Journal of Hand and Microsurgery最新文献

{"title":"From technique to global movement: What the world WALANT symposium 2026 tells us about the future of wide-awake surgery.","authors":"J Terrence Jose Jerome","doi":"10.1016/j.jham.2026.100496","DOIUrl":"10.1016/j.jham.2026.100496","url":null,"abstract":"<p><p>Wide-Awake Local Anesthesia No Tourniquet (WALANT) has evolved from an alternative anesthetic technique into a broader surgical philosophy centered on patient participation, intraoperative functional assessment, efficiency, accessibility, and resource-conscious care. The World WALANT Symposium 2026, held in Tiruchirappalli, India, brought together surgeons from diverse countries and healthcare systems and highlighted both the extraordinary international growth of WALANT and the questions that must define its next phase. The future should move beyond advocacy toward standardization, high-quality comparative evidence, responsible expansion of indications, structured training, and equitable global implementation.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 5","pages":"100496"},"PeriodicalIF":0.7,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851458","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":"Reconstructing the interosseous ligament: A technique using a single bundle synthetic tape.","authors":"Enrico Carità, Clelia Rota, Vasiliki Batsou, Mara Laterza, Alberto Donadelli","doi":"10.1016/j.jham.2026.100495","DOIUrl":"10.1016/j.jham.2026.100495","url":null,"abstract":"<p><p>Reconstruction of the interosseous membrane of the forearm has gained popularity over recent decades and several surgical techniques have been described to treat the longitudinal instability of the forearm after an Essex-Lopresti injury (ELI). We propose a synthetic reconstruction of the interosseous ligament (IOL) with double Arthrex FiberTape® and present data from cadaveric specimens used to test the reconstruction. After reconstruction, proximal migratory forces were applied to the radius to assess the radioulnar displacement at wrist level. Safety of the technique was also assessed by measuring the distance between the fixation system and the posterior interosseous nerve (PIN). These experiments provide preliminary biomechanical data to support further evaluation of this technique for potential clinical application.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 5","pages":"100495"},"PeriodicalIF":0.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841435","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":"Psychological outcomes following digital replantation and revascularization: A narrative review.","authors":"Diana Mastellone, Dev Patel, Kenyon Graham, Michael J Franco","doi":"10.1016/j.jham.2026.100492","DOIUrl":"10.1016/j.jham.2026.100492","url":null,"abstract":"<p><strong>Purpose: </strong>Literature on digital replantation has historically prioritized primary outcomes such as viability rates, return-to-work timelines, and restoration of range of motion and grip strength. Psychological and psychosocial sequelae, including post-traumatic stress disorder (PTSD), depression, anxiety, sleep disturbance, adjustment disorder, and body image disruption, are reported inconsistently, infrequently, or not at all. This narrative review examines the scope and quality of psychological outcome reporting in the digital replantation and revascularization literature from 2015 to 2025.</p><p><strong>Methods: </strong>A literature search of PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and the Cochrane Library was conducted for English-language studies published between January 2015 and December 2025, using combinations of terms including \"replantation,\" \"revascularization\", \"digit amputation\", \"PTSD\", \"anxiety\", \"depression\", \"adjustment disorder\", \"body image\", and \"psychosocial outcomes\". Studies reporting at least one psychological or psychiatric outcome following digital or upper extremity replantation, revascularization, or upper extremity amputation were included. Adult or mixed adult-pediatric cohorts were included. Given study heterogeneity, findings were synthesized narratively, to broadly characterize the available literature, by outcome domain.</p><p><strong>Results: </strong>Nineteen studies met inclusion criteria. Depression was the most frequently reported discrete outcome (10/19 studies, 52%), followed by anxiety (8/19 studies, 42%) and PTSD (7/19 studies, 36%). PTSD prevalence ranged from 46% to 69%, and depression and anxiety prevalence ranged from 7% to 71% across studies using validated instruments. Adjustment disorder was identified in two studies, including one large retrospective analysis (n = 1986) demonstrating significantly higher prevalence following replantation failure (2.7% vs <1%). Pre-injury anxiety was identified as an independent predictor of replantation failure in one prospective cohort. No included study reported formal psychiatric or behavioral health referral rates.</p><p><strong>Conclusions: </strong>There is a pervasive gap in the reporting of psychological and psychosocial outcomes following digital replantation and revascularization. Existing evidence demonstrates that psychiatric morbidity is more common than is currently reflected in traditional surgical outcome reporting. Standardized, validated psychological screening instruments should be incorporated into replantation outcome reporting, and multidisciplinary care models inclusive of behavioral health are warranted.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 5","pages":"100492"},"PeriodicalIF":0.