Affiliation:
1. Department of Plastic and Reconstructive Surgery Vanderbilt University Medical Center Nashville Tennessee USA
2. Department of General Surgery Sinai Hospital of Baltimore Baltimore Maryland USA
3. Meharry Medical College Nashville Tennessee USA
Abstract
AbstractIntroductionInstitutional protocols often mandate the use of x‐rays when a microneedle is lost intraoperatively. Although x‐rays can reliably show a macroneedle, the benefit of x‐rays in detecting microneedles in human tissues has not been established as available data on this topic are investigated in anthropometric models. The current study aims to evaluate whether x‐rays can reliably detect retained microneedles in a human cadaveric model. We hypothesize that microneedles would be detected at a significantly lower rate than macroneedles by x‐ray in human tissues.Materials and MethodsNeedles ranging from 4‐0 to 10‐0 were placed randomly throughout a cadaveric hand and foot. Each tissue sample was x‐rayed using a Fexitron X‐Ray machine, taking both anteroposterior and lateral views. A total of six x‐ray images were then evaluated by 11 radiologists, independently. The radiologists circled over the area where they visualized a needle. The accuracy of detecting macroneedles (size 4‐0 to 7‐0) was compared with that of microneedles (size 8‐0 to 10‐0) using a chi‐square test.ResultsThe overall detection rate for the microneedles was significantly lower than the detection rate for macroneedles (13.5% vs 88.8%, p < .01). When subcategorized between the hand and the foot, the detection rate for microneedles was also significantly lower than the rate for macroneedles (hand: 7.6% for microneedles, 93.2% for macroneedles, p < .01; foot: 19.5% for microneedles, 84.4% for macroneedles, p < .01). The detection rate, in general, significantly decreased as the sizes of needles became smaller (7‐0:70.5%, 8‐0:18.2%, 9‐0:16.7%, 10‐0:2.3%, p < .01).ConclusionX‐rays, while useful in detecting macroneedles, had a significantly lower rate of detecting microneedles in a cadaveric model. The routine use of x‐rays for a lost microneedle may not be beneficial. Further investigation with fresh tissue and similar intraoperative x‐ray systems is warranted to corroborate and support these findings.