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Letter to Editor Plastic and Aesthetic Research

Unburied K-wire induced injuries: taking the

edge off

Ravi Kumar Chittoria, Devi Prasad Mohapatra, Friji Meethale Thiruvoth, Dinesh Kumar,
Arjun Asokan, Nandhagopal Vijayaraghavan

Department of Plastic Surgery, JIPMER, Dhanvanthri Nagar, Gorimedu, Puducherry 605006, India.
Address for correspondence: Dr. A. Arjun, Department of Plastic Surgery, JIPMER, Dhanvanthri Nagar, Gorimedu, Pondicherry 605006,
India. E-mail: arjunashokan@gmail.com

Sir,
Unburied K-wires left projecting from the fingers after hand
surgery can lead to inadvertent injuries if left open, especially
in children or disoriented patients, particularly at the time of
reversal of anesthesia and in the immediate postoperative
period. Different ways have been described to circumvent
this. Many surgeons twist the K-wire on itself along with
capping of the wire tip, but this requires considerable
twisting force on an already inserted K-wire, which can lead
to malalignment or even refracture. Furthermore, the bent
[1]
K-wire acts like a hook, catching onto dressing materials or
clothes and subsequently may migrate out.
We present a simple and effective way of preventing such Figure 1: Silicone blocks capped over two unburied K-wires after a case
mishaps caused by unburied K-wire ends using silicone of contracture release
blocks. Silicone blocks are routinely used in procedures
like dorsal nasal augmentation and interpositional silicone is a must. This can be planned preoperatively. Our
arthroplasty for temporomandibular joint ankylosis. A theatre nurse routinely makes a sterilized block of silicone
[2]
small cuboid of silicone block is obtained from a solid available in all hand surgery cases where K-wiring is needed.
silicone block or from a left-over silicone block after The semi-rigid consistency of the silicone minimizes
sculpting for other indications. The block is approximately chances of penetrating injuries to the patient or
0.5 cm × 0.5 cm × 1.5 cm in size and is inserted gently caretakers. However, patients are counseled regarding
and with constant pressure over the K-wire end. proper precautions to prevent inadvertent injuries due to
The silicone block fits snugly over the K-wire and in our long silicone blocks. Being inert, there is less chance of
experience spontaneous expulsion of the block from the allergenicity as well. One major advantage is the availability
K-wire tip has not occurred [Figure 1]. The chance of the of silicone blocks in most operation theatres.
deeper migration is also minimized. Silicone block capping is a simple and effective way of
Sterilization of the silicone block is not essential but is preventing injury due to unburied K-wire tip.
desired, especially in the case of left-over blocks. Capping of
the K-wire can be done as the last step of hand surgery after REFERENCES
dressing. However in procedures where further operative
steps are needed following K-wiring, sterilization of the 1. Nicolaou M, Fleming A. A simple and cost-effective method of protecting
unburied K-wire ends. Ann R Coll Surg Engl 2009;91:714-5.
2. Chuangsuwanich A, Lohsiriwat V. Augmentation rhinoplasty with
Access this article online
custom-made S-shape silicone implant in Asians: a 15-year experience. Indian
Quick Response Code: J Plast Surg 2013;46:533-7.
Website:
www.parjournal.net How to cite this article: Chittoria RK, Mohapatra DP, Thiruvoth FM,
Kumar D, Asokan A, Vijayaraghavan N. Unburied K-wire induced
injuries: taking the edge off. Plast Aesthet Res 2014;1:121.
DOI:
10.4103/2347-9264.143561 Source of Support: Nil, Confl ict of Interest: None declared.
Received: 22-06-2014; Accepted: 07-08-2014

Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014 121