesthetic care (MAC). This study was conducted to directly compare the postoperative infection rates of carpal tunnel syndrome (CTS) and trigger finger (TF) release surgeries performed under WALANT and MAC. METHODS: A retrospective study comparing postoperative infection rates between patients undergoing CTS and TR releases was conducted. Our primary outcome measure was postoperative infection. Our secondary outcome was postoperative complications. Comparative statistics were used to compare means of infection between the groups. RESULTS: A total of 526 patients underwent CTS release (255 with WALANT and 271 with MAC), and 129 patients underwent TF release (64 with WALANT and 65 with MAC). Patients undergoing WALANT and MAC were statistically comparable in terms of sex, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. In patients undergoing CTS release, there were no infections with WALANT and 6 infections (2.2%) with MAC. In patients undergoing TF release, there were no infections in either group. There were similar rates of complications in patients undergoing WALANT and MAC for CTS and TF releases. CONCLUSION: There was no increased risk of infection with WALANT compared with MAC in CTS or TR surgeries. These surgeries can be safely conducted with lidocaine and epinephrine without a concern for increased risk of infections or complications.
Assuntos
Síndrome do Túnel Carpal , Dedo em Gatilho , Humanos , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Dedo em Gatilho/cirurgia , Estudos Retrospectivos , Anestésicos Locais , Complicações Pós-Operatórias/epidemiologiaRESUMO
La rotura primaria del tendón rotuliano es un cuadro poco frecuente que afecta principalmente a adultos jóvenes activos. Aun menos frecuente es la rotura crónica o recurrente del tendón rotuliano, y es esta última situación la que plantea una importante dificultad técnica a la hora de realizar el debido tratamiento quirúrgico. El objetivo de este artículo es presentar a un paciente que fue sometido a la reconstrucción quirúrgica del aparato extensor mediante el uso de aloinjerto luego de haber pasado por tres cirugías fallidas para la reparación del tendón rotuliano tras sufrir una lesión traumática. Se describen tanto la técnica quirúrgica como el protocolo de rehabilitación. Nivel de Evidencia: IV
Primary patellar tendon rupture is a rare condition most commonly seen in active young adults. Even less frequent is the chronic or recurrent rupture of the patellar tendon, the latter being the one which poses a greater technical challenge when performing a surgical treatment. Our objective is to present a case where the surgical reconstruction of the knee extensor mechanism was performed using an allograft. The procedure took place after three initial surgeries to repair the patellar tendon failed, following a traumatic injury. Both the surgical technique and the rehabilitation protocol are described. Level of Evidence: IV