Background:
Access to theatre is a precious resource in some hospitals. This can lead to patient and surgeon frustrations with added fear of surgical site infection or a compromised result. In Hutt Hospital (Regional Plastics Unit) - there is one acute theatre which is shared across multiple specialties. This often means that open hand injuries including flexor tendons can wait longer for their surgery. Given the complexity of Zone II flexor injuries, this study explored whether a delay to theatre increased complication rate and revision surgery.
Methods:
A retrospective analysis was performed over the last 5 years 2017-2022 where all isolated soft tissue Zone II flexor injuries were reviewed. Basic demographics and other parameters including: mechanism of injury, repair technique/surgeon experience, antibiotic administration, co morbidities, time of injury to theatre and complication rate was recorded.
Results:
144 patients, 309 flexor tendons were included. Average age: 31 years, 78% Male, 45% NZ European, 32% Maori. Average theatre delay time 25hours, Average time from injury to theatre was 58 hours. In the Complication group(C) vs the No-Complication group (NC) the average hours to theatre: (C: 27 NC: 23), average hours from injury to theatre (C: 75 NC: 45). The complication rate included: rupture 2.8%, Need for tenolysis: 18%, Contractures (without further surgery): 2% and infection 2.8%.
Discussion and Conclusion:
Limited data has looked into delay to theatre and complication rates specific to zone II flexor injuries. This study shows that delay to theatre from time of injury is shown to substantially increase the complication rate and revision surgery notably need for tenolysis, particularly after day two. This can help units guide patient surgical priority to aid better outcomes.