Scientific Abstract Presentations: Hand 6 Sunday, October 29 Sun, Oct 29 2:30-3:30 p.m. CDT

BACKGROUND: Recalcitrant carpal tunnel syndrome (CTS) represents a clinical challenge for hand surgeons. Perineural adhesions are often identified during revision surgery, and biologic wraps and synthetic grafts may reduce further scarring. There remains a lack of consensus regarding the optimal method of nerve coverage, and our aim is to compare outcomes in patients undergoing either an adipofascial flap or Axogen nerve wrap.

MATERIAL AND METHODS: A retrospective cohort comparison was conducted on patients who underwent revision carpal tunnel release (CTR) with either Axogen nerve wrap or adipofascial flap for coverage of the median nerve. Demographic data (age, gender, race, smoking status, and medical history), pre-operative symptoms, and EMG data were collected. Primary outcomes were postoperative symptoms, VAS, and PROMIS scores.

RESULTS: A total of 77 patients underwent revision CTR, with 51 (66%) receiving adipofascial flap coverage and 26 (34%) synthetic nerve wrap. Of these, 21 patients reported persistent symptoms since index surgery, 54 had recurrent symptoms, and no patients reported new symptoms. No differences were noted in severity noted (p=0.918) and presence of CTS (p=0.168) on preoperative EMG. Intraoperatively, the most common site of nerve compression was the transverse carpal ligament (TCL) for both the adipofascial (n=33) and nerve wrap (n=10) cohorts, with most patients demonstrating excessive tenosynovium (66% and 58%) and reconstitution of the TCL (78% and 65%). The mean follow-up time was 4.3 months for the adipofascial cohort and 6.7 months for the nerve wrap cohort. While both groups showed improved numbness/tingling and nighttime symptoms; when compared, there were no significant differences seen in post-operative numbness/tingling (p=0.291), nighttime symptoms (p=0.278), and VAS scores (p=0.573). Nerve wrap patients had higher post-operative PROMIS scores (p=0.005).

CONCLUSION: Patients who underwent median nerve coverage with either adipofascial flap or synthetic nerve wrap during revision CTR experienced similar postoperative outcomes in terms of numbness/tingling, nighttime symptoms, and VAS scores. Synthetic nerve wrap patients did report higher PROMIS scores; however, the clinical significance of this is unclear. The results of this study suggest that both adipofascial flap and synthetic nerve wrap may warrant equal consideration in patients suffering from recurrent CTS.

Purpose: Violent hand trauma has devastating implications in pediatric patients, but the epidemiology and injury patterns for this group are not well described. This study characterizes violent injuries among pediatric hand trauma patients in order to identify risks associated with violent hand trauma.

Methods: A retrospective review was conducted of all pediatric hand trauma patients presenting to our institution between 2010 and 2020. Patients were grouped into violent and non-violent cohorts. All charts were abstracted for demographic and clinical details. Population estimates and socioeconomic data were obtained from the United States Census Bureau. Summary statistics were computed, and a binomial regression was used to compute relative risks (RR). Significance was assessed at alpha=0.05.

Results: 1,311 patients sustained hand trauma, with 124 (9.5%) violent injuries. Among these patients, the average age was 14.1 ± 3.5 years. 27 of these patients (21.8%) were female, and 64 (51.6%) were non-white. The most common violent mechanisms were punching objects (n=46, 37.1%), assault (n=32, 25.8%), punching people (n=28, 22.6%), and accident (n=18, 14.5%). 23 patients (18.5%) required surgery. Displaced fractures, puncture injuries, and tendon injuries were more likely to involve violence (RR 1.55, CI 1.30-1.86, p<0.001; RR 4.94, CI 1.68-14.50, p=0.001; RR 2.16, CI 1.15-4.05, p=0.02). The small finger (n=65, 52.4%) and ring finger (n=37, 29.8%) were the most injured digits and were more associated with a violent injury mechanism (RR 1.39, CI 1.11-1.75, p=0.008; RR 1.45, CI 1.02-2.06, p=0.04, respectively). Metacarpal fractures were the most common site of injury (n=74, 59.7%) and were more likely to occur with violence (RR 4.85, CI 3.97-5.91, p<0.001). Hand trauma requiring nerve repair had an eight-fold greater likelihood of occurring with violence (RR 8.65, CI 1.23-60.77, p=0.009). Patients with median household incomes between $54,000 and $70,999 had a greater risk for violent hand injury (RR 1.49, CI 1.19-1.86, p=0.001). Finally, male gender, African American race, and age >12 years at the time of injury were all associated with violent injury mechanisms (RR 1.24, CI 1.12-1.37, p<0.001; RR 2.13, CI 1.72-2.62, p<0.001; RR 2.06, CI 1.83-2.31, p<0.001, respectively).

