OKOJ, Volume 13, No. 9

Complications of Vascular Access Lines in the Hand and Upper Extremity

Vascular access is often necessary in the inpatient and surgical settings. Peripheral intravenous access is the most common type of such access, with arterial access also often used. Although procedures for both peripheral intravenous and arterial access are generally recognized as safe, complications can and do occur with their use. The hand and upper extremity surgeon may be called on to manage some of the more severe complications of vascular access, such as infection, compartment syndrome, neuropathy, ischemia, or extravasation. This review discusses the most common types of vascular access in the upper extremity, their associated complications, and the management of these complications.

    • Keywords:
    • peripheral intravenous catheter

    • arterial access

    • infection

    • hematoma

    • pseudoaneurysm

    • phlebitis

    • thrombophlebitis

    • extravasation

    • vasospasm

    • thrombosis

    • embolism

    • Subspecialty:
    • Hand and Wrist

Recurrent Dupuytren Disease

Dupuytren disease poses two challenges to the treating surgeon: prevention of its recurrence through the primary procedure used for treating it, and treatment of its recurrence. As compared with average recurrence-free intervals after fasciectomy for Dupuytren disease, such intervals are shorter after minimally invasive treatment and longer after dermofasciectomy. In addition to surgical technique, local anatomy and diathetic factors influence the risk of recurrence of Dupuytren disease after its treatment. Recontracture may be due to the biology of Dupuytren disease, to pathologic changes resulting from its prior treatment, to tissue changes resulting from chronic joint contracture, or to a combination of these factors. A logical approach to treating recurrent Dupuytren disease requires consideration of the technique used for its prior treatment, the timeline to recontracture, the degree of deformity incurred by the disease, and patient selection.

    • Keywords:
    • recurrent Dupuytren contracture

    • fasciotomy

    • fasciectomy

    • dermofasciectomy

    • enzymatic fasciotomy

    • needle aponeurotomy

    • collagenase injection

    • Subspecialty:
    • Hand and Wrist

Knot Tying 101: Hip To Be Square

Orthopaedic surgeons spend most of their surgical planning thinking about bones and hardware. However, respecting the soft tissues (eg, the skin) is a key factor in promoting healing after orthopaedic surgery, particularly in the setting of trauma or infection. Attending and resident physicians alike often think that they are tying square knots, when in reality they are throwing a series of half hitches in opposite directions, ultimately creating a slip knot. The purpose of this article is to review the nature of a square knot, demonstrate how to tie a square knot, and review the most common error in technique that young surgeons often demonstrate in the operating room. With this article and the two video presentations accompanying it, we hope that tying knots square becomes more widely practiced, accepted, and understood.

    • Keywords:
    • knot tying

    • knots

    • square knot

    • slip knot

    • suture

    • stitch

    • Subspecialty:
    • Sports Medicine