Journal of Hand and Microsurgery最新文献

{"title":"Stroke, reward, and the reluctant hand: Why nucleus accumbens ultrasound neuromodulation matters to hand surgeons.","authors":"Vaikunthan Rajaratnam, Usama Farghaly Omar, Amr Eisa, J Terrence Jose Jerome","doi":"10.1016/j.jham.2026.100449","DOIUrl":"https://doi.org/10.1016/j.jham.2026.100449","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100449"},"PeriodicalIF":0.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of hourglass-like nerve constrictions with allogeneic nerve: a series report of 4 cases.","authors":"Minghua Zhao, Cuiping Cao, Meng Wang, Haixia Wang, Haixin Zhang, Yifan Wang, Jian Zhao, Xuyin Gong","doi":"10.1016/j.jham.2026.100447","DOIUrl":"10.1016/j.jham.2026.100447","url":null,"abstract":"<p><strong>Purpose: </strong>Hourglass-like constriction (HGC) is an anatomical finding of peripheral nerves, most commonly associated with immune-mediated inflammatory neuropathies such as neuralgic amyotrophy. Current treatment modalities primarily include conservative observation, neurolysis, autologous nerve grafting, and tendon transfer. Allogeneic nerves, as alternative graft materials for nerve reconstruction, have not been systematically reported in the management of hourglass-like constrictions. This study aimed to report the clinical outcomes of allogeneic nerve reconstruction in carefully selected cases of allogeneic nerve transplantation for treating multi-segmental radial nerve hourglass constrictions.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 4 patients (3 males, 1 female) with idiopathic radial nerve palsy treated in our department from February 2019 to February 2022. All cases presented with severe multi-segmental constrictions. Preoperative evaluation included electromyography and high-frequency ultrasound to assess nerve damage. Intraoperatively, constricted segments were completely resected, and allogeneic nerve grafts were used for reconstruction. Postoperative follow-up duration ranged from 18 to 26 months (mean 22 months).</p><p><strong>Results: </strong>All incisions healed primarily without clinically apparent immune rejection or infection. Motor function was evaluated using the British Medical Research Council (BMRC) muscle strength grading scale, combined with electromyography for nerve regeneration assessment. At 18 months postoperatively, all patients achieved significant recovery of active thumb and finger extension: 3 patients demonstrated M4 strength in extensor pollicis longus and extensor digitorum communis, while 1 patient showed M3 for extensor pollicis longus and M4 for extensor digitorum communis.</p><p><strong>Conclusion: </strong>For severe multi-segmental hourglass-like constrictions, resection combined with nerve grafting is recommended. Allogeneic nerve transplantation may represent a safe and effective treatment option in selected cases of radial nerve hourglass constrictions. However, further large-scale randomized controlled trials are required to validate its long-term efficacy in repairing long-segment, thick mixed nerve defects.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100447"},"PeriodicalIF":0.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of the amputated thumb using great toe transfer and dual bone lengthening technique with an Ilizarov mini-fixator.","authors":"Hiroyuki Gotani, Yusuke Miyashima, Thanat Charoenpol, Kosuke Sasaki, Hirohisa Yagi, Sopinun Siripoonyothai, Jun Tsujimoto, Haato Kimura, Yuji Murakami, Takashi Tsuchiya","doi":"10.1016/j.jham.2025.100394","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100394","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to introduce the thumb reconstruction technique both by microsurgical reconstruction using a great toe transfer and dual bone lengthening technique with an Ilizarov mini-fixator for the fingers.</p><p><strong>Methods: </strong>The great toe was transferred to the amputated thumb, followed by a bone lengthening procedure for the residual metacarpal bone to enable easy pinching. During the metacarpal bone lengthening, osteotomy was performed at two sites to shorten the period of bone fusion.</p><p><strong>Results: </strong>The great toe transfer was performed successfully and metacarpal bone fusion was achieved earlier than usual by dual osteotomy technique, allowing the patients to eventually resume their previous jobs.</p><p><strong>Conclusion: </strong>Our procedure reported herein, i.e., great toe transfer by microsurgery + dual osteotomy distraction lengthening, seems to serve as a useful procedure for thumb reconstruction from both cosmetic and functional improvement.