Journal of Hand and Microsurgery最新文献

{"title":"Utility of ultrasound imaging in the diagnosis of postoperative complications following upper extremity tendon repair.","authors":"Darren Sultan, Mark Guelfguat, Ralph Liebling","doi":"10.1016/j.jham.2024.100146","DOIUrl":"10.1016/j.jham.2024.100146","url":null,"abstract":"<p><p>Operated tendons are impacted by an inciting trauma and the subsequent treatment and will never again appear as they were prior to the insult. Post-operative tendons have unique ultrasound (US) findings that can be helpful to the surgeon in evaluating the success of repair, status of healing and confirmation that the repair remains intact. The advantage of US over physical exam or other imaging modalities is that it offers both static and dynamic assessment. The latter is of particular benefit in evaluating tendon function and gliding, which are meant to be visualized dynamically in order to provide information for the hand surgeon in defining the post-operative course. The goal of the pictorial review is to comprehensively present the US findings for postoperative complications in this field including tendon rupture, gapping, adhesion, suture granuloma and pulley disruption. Competence with ultrasound-assisted diagnosis in these domains can provide prompt feedback for providers and insight to improve patient care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100146"},"PeriodicalIF":0.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819730","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":"Unraveling the mysteries of parsonage turner syndrome: A journey towards optimal management. A systematic review.","authors":"Rinad Al Hinai, Linda Kelly, Michael O'Connor, Hannah Berman, Linda Abdul Jalil, Aubrie Sowa, Jake M McDonnell, Roisin Dolan","doi":"10.1016/j.jham.2024.100142","DOIUrl":"10.1016/j.jham.2024.100142","url":null,"abstract":"<p><strong>Aims: </strong>Parsonage Turner Syndrome (PTS) is a peripheral neuropathy manifesting as sudden onset pain, muscle weakness, and atrophy. This review aims to analyse long-term outcomes reported in adult patients with PTS, and establish an optimised management approach.</p><p><strong>Methods: </strong>A comprehensive literature search was performed using MEDLINE, PubMed, and the Cochrane Library. Articles that met the eligibility criteria were included. Analysis on time to presentation, presentation, interventions and long-term functional outcomes was conducted. All relevant information was collected by two independent reviewers.</p><p><strong>Results: </strong>Twenty-five studies, comprising 950 PTS patients, were identified. Patients averaged 43.8 years in age, with a F:M ratio of 0.6:1, and presented symptoms spanning 1-24 months prior to seeking medical attention. Management details were elucidated for 402 patients (42 ​%), with 87 ​% managed conservatively. Among conservatively managed patients, over 50 ​% exhibited no improvement. 62/402 (15 ​%) necessitated surgical interventions, including neurolysis, decompression, nerve transfers, and diaphragmatic plication. 25/31 (80.6 ​%) neurolysis cases demonstrated full functional recovery, including pain resolution and full muscle strength, between 1 day and 13 months (average 2.9 months). 2 nerve transfer cases achieved full forward flexion at 2.5 months. Overall, long-term outcomes of PTS, reported at 5-25 months, revealed residual neuropathic pain in 60 ​% and incomplete motor function return in 70 ​% of patients.</p><p><strong>Conclusions: </strong>PTS recognition and referral challenges persist, impeding timely management. While surgical interventions are advocated after three months for incomplete recovery, long-term surgical outcomes are inadequately reported. An optimal surgical strategy for stagnant nerve recovery needs to be devised for this challenging cohort of patients.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100142"},"PeriodicalIF":0.3,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819724","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 finger pulp with palmar digital artery perforator propeller flap using a digital artery perforator at the lateral base of the finger pulp.","authors":"Satoshi Kodaira, Keizo Fukumoto","doi":"10.1016/j.jham.2024.100144","DOIUrl":"10.1016/j.jham.2024.100144","url":null,"abstract":"<p><strong>Purpose: </strong>The digital artery perforator (DAP) flap is used to repair finger pulp defects as it can help preserve the digital artery. The standard DAP flap donor site is dorsal or lateral; however, the color of the flap typically poorly matches that of the finger pulp. The purpose of this study is to report two types of novel palmar DAP flaps.</p><p><strong>Methods: </strong>We designed two types of palmar DAP flaps using a digital artery perforator at the lateral base of the finger pulp and used them to reconstruct eight fingers of seven patients. The type A flap was created on the palmar lateral aspect of the middle phalanx and was rotated by 90°; it was used in combination with an oblique triangular flap for four small defects. The type B flap was created on the palmar aspect of the middle phalanx and was rotated by 180°; it was used in combination with skin grafts for four moderate defects.</p><p><strong>Results: </strong>All flaps survived completely despite transient congestion with the type B flap within 3 days of surgery.