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Identification of Microsurgical Suture Needles in the Hand Using Plain Radiographs
Francis P Bustos, BS1; Nathan S Lanham, MD2; Cay M Mierisch, MD3
1Virginia Tech Carilion School of Medicine, Roanoke, VA, 2University of Virginia, Charlottesville, VA, 3Carilion Medical Center, Roanoke, VA
Title: Identification of Microsurgical Suture Needles in the Hand Using Plain Radiographs.
Background: Retained surgical items (RSIs) comprise 1.2-3% of complications resulting in litigation in orthopaedic surgery and include sponges, needles, broken instruments, and guidewires. Previous studies have found that suture needles associated with 5-0 suture or smaller could not be reliably identified on plain radiographs and X-rays in search of such needles would subject patients to unnecessary radiation with little chance of needle identification.
Purpose: To evaluate plain radiograph identification of suture needles used in hand microsurgical procedures.
Hypothesis: Plain radiographs are not adequate for identification of microsurgical needles.
Methods: Four microsurgical suture needles ranging from 6.5 mm to 3.8 mm, paired with 8-0 to 11-0 suture, respectively, were affixed to the digits of an anthropomorphic phantom limb. Portable plain radiograph images were obtained and reviewed by a group of 20 individuals comprised of board certified attending radiologists, orthopaedic surgery residents, operating room registered nurses, and board certified attending orthopaedic surgeons. Reviewers utilized PACS/DICOM software to review the radiographs and were allowed to utilize window and level functions as needed. The total number of needles identified and the time required for needle identification was recorded. Intra-group differences were calculated using the Wilcoxon rank sum test. Statistical significance was set to p<0.05.
Results: 3.35 out of 4 needles were identified in a mean 276.55 seconds by all reviewers. Suture needles of each size were identified by reviewers from each group. Radiologists (n=5) identified all four suture needles in the least amount of time (141 seconds) (p=0.006). Orthopaedic surgery residents and operating room nurses identified a mean 3 of 4 suture needles while orthopaedic surgery attendings identified a mean 3.5 of 4 needles.
Conclusion: Identification of microsurgical suture needles as small as 3.8 mm, corresponding to 11-0 suture, is possible using plain radiographs with the use of PACS/DICOM software. Digital images provide the advantage of window and level features, which aid in visualization of the RSIs. Radiologists were found to be the most proficient at identifying suture needles.
Clinical Relevance: Institutional policies regarding incorrect needle counts during hand microsurgical cases should consider enlisting an attending radiologist to review plain radiographs of the operative extremity.
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