Conclusions: This represents the largest reported cohort in pediatric hand trauma to date, and our findings highlight several risk factors for violent hand injuries. In our population, adolescent African American males were at the highest risk for violent hand trauma. In addition, injuries to the ring and small finger, metacarpal injuries, and right-sided injuries are more likely to occur by violent mechanisms. These findings have important implications for injury prevention and can help emergency providers triage violent injuries for early referral to hand surgeons.

Introduction: Vascular malformations (VMs) involving the upper extremity (UE) are a heterogeneous group of lesions that can pose unique functional challenges. Surgery remains amongst the mainstays of VM treatment, but contemporary literature on surgical management of VMs are sparse. This longitudinal retrospective study aims to provide an update on the surgical management and outcomes of pediatric patients with upper extremity VMs a.

Methods: A retrospective review of patients evaluated at the Children's Hospital of Philadelphia between 2010-2021 was performed. Inclusion criteria were patients under age 18 with UE VMs who had surgery within the study period; exclusion criterion was lack of operative management. Demographics, lesion characteristics, treatments, and outcomes were collected. ANOVA, chi-square, and Fisher's exact tests were used for data analysis.

Results: A total of 34 patients and 43 operations were identified, with an average of 1.26 operations per patient (range 1-3 operations).. Average age was 5.83 years. Patient demographics included: 22 white (64.7%), 24 male (70.6%) patients with 22 right-sided (64.7%) malformations. Venous malformations were the most common (16/34, 47.1%), followed by VMs not otherwise specified (6/34, 17.6%), venolymphatic malformations (5/34, 14.7%) and lymphatic malformations (3/34, 8.8%). Lesions located on the hand were most common (13/34, 38.2%), followed by the forearm (9/34, 26.5%) and upper arm (5/34, 14.7%). The average lesion diameter was 3.64 cm. 29.4% (10/34) of patients had malformations that were associated with a functional deficit, including pain, limited range of motion, and nerve palsy. Four operations were performed after first trialing sclerotherapy. All malformations were managed with direct surgical excision, with 76.7% (33/43) requiring subcutaneous excision and 20.9% (9/43) requiring subfascial/intramuscular excision. Neurolysis was required in 5/43 (11.6%) operations. Forty-one (95.3%) of the excisions were primarily closed, and 1 (2.3%) had full thickness skin graft and 1 (2.3%) had a local flap. Three operations (7%) had complications, including a hematoma, wound necrosis, and intra-operative blood transfusion. Seven patients (16.2%) patients had recurrence requiring additional operative management. Amongst patients with at least one year of documented follow-up, 70.8% (17/24) had no residual VMs, but 29.2% (7/24) had persistent VMs despite treatment.

Conclusions: Surgery is a safe and effective option for localized, well-delineated UE VMs and can often be used to achieve primary closure on lesions with relatively low complication rates. It may be utilized more often in subcutaneous locations over deeper involvement. In line with other literature, recurrence is fairly common, and a proportion of patients may continue to have residual lesion despite treatment.

Purpose

Firearms are the second leading cause of mortality in children, but risk factors for pediatric hand firearm injuries are not well described. This study examines the pediatric hand trauma population to identify injury characteristics and risks associated with firearm injuries.

Methods

This was a retrospective cohort of pediatric hand trauma patients from 2010-2020. Patients were grouped into firearm and non-firearm injury cohorts. All charts were abstracted for demographic and clinical details. Population estimates and socioeconomic data were obtained from the United States Census Bureau. Summary statistics were computed, and a binomial regression was used to compute relative risks (RR). Significance was assessed at alpha=0.05.