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100394"},"PeriodicalIF":0.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve injuries following reconstructive and cosmetic breast surgery: A systematic review and meta-analysis.","authors":"John D Nguyen, Alec J Chen, Jeffrey Khong, Isabel A Snee, Myiah Quach, Ala Elhelali, Sami H Tuffaha, A Lee Dellon","doi":"10.1016/j.jham.2025.100396","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100396","url":null,"abstract":"<p><strong>Background: </strong>Breast surgery carries the risk of intercostal nerve injuries, with symptoms ranging from sensory disturbances to chronic pain. This study characterizes post-operative intercostal nerve injuries following breast surgery and available microsurgical management options.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed, Embase, Web of Science, and Scopus for the years 2003-2024. The primary inclusion criteria was a patient experiencing any neuropathic symptoms (defined as pain or sensory changes) following mastectomy, breast reconstruction, or aesthetic breast surgery.</p><p><strong>Results: </strong>Of 514 unique studies, 39 (n = 9083 patients) were included. The procedures included breast augmentation (n = 6291, 69.3 %), mastectomy without reconstruction (n = 1701, 18.7 %), mastectomy with reconstruction (n = 654, 7.2 %), and breast reduction (n = 434, 4.9 %). After these procedures, 1144 (12.6 %) patients experienced chronic pain and 135 (1.8 %) had nerve injuries, consisting of intercostal nerves (n = 133, 98.5 %) or brachial plexus nerves (n = 2, 1.5 %). Of patients with nerve injuries, 23 (9.2 %) underwent surgical interventions, which included neurectomy (n = 11, 47.8 %), neuroma excision (n = 10, 43.5 %), implant removal (n = 8, 34.8 %), and dorsal rhizotomy (n = 1, 4.3 %).</p><p><strong>Conclusion: </strong>This study demonstrates a substantial risk of chronic pain and peripheral nerve injuries following breast surgery. The low utilization of surgical options (4.6 %) may indicate limited patient unawareness of the pain relief which microsurgical intervention offers when conservative approaches fail in reduction or resolution of symptoms.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100396"},"PeriodicalIF":0.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12757640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularized iliac crest reconstruction of the distal fibula after trauma: Technical notes and long term follow up.","authors":"Pierluigi Tos, Davide Ciclamini, Alessandro Crosio, Valentina Cecconato, Bruno Battiston","doi":"10.1016/j.jham.2025.100393","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100393","url":null,"abstract":"<p><strong>Background: </strong>Large post-traumatic defects of the lateral malleolus are uncommon but present major reconstructive challenges, particularly in the presence of segmental bone loss, infection, or soft-tissue compromise. The lateral malleolus is essential for ankle stability, and its absence leads to mechanical imbalance and early degenerative changes. Traditional solutions-including non-vascularized grafts, allografts, arthrodesis, or fibular transfers-may be inadequate when biological conditions are poor or when three-dimensional reconstruction is required. Vascularized bone flaps offer improved union rates and enhanced resistance to infection. The vascularized iliac crest flap, although well-established in limb reconstruction, remains infrequently reported for distal fibula restoration.</p><p><strong>Methods: </strong>Three patients with severe post-traumatic lateral malleolar defects were treated between 2002 and 2015 at two microsurgical centers. Reconstruction was performed using free vascularized iliac crest flaps based on the deep circumflex iliac artery. Flap configuration (osteo-muscular or osteo-cutaneous) was adapted to defect size and soft-tissue requirements. Technical details-including flap harvest, shaping of the iliac crest segment, fixation, and vascular anastomoses-are described. Clinical and radiographic outcomes were evaluated over 8-14 years.</p><p><strong>Results: </strong>All flaps survived without major postoperative complications. Radiographs demonstrated consistent osseous union between the iliac crest graft and tibia. All patients achieved full weight-bearing and stable ankle function. Mild-to-moderate radiographic osteoarthritis occurred at long-term follow-up but remained asymptomatic. Soft-tissue coverage was reliable, and no secondary flap procedures were required.