</p><p><strong>Conclusions: </strong>Since this perforator is always present, the DAP flap is useful and yields esthetically pleasing results.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100144"},"PeriodicalIF":0.3,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819669","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 feasibility model for restructuring the role of the hand surgeon taking call at a level I trauma center.","authors":"Darren Sultan, Evan Rothchild, Elisa Atamian, Patrick O'Connor, Joseph A Ricci, Armen K Kasabian, Victor Moon, Ralph Liebling","doi":"10.1016/j.jham.2024.100145","DOIUrl":"10.1016/j.jham.2024.100145","url":null,"abstract":"<p><strong>Background: </strong>The discrepancy between the volume of hand-related consults and the concurrent lack of specialized hand surgeons available continues to strain an overburdened system. Recent attention has focused on the redistribution of this workload towards management in the outpatient realm.</p><p><strong>Methods: </strong>This is a retrospective review of hand consults for the plastic surgery service over summer and winter intervals at a Level I trauma center. Consults were triaged with non-plastic surgery residents managing consults through remote direction of a plastic surgery resident. Demographic, clinical and outcomes data were analyzed to make inferences regarding care.</p><p><strong>Results: </strong>There were 116 hand consults of which 94.8 ​% were managed acutely by non-plastic surgery clinicians. Lacerations and fractures were more common in the summer, while infections and dislocations were more common in the wintertime (p value ​= ​0.0029). The three most common procedures were reduction and splinting (41.4 ​%), suturing (28.4 ​%), and incision and drainage (6.0 ​%). 12.1 ​% were admitted for management of the hand-related issue. Average time to the OR was shortest for infections or compartment syndrome as compared to that for other acquired concerns (1.0 days versus 11.6 days, p ​= ​0.0027). There were two complications (1.7 ​%) involving an unplanned return to the OR, but neither resulted from a delay in treatment.</p><p><strong>Conclusions: </strong>We propose a model of offloading the majority of hand consults through coverage by trainees with trauma experience knowledgeable in the basics of hand exams and general procedures. This model was safe and effective across a wide range of hand-related complaints.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100145"},"PeriodicalIF":0.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819503","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 techniques to treat thumb spasticity in children and adults: A systematic review.","authors":"J J T Barrett-Lee","doi":"10.1016/j.jham.2024.100143","DOIUrl":"10.1016/j.jham.2024.100143","url":null,"abstract":"<p><p>Upper limb spasticity surgery is an area of increasing interest and advances have been made in assessment and management, however treatment of the thumb remains a challenge. This systematic review evaluated current techniques to treat thumb spasticity. A search of three databases identified 14 articles between 2005 and 2023. Studies were assessed for methodological quality and found to be low-to-moderate in most cases. Data was extracted but synthesis limited by heterogeneity in patient groups, procedures, and outcome reporting. Lengthening of the flexor pollicis longus, release of intrinsic muscles, and augmentation of antagonists, often by re-routing of extensor pollicis longus, were reported most frequently. Thirteen studies (92.9 ​%) demonstrated improved thumb spasticity, position, or function, and complications were uncommon, though deformities recurred in up to 30 ​%. Poor quality evidence precluded definitive conclusions on safety and efficacy. Future investigators should focus on standardising outcome reporting, with an emphasis on functional goals.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100143"},"PeriodicalIF":0.3,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819721","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":"Diagnostic and management strategies for pseudoaneurysm of the ulnar artery: A scoping review.","authors":"W Nicholas Jungbauer, Matthew D Rich, Nellie V Movtchan, Shelley S Noland, Ashish Y Mahajan","doi":"10.1016/j.jham.2024.100117","DOIUrl":"10.1016/j.jham.2024.100117","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudoaneurysm of the ulnar artery (PUA) can arise secondary to several inciting etiologies and may lead to pain, arterial insufficiency, and ulnar nerve palsy. Given the relative infrequency of PUA diagnosis, there is no consensus regarding its proper diagnosis and management strategies. The purpose of this review is to summarize the existing data regarding PUA and develop an algorithm for management.</p><p><strong>Methods: </strong>A review was performed following PRISMA Extension for Scoping Reviews guidelines. Manuscripts were included if they 1) studied patients over the age of 18, 2) discussed specifics of the PUA and 3) detailed its management.