Results

1,311 patients sustained hand trauma, with 22 (1.7%) firearm injuries. The most common firearms were air rifles (n=11, 50%), and pistols (n=9, 40.9%). Among air rifle injuries, 7 (31.8%) were from BB guns, while 4 (18.2%) were from pellet guns. The most common mechanisms were intentional assault (n=9, 40.9%), accidental assault (n=7, 31.8%), accidental self-inflicted discharge (n=5, 22.7%), and intentional self-inflicted discharge (n=1, 4.5%). 18 patients (81.8%) required ED management, and six (27.3%) required surgery. Injuries of the palm/dorsal hand and webspace were common (n=4, 18.2%, each), associated with greater risk of firearm involvement (RR 10.97, CI 3.51-34.32, p<0.001; RR 34.22, CI 6.74-173.61, p<0.001, respectively). Nerve injuries were less common (n=3, 13.6%), but had four times greater risk of firearm involvement (RR 4.06, CI 1.36-12.16, p=0.01). Open fractures were the most common (n=7, 31.8%), and more frequently involved firearms (RR 4.55, CI 3.27-6.34, p=0.02). Comminuted fractures were most likely to involve firearms (RR 7.72, CI 3.89-15.30, p=0.003). The most frequent management was splinting (n=11, 50%), but nerve repair and foreign body removal were more likely to involve firearms (RR 19.43, CI 2.12-177.91, p<0.001; RR 9.71, CI 1.23-76.60, p=0.009, respectively). Lastly, African American race had 2 times greater risk of firearm injury compared to other races (RR 2.00, CI 1.31-3.08, p=0.007).

Conclusions

This represents the largest reported cohort in pediatric hand trauma to date, and our findings highlight several risk factors for firearm injuries. African American patients with webspace, nerve, or palm/dorsal hand injuries have the highest risk of firearm injuries. In addition, open and comminuted fractures are more likely to occur by firearm. These findings have important public health and safety implications, aiding in the evaluation of firearm injuries for early referral to hand trauma surgeons.

Purpose:
The purpose of this study was to compare the number of elective hand surgeries performed during the pandemic to a corresponding pre-pandemic time-period and to quantify the impact to the surgical backlog in hand surgery.

Methods:
Patient health records for individuals who underwent surgical management of carpal tunnel syndrome (CTS), Dupuytren's disease (DD) or stenosing tenosynovitis (time-periods: March 2018 to July 2019 [pre-pandemic] and March 2020 to July 2021 [pandemic]) were retrieved from two academic institutions. The primary outcome was number of surgeries performed in each time-period. Secondary outcomes included wait-times for each surgery type during the pandemic compared to the corresponding pre-pandemic time-period. Wait-time was defined as the time-period between the surgeon's decision to treat surgically and the time of surgery (Wait 2). Cumulative percentage tables were generated to determine the proportion of patients that fell above a pre-determined cut-off of 182 days (a government-set target wait-time). A univariate comparison of wait-times and variables determined a priori (age; gender; socioeconomic status; geographic location; and comorbidities) was completed.

Results: The search retrieved 906 patient records (586 carpal tunnel release (CTR) cases, 153 fasciotomy/subtotal palmar fasciectomy cases and 167 pulley release/tendon release cases). Fifty-four patient records were pulled in duplicate. Patient records that exceeded more than one year were omitted as per care guidelines (n = 137). Therefore, 715 cases were included (447 CTR cases, 135 fasciotomy/subtotal palmar fasciectomy cases and 133 pulley release/tendon release cases). Two-hundred-and-sixty-four elective hand procedures were performed during the COVID-19 time-period, compared to 451 in the pre-pandemic time-period (n= 187, 41.5%). The number of surgeries for CTS reduced the most, with 291 surgeries during the pre-pandemic time-period compared to 156 performed during the pandemic (n=135, 46.4%). In regard to wait-times, 84.1% of CTR patients underwent surgery before the target wait-time cut-off in the pre-pandemic period compared to 78.1% of patients during the pandemic period. For fasciotomy/ subtotal palmar fasciectomy, 75.0% of pre-pandemic patients underwent surgery within the target time, compared to 81.1% of patients in the pandemic period. For pulley release/ tendon release, 92.9% of patients underwent surgery before the cut-off pre-pandemic, compared to 83.0% of patients in the pandemic period. No association or variation in wait-times was found in regard to the aforementioned variables.

