Limited Hand Surgery, Microvascular/Replantation On-call Resources Seen at Trauma Centers

LAS VEGAS — The availability of on-call resources for emergency
hand surgery and microvascular/replantation services at U.S. trauma centers
remains inconsistent, according to recently presented findings on level 1 and 2

Bret C. Peterson, MD, presented his team’s research at the 2011
Annual Meeting of the American Society for Surgery of the Hand.

“Less than half of the 117 level 1 trauma centers in the United
States have full-time microvascular/replantation call coverage. There are an
additional 8% of institutions with inconsistent coverage,” Peterson said.
“Twenty-nine percent of the level 2 trauma centers have full-time
microvascularization services. An additional 7% have inconsistent coverage. We
also concluded that hand call and emergency microvascular/replantation call is
not consistently defined.”

To determine the availability of emergency hand and microsurgical call
coverage, Peterson and colleagues conducted an unannounced, anonymous,
telephone survey of all level 1 and 2 trauma centers in the United States
between May and December 2010. Respondents were asked about the availability of
a hand and microvascular/replantation surgeon at the time of the call and
during the past or current month. Eighty-five percent of all level 1 and 86.3%
of level 2 trauma centers participated in the study.

Of the level 1 centers, 47% had full-time coverage and 45% had no
emergency coverage. Rates for the level 2 centers were 29% and 64%,

“Our study findings suggest the need to consider standardization of
terminology, a need to define what is hand surgery call, and is this separate
or is this just included in emergency microvascular/replantation call,”
Peterson said.

The investigators also recommended a hand trauma designation system and
the creation of a coordinated regional hand trauma system. — by Gina
Brockenbrough, MA

For more information:

  • Peterson BC, Mangiapani D, Kellogg R, Leversedge FJ. Hand and
    microvascular-replantation call availability study: A national real-time survey
    of level 1 and 2 trauma centers. Paper #1. Presented at the 2011 Annual Meeting
    of the American Society for Surgery of the Hand. September 8-10. Las Vegas.

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