Notice bibliographique
Résumé
Sir: Adequate operative exposure is important during pediatric hand surgery, which demands precise exposure in a small surgical field. A good retractor must be safe, simple, and easy to use, providing adequate retraction and a wide field of view.1,2 Self-retaining retractors are preferable to conventional retractors because they free up assistants and reduce the number of hands crowding the operative area. Arem described a self-retaining retractor for use in hand surgery consisting of weights applied to stay sutures.3 Although preferable to handheld retractors, this is difficult to reposition and cannot easily provide tension in multiple directions. Pearl et al. described a self-retaining retractor consisting of stay sutures fixed through cuts in the rim of a plastic bowl.2 This provides disposable and inexpensive exposure; however, creation and assembly is cumbersome, and the inflexible ring limits intraoperative repositioning. The ideal self-retaining retractor would provide good exposure, gentle yet adequate tension, and easy and quick repositioning of each digit individually in multiple planes. The Lone Star retraction system (Cooper Surgical), consisting of elastic stay hooks positioned by means of slots on the periphery of a disposable adjustable plastic ring frame, is a relatively inexpensive (approximately CaD $200)4 yet extremely effective self-retaining retractor for use during pediatric hand surgery. The sterile disposable Lone Star retractor consists of a hinged frame and hooks attached to elastic stays (Fig. 1). After the patient is prepared and draped, 2-0 silk stay sutures are placed through the nail plate and pulp of each digit and tied in a deliberately loose loop. One limb of the frame is secured with towel clips to the surgical drapes in the vicinity of the hand. The other limb is positioned upright, and the hinge between the two limbs is tightened. The hook of each elastic stay is placed through one of the previously placed loops in each finger and is then anchored on the frame. The elastic stays and the hooks are repositioned as necessary during the stages of the procedure (Fig. 2). On completion, the frame and stays may be left in place to facilitate application of a dressing, after which the stays and silk sutures are removed.Fig. 1.: The components of the Lone Star retractor include the hinged and slotted frame and the elastic stays with attached hooks. Also shown are 2-0 silk stay suture loops in the nail plate and pulp of the digits. Towel clips are used to secure the retractor frame to the arm board.Fig. 2.: The Lone Star disposable plastic ring is positioned using the adjustable hinges and secured using towel clips. The hook on each elastic stay is placed through the suture loop on the selected finger. The elastic stay is in turn anchored in the appropriate slot on the frame.The Lone Star retraction system has previously been described as an effective way of obtaining complete eversion of prolapsed hemorrhoids.4 Several features make this an appealing self-retaining retractor for use during pediatric hand surgery. First, the hinged frame with multiple slots for the stays provides the surgeon with many options in three-dimensional positioning of individual digits. Second, the long elastic stays keep the surgical site remote from the frame and allow the digits to remain stable in any position and to avoid excessive tension. Finally, the combination of hooks on the stays and suture loops on the digits facilitates quick repositioning. Because it is adjustable, disposable, quick to assemble, and easy to use, we believe that the Lone Star retraction system provides a versatile and superior alternative to conventional handheld or self-retaining retractors used during pediatric hand surgery. DISCLOSURE Neither author has any commercial associations or financial disclosures to declare. Aaron Knox, M.D. Division of Plastic Surgery University of British Columbia Vancouver General Hospital Vancouver, British Columbia A. Robertson Harrop, F.R.C.S.C. Division of Plastic Surgery Department of Surgery Alberta Children's Hospital Calgary, Alberta, Canada
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».