Conclusions: During the pandemic, a decreased total number of elective hand surgeries were performed when compared to the corresponding pre-pandemic period, contributing to a surgical backlog. Fewer hand surgery cases achieved target wait-times during the pandemic period. To mitigate surgical case backlog, potential solutions have been proposed and should be evaluated further.1,2

References

1. Ghoshal S, Rigney G, Cheng D, et al. Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19 Pandemic and Postvaccination Recovery Period. JAMA Network Open. 2022;5(8):e2227443-e2227443. doi:10.1001/JAMANETWORKOPEN.2022.27443
2. McKinsey & Company. Cutting through the COVID-19 surgical backlog. Published October 8, 2020. Accessed February 17, 2022. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/cutting-through-the-covid-19-surgical-backlog

Introduction: With the aim of helping patients make informed health care decisions and decreasing overall healthcare expenditures, the Centers for Medicare and Medicaid Services (CMS) established a price transparency law in 2021 requiring hospitals to publish standardized and accessible price data. We investigated compliance rates and price variation in common hand surgery procedures among prominent US hospitals.

Methods: We performed a multi-institutional economic evaluation study. The top 20 U.S hospitals were identified using 2021-2022 US News list of "Best Hospitals". Common operative hand procedures were grouped into 13 categories: incision and drainage, debridement, biopsy, De Quervain treatment, ganglion cyst treatment, synovectomy, tendon repair, Dupuytren's repair, reconstruction, tendon repair, neuroplasty, carpal tunnel release and cubital tunnel release. Price data, including payer-specific negotiated charge, discounted cash price, de-identified minimum and maximum negotiated charges, location of the procedure, and billing code, was collected for each category at each hospital system using current procedural terminology codes. Compliance rates and price variation were analyzed using descriptive statistics.

Results: 18 of the 20 hospitals evaluated provided publicly accessible price data. Nine hospitals (50%) provided all pricing information required by the CMS price transparency law for hand surgery procedures. Of the six CMS requirements, hospitals were most compliant with publishing billing codes (18/18, 100%) and procedure campus location (16/18, 100%). Hospitals were least complaint in publishing discounted cash price (13/18, 72%), de-identified minimum (13/18, 73%) and maximum charges (14/18, 78%). Prices for tendon sheath incision for De Quervains treatment demonstrated the greatest variation per average total gross charges between hospitals. Least price variation per average total gross was found for hand debridement procedures. Average gross total charge did not correlate with hospital rank.

Conclusions: Despite CMS legislation, there continues to be significant variation in price transparency as well as the cost of common hand surgery procedures, regardless of hospital reputation. Lack of transparency places patients at a disadvantage, particularly when seeking a physician and hospital system for elective surgeries.

Introduction: Lymphovenous bypass (LVB) is a microsurgical procedure to restore lymphatic drainage in patients with lymphedema. We sought to determine if the change in limb volume after LVA differed between indocyanine green lymphography (ICG) stage groups in patients with upper extremity lymphedema.

Methods: Adult patients that underwent upper extremity LVB were included. The mean percentage change in volume difference was calculated as follows: % Change = [(postoperative difference) – (preoperative difference)/(preoperative difference)] * 100, where postoperative difference is the absolute difference between the affected and unaffected limbs' volume at a specific endpoint and the preoperative difference is the absolute difference between the affected and unaffected limbs' volume preoperatively. The endpoints were 2 weeks, 2 months, and 6 months after the surgery. Patients were categorized based on the mean ICG (preoperative and postoperative 0 to 5 staging). After evaluating the endpoints for normality using Shapiro-Wilk tests, differences per endpoint among ICG stage groups were evaluated using Kruskal-Wallis tests. The limb volume change is expressed as a percentage. Data is presented as mean (standard deviation).

Results: 70 patients were identified for this study ('stage 1' = 2, 'stage 2' = 18, 'stage 3' = 21, 'stage 4' = 28, 'stage 5' = 1). Kruskal-Wallis's test was used to assess for significant differences in endpoint values among the ICG stage categories. The test, which compares median values, was statistically significant after two weeks (p-value = 0.04833 for week 2). The mean percentage change in volume difference among ICG stage categories at 2 weeks was as follows: ('stage 1' -296 (NA), 'stage 2' -112 (106), 'stage 3' -24.0 (81.3), 'stage 4' -44.6 (21.3), 'stage 5' NA. The remaining endpoints, on the other hand, had no statistical significance (2 = 2.6853, df = 2, p-value = 0.2611 for month 2; 2 = 3.0826, df = 2, p-value = 0.2141 for month 6; 2 = 2.7886, df = 2, p-value = 0.248 for year 1). Despite this, after month 2 of follow-up, there were significant differences in the mean volume change between the ICG staging categories.

