Journal of Hand and Microsurgery最新文献

{"title":"Dual-mobility thumb carpometacarpal joint arthroplasty. Keypoints of surgical procedure for a satisfying outcome.","authors":"Efstratios D Athanaselis, Filippos Zigras, Theofilos Karachalios, Sokratis Varitimidis","doi":"10.1016/j.jham.2024.100195","DOIUrl":"10.1016/j.jham.2024.100195","url":null,"abstract":"<p><p>Thumb carpometacarpal (CMC) arthritis is a prevalent pathology, particularly among elderly women, with a significant impact on patients' quality of daily life. Total joint replacement can provide a shorter rehabilitation period and satisfying function, at least in the short term with encouraging findings according to recent studies concerning its complications (e.g., dislocation, loosening) and longevity. TOUCH® is a second-generation, dual mobility prosthesis with promising results. Step-by-step surgical technique and keypoints for successful implantation and satisfying thumb function are presented in this article.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100195"},"PeriodicalIF":0.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886192","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":"Gender and racial diversity Assumed by text-to-image generators in microsurgery and plastic surgery-related subspecialities.","authors":"Makoto Shiraishi, Chihena Hansini Banda, Mayuri Nakajima, Mildred Nakazwe, Zi Yi Wong, Yoko Tomioka, Yuta Moriwaki, Hakuba Takeishi, Haesu Lee, Daichi Kurita, Kiichi Furuse, Jun Ohba, Kou Fujisawa, Shimpei Miyamoto, Mutsumi Okazaki","doi":"10.1016/j.jham.2024.100196","DOIUrl":"10.1016/j.jham.2024.100196","url":null,"abstract":"<p><strong>Background: </strong>Since the release of ChatGPT by OpenAI in November 2022, generative artificial intelligence (AI) models have attracted significant attention in various fields, including surgery. These advancements have been particularly notable for creating highly detailed and contextually accurate images from textual prompts. A notable area of clinical application is the representation of surgeon demographics in various specialties, particularly in the context of microsurgery and plastic surgery-related subspecialties.</p><p><strong>Methods: </strong>This cross-sectional study, conducted in June 2024, utilized the latest version of the Copilot Creative Mode powered by DALL-E 3 to generate images of surgeons across various plastic surgery subspecialties. Real-world demographic data from the US, Japan, and Zambia were compared with AI-generated images for an accurate representation analysis.</p><p><strong>Results: </strong>Five hundred images (350 from various subspecialties and 150 from geographical sources) were analyzed. The AI model predominantly generated images of male and female surgeons with a statistical underrepresentation of female and Black microsurgeons. Geographical prompts influenced the representation, with an overrepresentation of female (64.0 %; p < 0.001) and Black (16.0 %; p < 0.001) plastic surgeons in the US and exclusively Asian surgeons in Japan. Discrepancies were also observed in the depiction of surgical equipment, with the majority of AI-generated microsurgeons inaccurately portrayed using either surgical loupes (46.0 %) or optical microscopes (32.0 %), not with surgical microscopes (4.0 %).</p><p><strong>Conclusions: </strong>This study revealed significant disparities between AI-generated images and actual demographics in the fields of microsurgery and plastic surgery-related subspecialties, highlighting the need for more diverse and accurate training datasets for AI models.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100196"},"PeriodicalIF":0.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899228","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":"Using machine learning to identify risk factors for short-term complications following thumb carpometacarpal arthroplasty.","authors":"Rohan M Shah, Rushmin Khazanchi, Anitesh Bajaj, Krishi Rana, Saaz Malhotra, Jennifer Moriatis Wolf","doi":"10.1016/j.jham.2024.100156","DOIUrl":"10.1016/j.jham.2024.100156","url":null,"abstract":"<p><strong>Background: </strong>Thumb carpometacarpal (CMC) joint osteoarthritis is among the most common degenerative hand diseases. Thumb CMC arthroplasty, or trapeziectomy with or without tendon augmentation, is the most frequently performed surgical treatment and has a strong safety profile. Though adverse outcomes are infrequent, the ability to predict risk for complications has substantial clinical benefits. In the present study, we evaluated a well-known surgical database with machine learning (ML) techniques to predict short-term complications and reoperations after thumb CMC arthroplasty.</p><p><strong>Methods: </strong>A retrospective study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) years 2005-2020. Outcomes were 30-day wound and medical complications and 30-day return to the operating room. We used three ML algorithms - a Random Forest (RF), Elastic-Net Regression (ENet), and Extreme Gradient Boosted Tree (XGBoost), and a deep learning Neural Network (NN). Feature importance analysis was performed in the highest performing model for each outcome to identify predictors with the greatest contributions.