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799272","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":"New perspective on acute boutonniere deformity: An anatomical study with illustrative case report.","authors":"Lorenzo Andrea Ferrazzini, Thomas Giesen","doi":"10.1016/j.jham.2026.100490","DOIUrl":"10.1016/j.jham.2026.100490","url":null,"abstract":"<p><p>Acute boutonniere deformity is a heterogeneous clinical entity that has traditionally been attributed to rupture of the central slip of the extensor mechanism, with secondary palmar migration of the lateral bands. The temporal relationship between central slip detachment and lateral band displacement remains incompletely defined. We report a clinical case in which a patient presented with an immediate, actively irreducible boutonniere deformity caused by an uncommon injury pattern, characterized by longitudinal disruption of a single lateral band and rupture of the ipsilateral collateral ligament, with the central slip largely intact. The deformity could not be reduced by closed means and required surgical treatment.Motivated by this observation, we performed an exploratory anatomical study on 16 cadaveric fingers. Isolated lesions of the central slip or of a single lateral band did not, in this model, produce an actively irreducible boutonniere deformity. By contrast, combined injuries consisting of a longitudinal lesion of one lateral band and rupture of the ipsilateral collateral ligament consistently resulted in immediate palmar displacement of the lateral band below the axis of the proximal interphalangeal (PIP) joint, irrespective of central slip integrity.These exploratory findings suggest that, alongside the classical mechanism of central slip rupture, an under-recognized injury pattern combining longitudinal lateral band disruption and ipsilateral collateral ligament failure may produce an immediate, actively irreducible boutonniere deformity, with potential implications for early diagnosis and treatment. Further clinical validation is required.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 5","pages":"100490"},"PeriodicalIF":0.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765186","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":"WALANT beyond anesthesia: The end of physiological silence in hand, microsurgical and peripheral nerve reconstruction.","authors":"J Terrence Jose Jerome","doi":"10.1016/j.jham.2026.100479","DOIUrl":"10.1016/j.jham.2026.100479","url":null,"abstract":"<p><p>Wide Awake Local Anesthesia No Tourniquet (WALANT) is often introduced as an anesthetic technique that avoids general anesthesia, regional blocks, sedation, and tourniquet discomfort. This description is accurate, but incomplete. The deeper significance of WALANT is that it restores living physiology to the operating theatre. For more than a century, reconstructive surgeons repaired tendons, transferred nerves, corrected deformities, balanced muscles, and reconstructed movement in patients whose physiology was temporarily silent. Tendon tension was estimated, nerve function was predicted, muscle balance was assumed, and the final judgment of success was delayed until rehabilitation revealed the truth. WALANT challenges this old paradigm by allowing movement, tension, balance, spasticity, sensory response, and patient-specific biomechanics to be observed during surgery itself. Its expanding role in tendon transfer, thumb reconstruction, peripheral nerve surgery, brachial plexus reconstruction, spasticity surgery, and ambulatory microsurgery suggests that its greatest contribution may not be anesthetic freedom, but the birth of physiology-guided reconstruction. This editorial argues that WALANT has moved beyond tendons and beyond anesthesia. It has become a new way of thinking about reconstructive surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 4","pages":"100479"},"PeriodicalIF":0.7,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13324224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377554","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":"Clinical characteristics and annual incidence of pickleball-related upper extremity injuries among patients presenting to emergency departments, 2015-2024.","authors":"Rishub K Das, Wesley Thayer, Shady Elmaraghi, J Bradford Hill, Brian C Drolet","doi":"10.1016/j.jham.2026.100472","DOIUrl":"10.1016/j.jham.2026.100472","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 4","pages":"100472"},"PeriodicalIF":0.7,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200567","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":"Patient-specific 3D-printed perforator mapping guide for propeller flap reconstruction in the hand.","authors":"Yu Tai Tong, Marvin Man Ting Chung, Terence Tai Lun Poon","doi":"10.1016/j.jham.2026.100476","DOIUrl":"10.1016/j.jham.2026.100476","url":null,"abstract":"<p><p>Reconstruction of hand soft tissue defects relies on accurate perforator localization, yet conventional planning with computed tomography angiography or handheld Doppler requires mental three-dimensional (3D) translation, and is associated with mapping errors or intraoperative adjustments. This article evaluates the use of an innovative patient-specific, surface-conforming 3D-printed guides that convert segmented preoperative magnetic resonance imaging (MRI) data into tangible templates to project dorsal metacarpal artery (DMA) perforator emergence points onto the skin with reproducible accuracy. In an illustrative case, a 66-year-old man underwent wide local excision of a digital porocarcinoma followed by propeller flap reconstruction. The third and fourth DMA perforators were identified from MRI, with a 2 mm-thick dorsal hand shell designed with 1 cm fenestrations corresponding to perforator emergence points. The perforators were marked onto the skin through the custom guide preoperatively, with skin markings cross verified with handheld Doppler. Reconstruction proceeded using a fourth DMA perforator-based propeller flap rotated to achieve tension-free coverage, with complete flap survival and restoration of full digital motion and satisfactory aesthetics. The 3D-printed guide reduced cognitive load, accelerated perforator localization, and minimized unnecessary dissection, supporting shorter tourniquet duration and safer elevation. The hand's distinct bony landmarks and stable contours enable reliable registration of rigid surface guides. As costs and workflows for imaging-to-print continue to decrease, patient-specific 3D-printed guides represent a practical, scalable adjunct that improved accuracy, efficiency, and reproducibility in perforator-based hand reconstruction.