COMPARISON BETWEEN ADRENALINE AND WITHOUT ADRENALINE SOLUTION ON BLEEDING CONTROL OF SKIN GRAFT DONOR SITE: A RANDOMIZED CONTROLLED TRIAL

OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer’s lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) & 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique

PSYCHOLOGICAL IMPACT OF RIGHT HAND TRAUMA IN LABOR GROUP

OBJECTIVE: To determine the correlation between mean Disabilities of Arm, Shoulder, and Hand (DASH) scores and Impact of Event Scale-revised (IES-R) scores in laborer with right hand trauma. METHODS:  This correlational study was carried out at the Department of Plastic Surgery, Civil Hospital Karachi, Pakistan from January 2022 to June 2022. The inclusion criteria were laborers of any gender, age ≥18 years, presenting with right hand trauma having dominant hand infection and were medically fit and well and had no systemic illness. The severity of symptoms was assessed via DASH questionnaire. While psychological impact was assessed via IES-R.   RESULTS:    Out of 60 patients, 56 (93.3%) were males and 4 (6.7%) were females. Mean age of the patients was 45.07±14.96 years. Majority (n=50; 83.3%) of the patients were married. Overall, a moderate positive correlation was observed in between DASH score and IES score (r: 0.503, p: 5 years of experience (r: 0.663, p: <0.001); whereas strong positive correlation was observed for crush injury (r: 0.943, p: <0.001), puncture injury (r: 0.970, p: <0.001) and cut injuries (r:0.754: p=0.012). CONCLUSION: This study revealed a considerable relationship of DASH scale and psychological impairment in patients with right hand trauma. Worker who have gone through right hand trauma due to crush, puncture or cut injuries, married and those having more than 5 years of experience should be considered as high-risk population for psychological impairment