</p><p><strong>Results: </strong>We included a total of 7711 cases. The RF was the best performing algorithm for all outcomes, with an AUC score of 0.61±0.03 for reoperations, 0.55±0.04 for medical complications, and 0.59±0.03 for wound complications. On feature importance analysis, procedure duration was the highest weighted predictor for reoperations. In all outcomes, procedure duration, older age, and female sex were consistently among the top five predictors.</p><p><strong>Conclusions: </strong>We successfully developed ML algorithms to predict reoperations, wound complications, and medical complications. RF models had the highest performance in all outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100156"},"PeriodicalIF":0.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819727","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":"Dynamic CT features of scapholunate instability during the wrist extension to flexion-An in vivo study.","authors":"Melanie Amarasooriya, Rami Al Dirini, Kimberley Bryant, Gregory Ian Bain","doi":"10.1016/j.jham.2024.100158","DOIUrl":"10.1016/j.jham.2024.100158","url":null,"abstract":"<p><strong>Purpose: </strong>This biomechanical study aimed to assess the change in the radioscaphoid and the radiolunate angles during wrist extension to flexion in scapholunate instability compared to the healthy wrist.</p><p><strong>Methods: </strong>Dynamic CT scans of 19 participants with no history of wrist pathology and 19 patients with scapholunate instability without degenerative changes were selected. Motion sequence studied was wrist extension to flexion. Image segmentation followed by 3D registration techniques were used to calculate the displacement field between scaphoid and lunate models in each time point. The radiocarpal angles and centroid positions were computed in the neutral wrist and throughout wrist motion. Comparisons were made between the normal and the scapholunate instability wrists.</p><p><strong>Results: </strong>The scapholunate instability wrist had less range of extension to flexion compared to the normal wrist. The scapholunate instability scaphoid was flexed and internally rotated in the neutral wrist position and throughout the range of motion. The scapholunate instability scaphoid centroid remained radial and distal in the extended wrist. The scapholunate instability lunate was significantly extended from wrist 20° extension to 50° flexion. The scapholunate instability lunate centroid was more ulnar from 70° wrist extension to 50° flexion.</p><p><strong>Conclusions: </strong>The scapholunate instability scaphoid demonstrated rotational abnormalities in two planes throughout the wrist motion and abnormal centroid positions in the extended wrist. The lunate extension in scapholunate instability was significant mostly during wrist flexion. Radioscaphoid instability appear to be the primary pathology in SLI and can be used to differentiate the SLI wrist from the normal throughout wrist extension to flexion. Lunate extension is not different between the normal and scapholunate instability in the extended wrist.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100158"},"PeriodicalIF":0.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819412","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":"A comparison of handheld versus cart-based ultrasound in the evaluation and diagnosis of carpal tunnel syndrome.","authors":"Shiva D Yagobian, Sean R Wallace, John R Fowler","doi":"10.1016/j.jham.2024.100159","DOIUrl":"10.1016/j.jham.2024.100159","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is responsible for over 90 % of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting.</p><p><strong>Methods: </strong>43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8-20 MHz transducer. The GE Venue Go with a 4-20 MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired <i>t</i>-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p < 0.05).</p><p><strong>Results: </strong>The average CSA measurement obtained with the GE was 14.21 ± 4.89 mm². The average CSA measurement obtained with the Clarius handheld transducer was 13.54 ± 4.50 mm². The mean difference between the GE and Clarius groups was 0.62 mm² (95 % CI = -1.47 to 2.71), p = 0.55.</p><p><strong>Conclusion: </strong>CSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100159"},"PeriodicalIF":0.