Pre-operative, Operative and Postoperative Guidelines
There is a high tendency towards post-traumatic swelling of the hand and foot, which must be considered in the timing of the operation. Operation must either be carried out immediately, or after swelling has decreased, which means a delay of some days. Where operation is postponed, the skin of the operation site should be disinfected on the eve of surgery with a sterile alcohol dressing; one must, however, ensure that no moist enclosure results. Close attention must be paid to asepsis; the shapes of the hand and foot render disinfection difficult and unreliable. The use of a pressure device which forces disinfectant into the skin has proved to be suitable for these parts (Herold and Heim). This is especially important as adhesive plastic drapes cannot be used on the hand. The movement of fingers, especially in flexion, must be constantly checked during the operation to prevent any rotational deformity. A bloodless field is provided by a pneumatic tourniquet which should not be left in place longer than 2 h in younger patients.