and wrist Slows the blood movement through dressing Offers a local - PowerPoint PPT Presentation

• Focal pressure applied only to the proximal end of artery in the upper arm and elbow • Focal pressure applied to BOTH the proximal and distal ends of the artery in the forearm and wrist

• Slows the blood movement through dressing – Offers a local hemostatic solution • Chitosan provides for improved attachment & apposition of the dressing to the injury site • Chitosan binds red blood cells and platelets on the dressing’s surface – Provides for localized clotting independently from the normal clotting cascade* ➢ mitigates risk of emboli formation

• Strong adherence to damaged tissues and physiologic seals wound • Chitosan swells, gels and sticks together • Gel-like clot without an exothermic reaction • Completely independent of the body’s clotting mechanism – BENEFITS • Need direct pressure after application

• Indications and contraindications • Every amputation does not require a tourniquet • Most catastrophic-explosion • Mortality from injury or multiple amputations or explosive mechanism

• Absolute limits of tourniquet time have never been firmly established or universally accepted • SAFE DURATION-45 minutes to 4 hours • 2 hours most widely accepted figure • Wilgis produced the rational for 2 hour limit

• Amputated part placed into moist gauze (COMPLETELY COVERED) • Gauze placed and sealed in a plastic bag • Plastic bag placed into a plastic bag with water and ice • AMPUTATED PART MUST BE COMPLETELY COVERED

• Directly on or in ICE - FROZEN

• Submerged in Listerine, Gatorade, milk, dry ice, etc.

• Surgical team – 24 hours a day – hand & microsurgeon • Two available per day – Postoperative nurse experienced with microsurgery (1-2 years training) • National standard • NO health system provides this coverage in central Ohio

• What is a hand & microsurgeon? – Orthopaedic – Bone – Orthopaedic – Ligament – Orthopaedic – Joint – Ortho/plast/gen – Tendon – Neurosurgeon – Nerve – Vascular surgeon – Artery/vein – Plastic surgeon – skin

• Must be a thoroughly trained and accomplished hand surgeon (5 years) • Must be a competent microsurgeon (10 years) • Must have experienced postop management

• Hand and microsurgery needs to be regionalized at one center – Expertise – Reduces delay to repair • Health systems currently drive decentralization • Health system don’t mandate competency

• Hand & Microsurgery Associates is 1/51 recognized groups capable of replantation, revascularization and care of the mangled hand and upper extremity • Only group in Ohio recognized by ASSH • Only group in Ohio with 6 replantation/microsurgeons • Only 170 replantation/microsurgeons in USA