Sensitive peripheral nerve repair during COVID-19 emergency: does the outpatient surgical setting work as well as the operating theater?

Leonardo Garutti; Federico Tamborini; Alessandro Fagetti; Tommaso Baroni; Elisa Bascialla; Andrea Minini; Mario Cherubino; Luigi Valdatta

doi:10.1007/s00238-023-02085-x

Sensitive peripheral nerve repair during COVID-19 emergency: does the outpatient surgical setting work as well as the operating theater?

Eur J Plast Surg. 2023 Jun 9:1-5. doi: 10.1007/s00238-023-02085-x. Online ahead of print.

Authors

Leonardo Garutti¹, Federico Tamborini^{2

3}, Alessandro Fagetti³, Tommaso Baroni¹, Elisa Bascialla¹, Andrea Minini³, Mario Cherubino^{1

2

3}, Luigi Valdatta^{1

2}

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy.
² Division of Plastic Surgery, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy.
³ Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy.

Abstract

Background: Nerve injuries are a common occurrence among hand injuries, which at the time of the COVID-19 emergency, did not appear to have reduced their incidence. The treatment of these injuries is urgent, but the pandemic has led to a reduction in the availability of resources and a consequent reorganization of activities. Principles about Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery expressed by LaLonde helped hand surgeons to adapt to this new condition by demonstrating a possible outpatient pathway for the treatment of hand traumatic conditions. In the present study, we bring our experience in nerve repair at time of COVID-19 emergency.

Methods: We retrospectively enrolled in this study all patients surgically treated for a peripheral nerve injury (PNI) during the COVID-19 emergency period from March 2020 to March 2022. Demographical, anamnestic, surgical, and postoperative data were recorded and analyzed. Persisting Tinel was set as the primary outcome, while hypoesthesia and other complications as secondary outcomes.

Results: Thirty-six patients have been enrolled. Despite some difference in group homogeneity in term of hypertension and multi-digital involvement, we registered no difference in term of outcomes (P > 0.05) between patient operated in surgical theater and in outpatient clinic and between the various techniques of nerve repair employed (P > 0.05).

Conclusions: Nerve repair on an outpatient facility is technically feasible and was found in this study to be safe and effective. Compared to hospitalization, the outpatient setting has a more "agile" organization and lower costs, making it preferable in selected cases.Level of evidence: Level IV, Therapeutic.

Keywords: Ambulatory hand surgery; COVID-19; Field sterility; Nerve repair; WALANT.