A Helpful Assistant for Disinfection in Hand Surgery Procedures: The LocArm Holder.

Abstract

Although there is no consensus regarding the best skin disinfection technique, whatever antiseptic solution is used, the "prep and drape" portion of most upper extremity procedures requires the presence of at least one operative room assistant or scrub nurse to elevate and hold the hand and forearm. Nonetheless, especially in a busy hand surgery practice and during fast procedures, an operative room assistant or scrub nurse are frequently not available leading to a reduced time efficiency between procedures. This article describes an innovative easy-to-use and hands-free device that helps the surgeon during disinfection of the skin and the setup of the surgical field by keeping elevated the upper limb with respect for tissues. The development of the surgical arm holder starts from three easily available and washable thermoplastic splint sheets 40 × 60cm with 2.5cm thickness. The final device measures 40 × 25 × 15cm and is placed underneath the proximal third of the humerus in order to keep the upper limb suspended at about 10-15cm from the operating table. A retrospective analysis of the "surgical malpractice claims" and institutional non-conformities registered in the period 2011-2020 was conducted in our Hospital looking for bone or soft tissue complications related to the use of the device. Three thousand one hundred eighty-seven surgical procedures were performed between 2011 and 2020 using this device. The retrospective analysis of all "surgical malpractice claims" showed no skin lesions, no neurological complications (such as neuroapraxia), no need for secondary bone procedures or interference with the draping process. Our device proved to be a low-cost, easy to use and alternative solution helping surgeons during the disinfection phase, improving hospital pre-operative flow and reducing the need for other staff members to be engaged in holding the upper limb in the operating room.