Microsurgeons do better--tactile training might prevent the age-dependent decline of the sensibility of the hand

Surgical experience and different glove wearing conditions affect tactile sensibility

Background

The fingers' tactile sensibility is essential in surgery, especially in microsurgery. Therefore, surgeons seeking to improve their performance often prefer certain glove brands and wearing habits. There is the need of objectively testing these glove wearing conditions and determine the effect of surgical experience with regard to tactile sensibility by comparing surgeons with non-surgeons.

Methods

This cross-sectional single-center pilot-study was conducted between June and August 2021. Two groups of 27 surgeons and 27 non-surgeons underwent two-point-discrimination (2PD) and Semmes-Weinstein monofilament testing (SWMT) of both index fingers with bare hands and with wearing six different brands of surgical gloves. Different wearing conditions, such as single-gloving, double-gloving, well-fitted, under- and oversized gloves, were evaluated within and between the groups.

Results

Most glove types decreased tactile sensibility (2PD and SWMT) of surgeons and non-surgeons. Interestingly, the thinnest gloves showed similar 2PD values to bare hands in both groups. Double-gloving negatively impacted SWMT, without influencing 2PD. Undersized gloves showed better 2PD and SWMT than well-fitted gloves, while oversized gloves showed no tactile drawbacks. With bare hands and certain glove conditions, the surgeons' 2PD and SWMT was significantly better than the non-surgeons', indicating a positive effect of surgical experience on tactile sensibility.

Conclusion

Our study demonstrated the positive impact of surgical experience on tactile sensibility, as demonstrated by the surgeons. The sensibility of the gloved hand varies on the surgical glove type, but favors thinner gloves, single gloving (rather than double gloving) and undersized or well-fitted gloves.

Do your surgical glove characteristics and wearing habits affect your tactile sensibility?

Backround

Tactile sensibility plays a critical role in medicine, especially in surgical practice. In order to prevent surgical site infections and protect the surgeon, the use of surgical gloves is standard practice. However, wearing these might affect the sensibility of the hand disadvantageously, especially in disciplines that require precision work.

Methods

We evaluated the influence of six different glove types, as well as gloves wearing habits (double gloving, over- and undersized gloves) on tactile sensibility using two-point-discrimination and Semmes-Weinstein monofilament testing in 27 non-surgeons.

Results

There were significant differences regarding tactile sensibility of gloved compared to bare hands and between different types of gloves. While undersized gloves and double gloving did not affect tactile sensibility, oversized gloves were associated with a significant deterioration of the sensibility of the hand in the Semmes-Weinstein monofilament test.

Conclusion

This study demonstrates that surgical gloves negatively affect the sensibility of the hand and show significant differences between different types of gloves.

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There were significant differences regarding tactile sensibility of gloved compared to bare hands.

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There were significant differences between different types of gloves.

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Undersized gloves and double gloving did not affect tactile sensibility.

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Oversized gloves were associated with a significant deterioration of the sensibility.

Inter- and intra-tester reliability of sensibility testing in healthy individuals

Static two-point discrimination (S2PD) and Semmes-Weinstein monofilament (SWM) tests are the most widely used tests for evaluation of sensory deterioration. It is a necessity to know the inter- and intra-tester reliability of these tests to determine the suitability of method. Another important point in evaluation of sensory deterioration is whether or not there is a reference point which can be compared with the test results. So, it is important to know the reliability of sensory evaluation tests on the healthy extremities. The aim of this study was to evaluate the inter- and intra-tester reliability of the S2PD and SWM tests applied to the fingers of healthy individuals. One hundred and sixty three healthy fingers from 83 individuals were included into the study. An experienced orthopaedic surgeon and a physiotherapist examined all the individuals separately. The reliability of the S2PD test was found to be little and low. The reliability of the SWM test was determined as low and moderate. The reproducibility scores of both tests were at a poor level. Therefore, in the evaluation of states with sensory deterioration, the use of the healthy contralateral extremities as a standard reference point could be considered unreliable. Prognosis, grading or follow-up of treatment should not be made according to the results of the S2PD and SWM tests only. It would be more correct to use these tests as a diagnostic tool rather than quantitative follow-up for neurological function in pathological conditions.

The effects of training on tactile enumeration

Subitizing is a fast and accurate process of enumerating small quantities. Whether subitizing carried out in the tactile modality is under debate. We previously found a moderately increasing RT slope from one to four stimuli and a large decrease in RT for five stimuli when using one hand. Yet, a high error rate was observed, making it difficult to determine if the RT pattern found was indeed subitizing. To increase accuracy, we carried out training of the tactile enumeration task using one hand for 6 days. We compared performance in the trained and additional non-trained tasks between two groups-the 6-day training group (6DT) and the non-trained controls (C)-after three periods (1 week, 1 and 6 months after the training of the 6DT group ended). Results showed an increase in accuracy rates for both groups but a decrease in RT for the 6DT group only for the trained task. This RT improvement was present even after 6 months. Importantly, the RT slope of one-hand enumeration did not change after training, showing a moderately increased slope up to four stimuli and a decrease for five stimuli. Our study shows the training long-term effect on tactile enumeration and emphasizes the embodiment of finger counting on enumeration. Two possible enumeration processes are discussed-accelerated counting and subitizing-both based on spatial cues and pattern recognition of familiarized finger-counting patterns.