Conclusion: The results of the Kruskal-Wallis test suggest that there is a significant difference in the mean percentage change in volume between ICG staging categories after two weeks of follow-up. However, there were no significant differences in the mean volume change between ICG staging categories after month 2, month 6, or year 1 of follow-up. These results suggest that the ICG staging system is a useful tool for predicting patient outcomes after two weeks of follow-up, but further research is needed to determine its predictive power beyond this point.

Background: The prevalence of chemotherapy-induced peripheral neuropathy (CIPN) is as high as 68% in the first month after treatment with targeted anticancer drugs. A study of 1,725 patients treated with microtubule inhibitors suggested that cryotherapy with frozen gloves at -20 to -30°C was effective in preventing CIPN but these temperatures can result in frostbite, leading to a worldwide recall of cooling equipment. Since then, the effectiveness and safety of cooling temperatures for CIPN prevention remain unknown. Previous reports of post-exercise muscle cooling therapy, on safe cooling with phase change material (PCM) at 15°C for 6 hours have demonstrated an adequate safety profile without frostbite. Based on this evidence, we developed the Cool Water Electric Circulation Seat (CECS), which maintains a sustained temperature of 15 degrees Celsius.Recently, video-capillaroscopy (VC) has been improved to enable observation of blood flow in microcirculation with a high resolution of 1.2 megapixels at 620x magnification. In this study, as a preliminary experiment, cooling the hand and finger with the CECS was performed, and blood flow in the superficial skin layer was evaluated using video-capillaroscopy.

Methods: A total of 21 healthy Japanese adult volunteer left hands were continuously covered by CECS and cooled at 15°C for 2.5 hours, which is the standard time for the administration of Taxanes (anti-cancer drugs) . The blood flow status of the dorsal hand and the nail capillary of the ring finger before and after cooling was captured using video-capillaroscopy (GOKO Bscan-ZD). Data was recorded three minutes before and after cooling. We measured still images of VC using ImageJ software. The area of capillaries was obtained by dividing the blood vessel area (Pixels) by the area of the entire visual field. We defined the blood vessel area reduction rate (%) as the percentage of reduction in the blood vessel area after cooling. The red blood cell movement was evaluated as 0 points for unobservable, 1 point for slow movement, and 2 points for fast movement.

Results: The average age was 40.2±12.5 years. The superficial temperature of the finger before treatment was 36.129±0.299℃ and dropped to 24.043±1.735℃ after cooling (p<.001). In the finger, the area before cooling was 13±2.6 % and was significantly reduced after cooling to 3.73±1.2 % (Mean difference 8.7, 95%CI 7.85 - 10.3; p<.001). The superficial temperature of the hand before treatment was 36.29±0.245℃and dropped to 23.219±0.961℃ after cooling (p<.001). On the hand, the area before cooling was 11.2±2.88 % and was significantly reduced after cooling to 3.848±1.621 % (Mean difference 13.071, 95%CI 12.57-13.57, p<.001). Before cooling the movement of RBC was categorized as slow (52.4%) or fast (47.6%). After cooling, RBC movement was classified as slow (23.8%) or no movement (76.2%) (p<.001). Temporary redness and pain were reported in 38.1% and 28.6% of the cases 30 minutes after cooling, and these were completely recovered after 1day, respectively.

Conclusion: The CECS has the potential to provide adequate and safe cooling for maximum prevention of CIPN and to allow cooling therapy to continue without risk of frostbite.

Purpose: Treating traumatic wounds with exposed tendon and/or bone is often costly to both patients and the healthcare system, requiring rigorous wound care, lengthy hospital stays, and multiple surgical procedures including use of dermal matrices, secondary skin grafting, and possible flap reconstruction. Here, we aim to compare the costs associated with using Novosorb Bio-degradable Temporizing Matrix (BTM) in reconstruction of complex upper extremity wounds with wounds reconstructed with Integra CCS Bilayer. We hypothesize that BTM is a cost-effective option for reconstruction of complex upper extremity wounds

Methods: A retrospective, IRB-approved chart review was performed for all patients with isolated upper extremity trauma who underwent reconstruction of complex upper extremity soft tissue defects with either BTM or Integra between January 2017 and May 2022. Patients with poly-trauma or admitted for other medical reasons were excluded from analysis. Demographic data, comorbidities, wound etiology, wound size, secondary surgery and complications were recorded. Cost of procedures were determined using Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule.

