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British Journal of Oral and Maxillofacial Surgery 53 (2015) 301–302
Technical note
Blunt wires in oral and maxillofacial surgery C. Brandtner ∗ , F. Borumandi, C. Krenkel, A. Gaggl Department of Oral and Maxillofacial Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria Accepted 3 December 2014 Available online 29 December 2014 Keywords: Blunt wire; Surgical glove perforation; Percutaneous injuries; Needlestick injuries
The use of wires in maxillofacial surgery is simple, quick, economical, and minimally invasive.1 However, the sharp ends can lead to a higher than normal number of wire-stick injuries (Fig. 1) with the potential risk of virus-associated diseases and infections such as hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV).2 Thomas et al. reported that anti-HCV was found in 2.0% of oral surgeons, and serological markers of HBV infection in 21.2%.3 Most percutaneous injuries sustained by medical practitioners occur with sharp needles. Over the last 2 decades, advances in the prevention of accidental needlestick injuries during operation have included the development of needles with blunt, tapering points, and this suggests that the use of blunt wires would also reduce the risk of percutaneous injuries (Fig. 1).4 Surgical wires are made of surgical stainless steel, and for medical purposes are delivered as a round bar. The sharp, cut ends can be blunted on a grinding disc but this is timeconsuming and has a high risk of injury. Another method is to cut and blunt the wires using a laser-beam welding system. Laser-beam welding, which has high power density (around 1 MW/cm2 ), can result in the rapid heating and cooling of small zones. Cutting is done manually with a neodymiumdoped yttrium aluminium garnet (Nd:YAG) Dentaurum laser (Dentaurum, JP Winkelstroeter KG, Ispringen, Germany) for manual use. The workpiece is positioned under the stereomicroscope of the device. After a short exposure (0.5–20 ms), the wire melts to form beads at the ends (Fig. 2). The wires are held in
∗ Corresponding author. Tel.: +43 662 4482 57219; fax: +43 662 4482 884. E-mail address: [email protected] (C. Brandtner).
Fig. 1. Risk of perforating surgical glove with conventional wire compared with blunt wire.
a bundle so it takes about one minute to blunt 10 tips. After sterilisation they are ready for use. The wires with blunt tips are not cut until the last one is twisted. They are then shortened and the ends bent into a pigtail.
Fig. 2. Blunt wire with melted beads at the tip and conventional wire.
http://dx.doi.org/10.1016/j.bjoms.2014.12.003 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
302
C. Brandtner et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 301–302
We use 1000 wires in our department every year, mainly for intermaxillary fixation, reduction of fractures in trauma cases, and orthognathic procedures. No wire-stick injuries from this department have been registered with the occupational health service since their introduction. The blunt tips glide easily through mucosal soft tissues and interdental spaces. Healthcare professionals in the field of oral and maxillofacial surgery have a higher than normal risk of wire-stick injuries, but this could be reduced if wires were blunted. Conflict of interest We have no conflicts of interest.
Ethics statement/confirmation of patient permission No ethical approval required.
References 1. Singh V, Bhagol A, Kumar I. A new and easy technique for maxillomandibular fixation. Natl J Maxillofac Surg 2010;1:24–5. 2. Bali R, Sharma P, Garg A. Incidence and patterns of needlestick injuries during intermaxillary fixation. Br J Oral Maxillofac Surg 2011;49:221–4. 3. Thomas DL, Gruninger SE, Siew C, et al. Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America. Am J Med 1996;100:41–5. 4. Mingoli A, Brachini G, Sgarzini G, et al. Blunt needles for patients’ and surgeons’ safety. Arch Surg 2010;145:210–1.
British Journal of Oral and Maxillofacial Surgery 53 (2015) 301–302
Technical note
Blunt wires in oral and maxillofacial surgery C. Brandtner ∗ , F. Borumandi, C. Krenkel, A. Gaggl Department of Oral and Maxillofacial Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, Austria Accepted 3 December 2014 Available online 29 December 2014 Keywords: Blunt wire; Surgical glove perforation; Percutaneous injuries; Needlestick injuries
The use of wires in maxillofacial surgery is simple, quick, economical, and minimally invasive.1 However, the sharp ends can lead to a higher than normal number of wire-stick injuries (Fig. 1) with the potential risk of virus-associated diseases and infections such as hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV).2 Thomas et al. reported that anti-HCV was found in 2.0% of oral surgeons, and serological markers of HBV infection in 21.2%.3 Most percutaneous injuries sustained by medical practitioners occur with sharp needles. Over the last 2 decades, advances in the prevention of accidental needlestick injuries during operation have included the development of needles with blunt, tapering points, and this suggests that the use of blunt wires would also reduce the risk of percutaneous injuries (Fig. 1).4 Surgical wires are made of surgical stainless steel, and for medical purposes are delivered as a round bar. The sharp, cut ends can be blunted on a grinding disc but this is timeconsuming and has a high risk of injury. Another method is to cut and blunt the wires using a laser-beam welding system. Laser-beam welding, which has high power density (around 1 MW/cm2 ), can result in the rapid heating and cooling of small zones. Cutting is done manually with a neodymiumdoped yttrium aluminium garnet (Nd:YAG) Dentaurum laser (Dentaurum, JP Winkelstroeter KG, Ispringen, Germany) for manual use. The workpiece is positioned under the stereomicroscope of the device. After a short exposure (0.5–20 ms), the wire melts to form beads at the ends (Fig. 2). The wires are held in
∗ Corresponding author. Tel.: +43 662 4482 57219; fax: +43 662 4482 884. E-mail address: [email protected] (C. Brandtner).
Fig. 1. Risk of perforating surgical glove with conventional wire compared with blunt wire.
a bundle so it takes about one minute to blunt 10 tips. After sterilisation they are ready for use. The wires with blunt tips are not cut until the last one is twisted. They are then shortened and the ends bent into a pigtail.
Fig. 2. Blunt wire with melted beads at the tip and conventional wire.
http://dx.doi.org/10.1016/j.bjoms.2014.12.003 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
302
C. Brandtner et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 301–302
We use 1000 wires in our department every year, mainly for intermaxillary fixation, reduction of fractures in trauma cases, and orthognathic procedures. No wire-stick injuries from this department have been registered with the occupational health service since their introduction. The blunt tips glide easily through mucosal soft tissues and interdental spaces. Healthcare professionals in the field of oral and maxillofacial surgery have a higher than normal risk of wire-stick injuries, but this could be reduced if wires were blunted. Conflict of interest We have no conflicts of interest.
Ethics statement/confirmation of patient permission No ethical approval required.
References 1. Singh V, Bhagol A, Kumar I. A new and easy technique for maxillomandibular fixation. Natl J Maxillofac Surg 2010;1:24–5. 2. Bali R, Sharma P, Garg A. Incidence and patterns of needlestick injuries during intermaxillary fixation. Br J Oral Maxillofac Surg 2011;49:221–4. 3. Thomas DL, Gruninger SE, Siew C, et al. Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America. Am J Med 1996;100:41–5. 4. Mingoli A, Brachini G, Sgarzini G, et al. Blunt needles for patients’ and surgeons’ safety. Arch Surg 2010;145:210–1.