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819501","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":"Ganglion cysts of the wrist: A bibliometric analysis review of the top 50 highly cited publications.","authors":"Abdulmalek W Alhithlool, Ibrahim R Halawani, Zainalabden E Jefri, Amjad W AlHithlool, Raghad Yasir Shosho, Maha Sulaiman Albarrak, Mohammed Essam Kattan, Sarah W Alkhonizy, Amr Youssef Arkoubi, Abdulaziz Saleh Almodumeegh, Hatan Mortada","doi":"10.1016/j.jham.2024.100155","DOIUrl":"10.1016/j.jham.2024.100155","url":null,"abstract":"<p><strong>Introduction: </strong>Ganglion cysts (GCs) are a form of benign soft tissue mass commonly seen on the dorsum of the wrist that could also form in the hand. They can cause pain and impede physical activities. Despite extensive studies, there has not been a thorough analysis of the top 50 GC articles. This bibliometric analysis examines the most cited research on GC of the wrist with the aim of uncovering existing trends and future directions in the field.</p><p><strong>Methods: </strong>The authors conducted a comprehensive search utilizing the Web of Science Core Collection on November 16, 2023, to identify the top 50 cited articles on wrist GC published between 1988 and 2023. Subsequently, data were extracted from each article encompassing details such as the title, authors, first/senior authors, publication year, country, journal, total citations, annual average citations, research setting, funding, study design, level of evidence, and primary outcome.</p><p><strong>Results: </strong>The predominant publication venue was identified as The Journal of Hand Surgery, with (44 %) originating from the United States, followed by contributions from the United Kingdom (14 %), South Korea (8 %), and China (4 %). Key findings included surgical techniques, diagnostic investigations, patient outcomes, treatment plans, epidemiology, and comparative analyses. Notably, there was a peak in citations in the early 2010s.</p><p><strong>Conclusion: </strong>In recent decades, significant progress has been made in the study of wrist GC, mostly driven by the United States with an emphasis on surgical techniques and diagnostic investigations.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100155"},"PeriodicalIF":0.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819419","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 vs standard anaesthesia in the management of flexor tendon injuries: A systematic review and meta-analysis.","authors":"Rahy Farooq, Muhammad Yasir Raufi, Bryan Soe, Amir-Humza Suleman, Shaikh Sanjid Seraj, Abida Arif, Shafiq Rahman, Waseem Bhat","doi":"10.1016/j.jham.2024.100157","DOIUrl":"10.1016/j.jham.2024.100157","url":null,"abstract":"<p><p>Wide awake local anaesthesia no tourniquet (WALANT) surgery has gained increasing popularity in recent years for hand surgery fast-tracked by the COVID pandemic. It involves infiltration of lidocaine with adrenaline to the operative region ensuring a good visual field owing to the vasoconstrictive effects of epinephrine. It has numerous advantages over traditional anaesthetic (TA) for flexor tendon repairs including testing of tendon strength on table as well as immediate revision of the repair if needed. Currently there are a number of studies in the literature evaluating WALANT versus TA in flexor tendon injuries with continuing debate on the optimal modality but no amalgamated synthesis of data. The authors report the first systematic review and meta-analysis on the topic. The authors conducted the review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA) guidelines. All studies comparing flexor tendon repairs under WALANT versus TA were included. The primary outcome measure was range of movement (ROM) with secondary outcomes including adhesions/tenolysis, rupture as well as re-operation rates. OpenMeta[Analyst] software was utilised for data synthesis. Five studies in total met the inclusion criteria with an overall assessment of 624 fingers. There was no significant difference observed between WALANT and TA for tendon rupture; odds ratio 1.027 (0.450, 2.342) p-value = 0.950, the incidence of adhesions/tenolysis; odds ratio 0.601 (0.172, 2.093) p-value = 0.424 or re-operation rates; odds ratio 1.193 (0.544, 2.618) p-value = 0.659. ROM was reported to be better in the WALANT cohort; odds ratio: 1.641 (1.010, 2.669) p-value = 0.046. WALANT offers a safe and effective mode of anaesthetic over traditional modalities with comparable outcomes for flexor tendon repairs. Although ROM appears superior, the number of randomised control trials are currently low and more high quality studies are necessitated to enhance the current evidence base.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100157"},"PeriodicalIF":0.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819736","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":"Maximizing hand function following zone II flexor tendon repair: A systematic review and meta-analysis of rehabilitation strategies.","authors":"Hatan Mortada, Abdulmalek W Alhithlool, Mohammed Essam Kattan, Alanoud Abdulaziz Alfaqih, Danah Mansour Alrajhi, Aseel Abdulkreem Alkhmeshi, Abdulaziz Saleh Almodumeegh, Abdullah Kattan","doi":"10.1016/j.jham.2024.100152","DOIUrl":"10.1016/j.jham.2024.100152","url":null,"abstract":"<p><strong>Introduction: </strong>Injuries to the flexor tendons of the hand pose significant challenges in both surgical repair and postoperative rehabilitation. Despite advancements in techniques, there remains uncertainty about the most effective postoperative rehabilitation protocol/strategy. This study aims to address this debatable issue by evaluating different rehabilitation protocols following surgical repair in zone II flexor tendon repair.