</p><p><strong>Conclusions: </strong>The free vascularized iliac crest flap is a dependable and versatile reconstructive option for extensive lateral malleolar defects. It provides stable ankle restoration, predictable union, and durable function, and should be considered when conventional grafting or fibular transfers are unsuitable, particularly in complex post-traumatic or infected environments.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100393"},"PeriodicalIF":0.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing trends in peripheral nerve repair: A two-decade TriNetX analysis of grafting techniques and the ascendancy of allografts.","authors":"Tyler Reinoso, Emerson Rowe, David Kirby, Sina Ramtin, Asif M Ilyas","doi":"10.1016/j.jham.2025.100395","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100395","url":null,"abstract":"<p><strong>Background: </strong>Various modalities exist for repairing transected nerves not amenable to primary repair; including, autograft, vein graft, conduit, and allograft. The study was hypothesis was that there is increasing utilization of allografts for peripheral nerve repairs.</p><p><strong>Materials & methods: </strong>The TriNetX Research Network was queried from 2002 to 2022 for all patients undergoing peripheral nerve repair. Demographic information, usage patterns, and comorbidities associated with different grafting methods by CPT were extracted and analyzed.</p><p><strong>Results: </strong>Out of 33,262 patients undergoing peripheral nerve repair, 31,756 with available demographic data were identified and included. Primary repair cases totaled 17,159, followed by conduit (n = 9282), allograft (n = 3582), autograft (n = 2886), and vein autograft (n = 353). Noting that a cpt for an allograft was introduced in 2017, a logistical regression analysis was performed to further sub-analyze allograft usage. The utilization of allografts significantly increased in 2021-2022 compared to 2019-2020, with an odds ratio (OR) of 1.4 (95 % confidence interval [CI]: 1.1-1.7; P = 0.001), indicating a greater increase compared to autograft utilization during the same interval. The mean per-year rate of change (range) between 2017 and 2022 for nerve allograft, conduit, autograft and vein autograft was +93.4 (+16.5 to +176.5), +6.3 (-37 to +45), -1.4 (-7.5 to +7.5), and +2 (-2.5 to +6.5), respectively.</p><p><strong>Conclusion: </strong>This study presents a twenty-year analysis of the changing trends in nerve repair and grafting techniques employed by nerve surgeons. Conduit repair has remained a major grafting technique used among surgeons. However, since its introduction, nerve allograft repair demonstrates a consistent positive upward trend in usage within the last 6 years, In contrast, autograft usage has decreased while vein graft usage is least common with a less relevant change in usage. These trends suggest an increasing preference for allograft, potentially displacing other nerve grafting methods, including autografting.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100395"},"PeriodicalIF":0.5,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy and safety of endoscopic, open, and mini-open techniques for carpal tunnel release: A meta-analysis.","authors":"Marc Boutros, Guy Awad, Jean-Pierre Saad, Kamal Bou Hamdan, Maya Bou Hamdan, Bassem Elhassan","doi":"10.1016/j.jham.2025.100392","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100392","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. In addition to traditional open carpal tunnel release (OCTR), endoscopic (ECTR) and mini-open (MOCTR) approaches have been developed as minimally invasive alternatives. However, comparative evidence regarding their clinical efficacy and safety remains inconsistent.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were performed according to PRISMA guidelines, including 44 comparative studies (38 comparing ECTR vs OCTR and 6 comparing ECTR vs MOCTR) involving adult patients with idiopathic CTS. Outcomes extracted included pain (VAS), functional scores (BCTQ-SSS, BCTQ-FSS, DASH), grip and pinch strength, sensory symptoms, and complications such as pillar pain, nerve injury, opioid use, and revision CTR.</p><p><strong>Results: </strong>Across all functional measures (DASH, BCTQ-FSS, BCTQ-SSS), pain, and sensory outcomes, pooled analyses demonstrated no statistically significant differences between ECTR, OCTR, and MOCTR. Grip and pinch strength were also comparable, indicating equivalent long-term motor recovery. Postoperative VAS pain scores did not differ significantly between ECTR and OCTR (p = 0.10). Nerve injury also showed no significant difference between techniques in the random-effects model (p = 0.56). Opioid prescription rates were similar across groups. Notably, ECTR demonstrated a significantly lower revision CTR rate compared with OCTR (risk ratio = 0.46, 95 % CI 0.29-0.73; p = 0.0009).