Melbourne Hand Surgery 

melbhandsurgerydoxymedrjilltomlinson

We recommend that adults and children over 12 wear face masks when attending our clinic, but no longer provide masks to patients and carers. Videoconsultations are conducted via telehealth at our dedicated virtual clinic. We are experiencing high demand for appointments hence require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation. If our surgeons assess that your condition (especially recent injuries) is best managed with hand therapy rather than surgery we may recommend that you see a qualified hand therapist (physiotherapist or occupational therapist) rather than schedule an appointment with our surgeons. Dr Tomlinson does not offer consultations and surgical services where a Medicare Rebatable Item Code does not apply; this includes injections for palmar hyperhidrosis. Dr Tomlinson has scheduled sabbatical leave during much of October, November and December 2023 so will not be available for urgent or emergency referrals during that time. 

Rheumatoid arthritis, medications and surgery

 

capsules 200x150Decisions to stop or continue medications before or after surgery need to take into consideration your medical conditions as well as the type of surgery. For minor procedures that are performed under local anaesthetic there is usually no need to stop regular medications for rheumatoid arthritis, but for larger procedures it may be recommended to stop the medication prior to surgery and recommence it once your wounds have healed (usually 2 weeks after surgery). Current evidence suggests:

Medication Perioperative management
NSAIDs Continue for hand surgery unless unusually high bleeding risk exists
Methotrexate Continue
Sulfasalazine Insufficient data
Azathioprine Insufficient data
Cyclophosphamide Insufficient data
Cyclosporine Discontinue 3-4 days before surgery, recommence after wounds have healed
Hydroxychloroquine Discontinue prior to surgery; recommence after wounds have healed
Penicillamine Discontinue on day of surgery, recommence after wounds have healed
Leflunomide® Insufficient data
Infliximab® Insufficient data
Etanercept® Insufficient data
Adalimumab® Insufficient data
Hydrocortisone Continue
Prednisolone Continue
Methylprednisolone Continue
Dexamethasone Continue

Reference

Thorsness RJ, Hammert WC. Perioperative management of rheumatoid medications. J Hand Surg AM 2012; 37A; p1928-1931

 

FRACS

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