</p><p><strong>Methods: </strong>A systematic review and meta-analysis followed PRISMA guidelines, searching databases up to December 2023. Inclusion criteria covered studies on zone II flexor tendon repair in adults, with various rehabilitation strategies and hand function as primary outcomes. Data extraction and bias assessment employed predefined tools.</p><p><strong>Results: </strong>Among 916 initial articles, 28 met the inclusion criteria. Published from 1980 to 2023, these studies involved 1414 patients, predominantly affecting the little, index, and middle fingers. Various suture techniques and materials were used, with early active and passive motion as primary rehabilitation protocols.</p><p><strong>Conclusion: </strong>This review highlights early active and passive motion as common postoperative rehabilitation strategies for zone II flexor tendon repair. While active motion showed greater range of motion improvement, both protocols had comparable reoperation rates and grip strength outcomes. Future research should focus on refining protocols and assessing long-term outcomes to optimize patient care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100152"},"PeriodicalIF":0.3,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819652","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":"A two-stage surgery for completely degloving injury of multiple fingers: A retrospective cohort study.","authors":"Hongjun Liu, Tao Guo, Bin Wang, Fan Wu, Wenzhong Zhang, Tao Xu, Jiaxiang Gu, Yiming Lu","doi":"10.1016/j.jham.2024.100151","DOIUrl":"10.1016/j.jham.2024.100151","url":null,"abstract":"<p><strong>Purpose: </strong>The completely degloving injury of multiple fingers is a challenging clinical problem. Based on our technical experience, a novel two-stage surgery of abdominal hypodermal pocket followed by separation and full thickness skin grafting was conducted.</p><p><strong>Methods: </strong>From January 2017 to August 2020, 7 cases (17 fingers) of degloving injury of multiple whole fingers who were treated in a two-stage fashion; an emergency first stage surgery of abdominal hypodermal pocket embedding and a second stage surgery (4 weeks later) of full thickness skin grafting, were retrospectively studied. The results were evaluated according to the patient subjective evaluation, static two-point discrimination and disabilities of the arm, shoulder and hand (DASH) scores and active range of motion (ROM) of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints.</p><p><strong>Results: </strong>All seven cases healed successfully, although two cases experienced distal phalanx necrosis. The affected fingers recovered with a good appearance and soft texture and the results were either satisfying or acceptable for all participants. The active ROM of MP joint ranged from 55° to 64° with an average of 59.5° three months postoperatively and ranged from 70° to 81° with an average of 77.2° six months postoperatively, while the active ROM of PIP joint ranged from 58° to 69° with an average of 64.1° three months postoperatively and from 76° to 86° with an average of 81° six months postoperatively. One year postoperatively, the static two-point discrimination ranged from 7 to 10 mm with an average of 8.6 mm and DASH scores ranged from 25 to 42 with an average of 37.</p><p><strong>Conclusion: </strong>A novel two-stage surgery of abdominal hypodermal separated pockets followed by full thickness is an effective and worthwhile option for treating the completely degloving injury of multiple fingers.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100151"},"PeriodicalIF":0.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819505","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":"Nuances in endoscopic carpal tunnel release a guide to improving outcomes.","authors":"Yao Zu Sean Kong, Yong Chiang Kang","doi":"10.1016/j.jham.2024.100150","DOIUrl":"10.1016/j.jham.2024.100150","url":null,"abstract":"<p><p>Endoscopic technique of carpal tunnel release is widely accepted as successful and safe as long as the surgeon is well-trained. Compared to the traditional open technique, there exists a steep learning curve for familiarisation of equipment, training of hand-eye coordination and appreciating tactile feedback. The available literature and manuals do not illustrate the practical challenges encountered during the procedure. We describe a guide for single-portal technique under local anesthesia, including surgical planning, cautions, and troubleshooting processes based on our experience with 136 cases in Asian hands which is known to be smaller.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100150"},"PeriodicalIF":0.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819658","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}