</p><p><strong>Conclusion: </strong>Open, mini-open, and endoscopic carpal tunnel release techniques provide comparable outcomes in pain relief, functional recovery, strength, sensory symptoms, and overall safety for idiopathic CTS. Although revision CTR occurred less frequently after ECTR in the pooled analysis, the clinical significance of this difference remains uncertain. Technique selection should therefore be individualized based on surgeon expertise, patient priorities, and resource availability.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100392"},"PeriodicalIF":0.5,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do it right the first time; implementation of three-dimensional technology for bone defect reconstruction in upper extremity surgery.","authors":"Hedayatullah Esmati, Tim de Jong, Kim Y Jochem, Vincent M A Stirler, Rob F M van Doremalen, Hinne A Rakhorst","doi":"10.1016/j.jham.2025.100390","DOIUrl":"10.1016/j.jham.2025.100390","url":null,"abstract":"<p><p>Three-dimensional (3D) technology has rapidly evolved from an innovative concept into an essential surgical tool. The increasing availability of high-resolution imaging, affordable 3D printers and user-friendly software has accelerated the integration of 3D technology into clinical practice, including upper extremity surgery. Despite the growing interest, many surgeons remain uncertain about how to practically implement this technique in clinical workflows. This review illustrates the clinical use of 3D technology in upper extremity bone defect reconstruction. We highlight both the preoperative and intraoperative applications of 3D technology, illustrated by detailed case examples. We also provide a practical guideline to support clinicians in adopting 3D technology as part of their routine surgical practice.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100390"},"PeriodicalIF":0.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maltreated and misdiagnosed finger fractures: a malpractice claim analysis from the Swedish national patient insurance register 2011-2021.","authors":"Jonny K Andersson, Amanda Davidsson, Marcus Sagerfors","doi":"10.1016/j.jham.2025.100382","DOIUrl":"10.1016/j.jham.2025.100382","url":null,"abstract":"<p><p>Finger fractures are among the most common fractures of the upper limb. The number and cost of maltreated and misdiagnosed finger fractures in Sweden is unknown. The aim was to study the number, complications, causes, and cost of maltreated and misdiagnosed finger fractures, 2011-2021, in Sweden.Claims matching the prespecified ICD-10-SE codes S62.6-7 (finger fractures) and T92.2 (sequelae after finger fracture) during the 2011-2021 timeframe were identified. The data were extracted from the Swedish National Patient Insurance Company Register and analyzed in terms of epidemiology and cost.Of the 1621 assessed cases, 384 reported maltreated and misdiagnosed finger fractures were found. The mean age was 41 years (range 2-88). Thirty-one percent of the healthcare-related injuries occurred in emergency care, primarily due to maltreatment leading to malunion after non-operative treatment. Thirty-six percent of healthcare-related injuries occurred in specialist departments, mostly due to malunion after surgical intervention. In primary care, the leading cause was misdiagnosis, often due to inadequate examination and lack of X-ray examination. The total aggregated direct and indirect costs amounted to SEK 25 557 200 (USD 2 505 608, Euro 2 165 864, Yen 424 249 520).</p><p><strong>Conclusion: </strong>Finger fractures affect people of all ages and can lead to significant socioeconomic and medical invalidity. Maltreated fractures mainly occur in emergency care (due to malunion after immobilization) and specialist care (due to malunion after surgery). Misdiagnosed fractures were more common in primary care. A suggestion for claims prevention would be improved physician education, updated guidelines regarding the use of X-rays, seeking specialist opinions in uncertain cases, evaluating surgical technique, and optimizing postoperative care could probably help reduce the number of these injuries.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100382"},"PeriodicalIF":0.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide awake anesthesia has awakened us widely.","authors":"Xavier Gueffier, J Terrence Jose Jerome","doi":"10.1016/j.jham.2025.100362","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100362","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100362"},"PeriodicalIF":0.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}