</p><p><strong>Results: </strong>Thirty-one manuscripts were included, presenting data on 32 patients with a mean ​± ​standard deviation age of 46.9 ​± ​19.6 years. Ulnar artery injury mechanism included trauma (13/32, 40.6 ​%), iatrogenic (9/32, 28.1 ​%), and inherent connective tissue disease (4/32, 12.5 ​%), among others. Ultrasonography was the most common imaging modality (14/32, 43.7 ​%), and a majority (22/32, 68.8 ​%) of patients were managed surgically, typically via pseudoaneurysm resection ​± ​venous grafting for reconstruction. Non-operative interventions included ultrasound-guided compression therapy and thrombin injection.</p><p><strong>Conclusion: </strong>While PUA are infrequently diagnosed, inciting events such as accidental or iatrogenic trauma continue to be documented, and management guidelines are lacking. Duplex ultrasonography is recommended as the first line imaging study, with subsequent Allen Test to assess for ulnar artery vs. mixed dominance for hand perfusion. A pseudoaneurysm of 3 ​cm is proposed as a general threshold for considering intervention, with caveats for smaller lesions causing pain or neurologic symptoms. This review serves as a reference for physicians who encounter PUA.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 4","pages":"100117"},"PeriodicalIF":0.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134159","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":"Osteofibrous Dysplasia of Humerus: An Unusual Presentation of a Rare Lesion.","authors":"K Venkatadass, Deepak Jain, Owais Ahmed, S Rajasekaran","doi":"10.1055/s-0042-1757181","DOIUrl":"10.1055/s-0042-1757181","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"1 1","pages":"100010"},"PeriodicalIF":0.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41568489","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":"Emergency Foot Fillet Free Flap Based on Posterior Tibial Vessels for Reconstruction of Contralateral Heel and Sole: A Unique Spare Part Surgery.","authors":"Hari Venkatramani, Smitkumar K Patel, Monusha Mohan, Vamseedharan Muthukumar, S Raja Sabapathy","doi":"10.1055/s-0042-1749443","DOIUrl":"10.1055/s-0042-1749443","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction of the sole is an extremely challenging problem for a reconstructive microsurgeon. The specialized nature of its skin and subcutaneous tissue makes reconstruction arduous. When posed with complex bilateral lower extremity trauma where one limb was nonsalvageable, we harvested the uninjured foot fillet flap for free flap cover to reconstruct the contralateral sole. We report two such cases with follow-up assessment.</p><p><strong>Patients and methods: </strong>Two cases of sole reconstruction with emergency foot fillet free flap scavenged from the amputated contralateral limb were retrospectively analyzed. In both the patients, foot fillet free flap based on the posterior tibial neurovascular bundle was used. The follow-up assessment data collected included flap status, presence of any complications and prosthesis use, and functional status of the limbs at final follow-up.</p><p><strong>Results: </strong>Both the free flaps survived. Postoperative period was uneventful. No complications such as wound infection, delayed healing, flap necrosis, or scar breakdown were noted. The plantar flaps had recovery of protective sensation. Both the patients are ambulant; the first man with a fitted prosthesis and the second woman with the aid of a walker.</p><p><strong>Conclusion: </strong>The opportunity to utilize spare tissue from the amputated limb should be seized. Loss of the plantar aspect of foot poses a real challenge. The plantar foot fillet free flap is a durable flap with preservation of plantar sensations. It is probably the best choice as it replaces \"like with like.\" Prerequisites for utilizing the \"spare part surgery\" concept are meticulous initial debridement as well as emergency free tissue transfer, which require senior input and excellent infrastructure.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 1","pages":"100004"},"PeriodicalIF":0.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296998","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":"JHAM's next chapter: A thrilling leap with Elsevier in 2024!","authors":"J Terrence Jose Jerome, Jorge Boretto, Luigi Troisi, Takehiko Takagi, Mohamed A Ellabban, Sonu Jain","doi":"10.1016/j.jham.2024.100058","DOIUrl":"10.1016/j.jham.2024.100058","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 1","pages":"100058"},"PeriodicalIF":0.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296999","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":"Relative Motion Extension Splint after Extensor Tendon Reconstruction.","authors":"Egemen Ayhan, Ozge Buket Arslan, Kadir Cevik, Cigdem Oksuz","doi":"10.1055/s-0043-1761222","DOIUrl":"10.1055/s-0043-1761222","url":null,"abstract":"<p><p>Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique and relative motion extension (RME) splint changed practice in extensor tendon reconstruction and therapy. We wanted to share our approach for zones 5 to 8 extensor tendon management following the up-to-date developments. The impacts of surgery under WALANT and early active motion therapy with RME splinting were explained frankly and shown in several videos throughout the article.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"1 1","pages":"100020"},"PeriodicalIF":0.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57979605","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}