Table 4 Summary does patient selection or preparation influence outcomes of hand surgery
From: Hand surgery and hand therapy clinical practice guideline for epidermolysis bullosa
Key D = theoretical/foundational Quality of evidence: 1: systematic review with high bias risk, 3 = non-analytic studies, case reports, case series 4 = expert opinion ✓ = recommended best practice based on the clinical experience of the guideline development group Section 5A | |||
|---|---|---|---|
Outcome/recommendation | Recommendation strength | Quality of evidence | Key references |
Surgeons should respect individuals wishes; stage of deformity should not determine whether surgical intervention takes place | D✓ | 4 | |
At least 3 factors must be considered in surgical selection: degree of deformation (presence of secondary changes in joints, bones, tendons); individual’s ability to follow postoperative hand therapy, an individual’s desire to improve hand function with surgery | D✓ | 4 | |
Patient selection influences outcomes. Most important criteria: age, degree of deformity, these parameters are interconnected | D✓ | 4 | |
Pre and postoperative assessments using PROMs should be completed by a hand therapist as function is most valuable outcome | D✓ | 4 | |
Post-operative hand therapy should be in place prior to surgery to maximise outcome | D✓ | 4 | |
Individuals should be educated on likely outcomes, recurrence, and contraindications. Discussion of three main factors that determine recurrence rate: (1) severity of disease, (2) patient cooperation in postoperative program (3) type of graft used. (4) basic skin disease unaltered by surgery, recurrence therefore inevitable | D✓ | 4 | |
Surgery should not be completed if Hb below 100 g per litre (g/L) for wound healing | [44] | ||
An individual’s nutritional state needs to be optimized prior to surgery | |||
Preoperative assessment may influence outcomes. Important parameters are nutritional status, swabs, location of skin lesions Pre op swabs are essential, never operate with strep Postpone surgery if: Streptococcus, anemia < 70 g/L, poor nutritional status (in case you can improve it, aim for 100, if possible, iron infusion or blood transfusion may be needed pre-operatively), localization of the fresh wounds (i.e. on sites of regional block, or close to surgical field) | D✓ | 4 | |