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 4","pages":"100476"},"PeriodicalIF":0.7,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057463","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":"Wrist and elbow arthroscopy case volume is low and declining in orthopedic residency and fellowship training.","authors":"Maxwell A Northrop, Paul J Pottanat, Kevin Cahoy, Alexander J Ment, Michael R Otten, Mary-Katherine Lynch, Dane N Daley, Charles A Daly","doi":"10.1016/j.jham.2026.100473","DOIUrl":"10.1016/j.jham.2026.100473","url":null,"abstract":"<p><strong>Purpose: </strong>Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that graduating orthopedic surgery residents and fellows receive.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education (ACGME) case log data from 2014 to 2024 was reviewed for graduating orthopedic residents, hand surgery fellows, and orthopedic sports medicine fellows in the United States. Mean and median numbers of wrist and elbow arthroscopy cases logged per resident or fellow were compared to assess procedure volume. The 10th and 90th percentiles of case volumes were analyzed to assess variability. Trends were evaluated over time to determine changes in case exposure.</p><p><strong>Results: </strong>Wrist arthroscopy volume reported by orthopedic residents decreased from 4.6 ± 5 (median 3, range 0-46) to 3.0 ± 3 (1, 0-23) cases per resident (<i>p</i> < 0.001). Elbow arthroscopy volume decreased from 2.1 ± 2 (2, 0-18) to 1.8 ± 3 (1, 0-38) cases per resident (<i>p</i> < 0.001). Among hand surgery fellows, wrist arthroscopy volume decreased from 18.5 ± 13 (15, 3-102) to 14.4 ± 8 (13, 5-65) cases per fellow (<i>p</i> < 0.001), and elbow arthroscopy volume from 5.2 ± 7 (4, 0-35) to 2.6 ± 3 (1, 0-20) cases per fellow (<i>p</i> < 0.001). Sports medicine fellow elbow arthroscopy volume decreased from 6.6 ± 8 (4, 0-48) to 3.1 ± 4 (2, 0-23) cases per fellow (<i>p</i> < 0.001). Wrist arthroscopy volume was not reported for sports medicine fellows.</p><p><strong>Conclusions: </strong>Despite the established role of wrist arthroscopy in upper extremity orthopedic surgery, resident exposure is limited and has declined over recent years. Fellowship training has not offset this decline, with wrist and elbow arthroscopy volume decreasing significantly in hand and sports medicine fellowships. These trends raise concerns over preparedness to safely and independently perform these technically demanding procedures in practice after training.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 4","pages":"100473"},"PeriodicalIF":0.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057426","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":"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":"10.1016/j.jham.2026.100449","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100449"},"PeriodicalIF":0.7,"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":"Measuring the carbon cost of hand surgery: A single-centre observational study.","authors":"Louise Leijonberg, Sandip Hindocha, Kavish Maheshwari","doi":"10.1016/j.jham.2026.100448","DOIUrl":"10.1016/j.jham.2026.100448","url":null,"abstract":"<p><strong>Purpose: </strong>Healthcare contributes considerably to global greenhouse gas emissions, with operating theatres amongst the most energy-intensive hospital environments. While carbon footprints have been quantified for several surgical procedures, the environmental impact of hand surgery, characterised by high case volumes and short procedures, remains poorly studied. This study aims to quantify carbon emissions of hand surgery procedures.</p><p><strong>Methods: </strong>This single-centre observational pilot study quantified the carbon emissions associated with hand surgery procedures performed during two half-day theatre lists at a UK NHS hospital. Data was collected under the Greenhouse Gas Protocol Scopes and emissions calculated using UK Government greenhouse gas conversion factors. Data collected included theatre electricity and heating, anaesthetic use, staff and patient transport, waste incineration, supply-chain emissions, and instrument sterilisation.</p><p><strong>Results: </strong>Five trauma hand surgery cases were analysed. Case-level emissions ranged from 8.32 to 22.56 kg CO₂. When combined at a list level, total emissions were substantial, reaching 311.36 kg CO₂ and 285.30 kg CO₂ per half-day list. Purchased electricity (Scope 2) was the largest contributor, followed by heating and anaesthetic gases (Scope 1). Scope 3 emissions were largely attributed to staff travel and single-use consumable supply-chain emissions, while waste disposal and reusable instrument sterilisation contributed comparatively little.</p><p><strong>Conclusions: </strong>Individual hand surgery procedures have a relatively low carbon footprint, but the cumulative emissions at list-level are large. Theatre energy use, heating and staff transport represent key targets for emission reduction. Interventions focusing on energy-efficient infrastructure, renewable energy, greener staff travel, and reduced reliance on single-use consumables may result in meaningful environmental benefits. Larger multicentre studies with improved energy metering are needed to refine estimates and guide sustainable surgical practice.</p><p><strong>Clinical relevance: </strong>Quantifying the carbon emissions associated with common hand surgery procedures may help hand surgery teams and healthcare organisations identify opportunities to reduce emissions.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100448"},"PeriodicalIF":0.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640076","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}