How to prevent the avulsed soft tissues from wrapping around the K-wire

How to prevent the avulsed soft tissues
from wrapping around the K-wire
Dear Sir,
Bony fixation methods for amputated digits must
be simple, easy to use, create minimal additional
bone and soft tissue damage and must be applicable
with speed and consistency (Gordon and Monsanto,
1987; Whitney et al., 1990). Various methods such as
fixation with single or multiple K-wires, intraosseous
wires, plates and screws and external fixation have
been reported for this purpose (Yamano et al., 1982).
All these methods provide adequate fixation when
used properly.
We prefer to obtain fixation with crossed K-wires
in digital replantation cases in our clinic. Use of
K-wires produces acceptable alignment and adequate
fixation in our hands. However, in amputations
with avulsion of soft tissues, placing the K-wires may
be troublesome. It is difficult to retract the avulsed
and stretched vessels, nerves and tendinous structures
away from the K-wire while trying to obtain
proper alignment of the amputated and fractured
segments. Despite all efforts, these vital soft tissues
are frequently wrapped around the K-wires.
After dealing many times with this problem, we
have found a way to place the K-wire safely in
cases with avulsed soft tissues. Before inserting
the wire into the bone, we first pass it through a
plastic aspiration tube that is 5 cm in length and
slightly wider than the wire (Figure 1). The soft tube
not only keeps the soft tissues away from the K-wire
which is rotating at high speed but also does not
restrict its movements. This simple solution can be
applied whenever there is a risk of wrapping soft tissues
around the K-wire and difficulty in retracting the
soft tissues.