Results: 27 patients were identified: 18 (66.7%) BTM and 9 (33.3%) Integra. Age, sex, medical comorbidities, wound size, and duration of hospital stay were similar between the groups. Average template size was 101.8 cm2 for BTM and 64.7 cm2 for Integra (p = 0.19). Skin grafting was required in 8 patients (44.4%) in the BTM group compared to 5 patients (55.6%) in the Integra group, p=0.013. Time to skin graft was 43.4 days in BTM group and 21.4 days in Integra group, p=0.002. 6 patients (33.3%) in BTM group experienced complications compared to 5 patients (55.6%) in Integra group, p=0.002. Mean number of secondary procedures required after template placement was 0.67 in BTM group compared to 1.56 in Integra group, p=0.049. Overall, there was no differences in successful wound closure between the two groups, BTM 94.4% vs Integra 77.8%, p=0.48. Less patients in BTM group experienced complications, BTM 33.3% vs Integra 55.6%, p=0.0018. There were no differences in time to wound closure BTM 86.1 vs Integra 58.3 days, p=0.09.

At our institution, 100 cm2 of BTM cost $850 and $3150 for Integra. The average cost of skin grafting is $958.78. When factoring in cost of product, skin grafting (in indicated), and cost of secondary surgeries (including debridement and secondary flaps), the average cost of wound reconstruction with BTM was $1361.92 compared to the average cost of Integra $3185.71 p=0.049.

Conclusion: We have found that Novosorb BTM is effective in management of complex upper extremity. When compared to wounds reconstructed with Integra, those with Novosorb BTM had lower complication rates. Though there was no statistical significance in successful wound closure, likely due to the small sample size, BTM cohort had 94.4% successful wound closure compared to 77.8% with Integra. Given the difference in product cost of $2300, decreased need for secondary skin grafting and revision procedures, wounds reconstructed with Novosorb BTM have significantly lower cost when compared to Integra.

Introduction: Gunshot wounds (GSW) of the upper extremity (UE) create significant morbidity in the United States. Washout in the trauma bay or operating room (OR) are often employed as initial management of these injuries, but this practice can be time and resource intensive and may not necessarily improve outcomes. Thus we sought to examine the impact of washout on civilian UE GSW complications at an urban level 1 trauma center.

Methods: All adult patients with UE GSWs from 2015-2020 with at least 6-months post-injury follow-up in the University of Pennsylvania Trauma registry were studied for demographics, injury pattern, trauma bay treatment, operative details, and post-operative outcomes. Inclusion criteria was adults ≥ 18 years old and patients with GSW to the upper extremity. Exclusion criteria was children < 18 years old or patients with simultaneous non-ballistic trauma. Patients were grouped according to location of washout. Fisher's exact and ANOVA tests were used for statistical analysis.

Results: Of the 360 patients included in the study, 120 (33.3%) received neither trauma bay nor OR washout, 105 (29.2%) received only trauma bay washout, 84 (23.3%) received only OR washout, and 51 (14.2%) received both trauma bay and OR washout. All patients received antibiotics. There was no difference in patient age or race across groups, but patients who did not go to the OR had fewer fractures (20.4% vs. 85.2%, p<0.001) and lower rates of compartment syndrome (0% vs 4.4%, p=0.006), unplanned reoperation (0.9% vs. 5.9%, p=0.013) and unplanned readmission (0.4% vs. 11.9%, p<0.001) compared to those who went to the OR. Patients who received trauma bay washout had fewer GSWs (3.8 vs. 2.3, p<0.001) compared to patients with neither trauma bay nor OR washout. There was no significant difference in injury type (including soft tissue, fracture, peripheral nerve, and tendinous injuries), number of unplanned reoperations, unplanned readmissions, sepsis, DVT/PE, SSTI/DSTI, or 30-day mortality. Amongst those who went to the OR, patients who received a trauma bay washout prior to the OR had no significant difference in time to OR, injury type or post-operative complications compared to patients with only OR washout.

Conclusion: Most of our UE GSW patients had washouts, although OR washout patients had significantly more complications compared to those who had no washout or only trauma bay washout. However, this more likely reflects differences in injury type and increased severity of injuries that necessitated operative attention rather than time or location of the washout. These findings suggest certain UE GSW injuries can be successfully treated and washed out in the trauma bay, and that operative washout patients more likely have fractures and more extensive injuries. Further prospective research may help delineate the role of the initial washout and its impact on definitive treatment and clinical outcomes.