Journal of Hand and Microsurgery最新文献

{"title":"Pedicled adipofascial flaps for treatment and prophylaxis of neurodesis and neuromas in continuity of the upper extremity: A case series of 22 patients.","authors":"Sergio Asensio Ramos, Rafael Sánchez-Del Hoyo, Francisco Javier García Bernal","doi":"10.1016/j.jham.2025.100320","DOIUrl":"10.1016/j.jham.2025.100320","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Trauma to a peripheral nerve can lead to neuromas in continuity and perineural adhesions or fibrosis (neurodesis), causing pain and functional impairment. We present a retrospective study regarding our experience in managing these types of injuries using pedicled adipofascial flaps.</p><p><strong>Material and methods: </strong>We present a series of twenty-two patients treated between 2012 and 2023 for neurodesis or neuromas in continuity in the upper limb, performing external neurolysis and twenty-three adipofascial flaps. The affected nerves were the median nerve (n = 22) and the superficial branch of the radial nerve (n = 1). The ulnar artery perforator adipofascial flap was used in ten cases, the hypothenar fat pad flap in ten cases and the radial artery perforator adipofascial flap in three cases. Pain outcomes were measured using the Visual Analog Scale (VAS) pre and postoperatively, and a statistical analysis of the data was performed. STROBE guidelines were followed.</p><p><strong>Results: </strong>The average pain VAS scores pre and postoperatively were 7.13 and 2.3, respectively, representing a statistically significant improvement (p < 0.001). No statistically significant differences were found based on the type of flap used (p = 0.38) or the patients' age (p = 0.47). Complications included one surgical wound dehiscence of the donor site of an ulnar flap and another one in the recipient site (n = 2).</p><p><strong>Conclusion: </strong>Adipofascial flaps are a useful therapeutic option for managing neuromas in continuity and neurodesis of peripheral nerves in the upper extremity, achieving a significant reduction in pain.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100320"},"PeriodicalIF":0.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676086","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":"Complex regional pain syndrome of wrist and hand following distal radius fracture: A long-term follow-up study: 16 years (range 10-22 years).","authors":"Raghavendra S Kulkarni, Kulkarni Aditya Prakash, SriRam R Kulkarni","doi":"10.1016/j.jham.2025.100317","DOIUrl":"10.1016/j.jham.2025.100317","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this longitudinal prospective research on distal radius fractures was to identify and analyse impairments resulting from complex regional pain syndrome at long term follow up.</p><p><strong>Material and methods: </strong>The clinical and radiological assessment was performed up to 16 weeks then at 6, 9, 12 months following distal radius fracture for 62 patients of diagnosed complex regional pain syndrome and were treated between 2000 and 2011 at one institute. All patients were invited for re-examination at final long term follow up and the clinical assessment which was performed after an average of 16 years (range 10 years-22 years). Out of the 62 patients 44 (70.9 %) attended for this long term clinical follow up. Women constituted 11 (25.0 %). The main outcome measures were the impairments assessed by standard physical examination, pain, grip strength, vasomotor instability and finger mobility. The mean duration of treatment was 274.4 ± 24.2 days.</p><p><strong>Results: </strong>The mean interval between distal radius fracture, inciting event and the diagnosis complex regional pain syndrome was 2.3 (range 1-5) months. At long term follow-up the pain and tenderness were present in 41 (93.2 %) and 36 (81.8 %) patients, this association was highly significant (chi-square = 29.3, P < 0.001). The prevalence of vasomotor instability was high, in 37 (84.1 %) patients. Grip strength was significantly lower on the affected fracture side than normal hand (57.4 ± 8.2 against 148.2 ± 12.4 mm of Hg, P < 0.001). There was a strong association between all three manifestations of sensory, motor and autonomic features in this study report (p < 0.001.</p><p><strong>Conclusion: </strong>Pain along with loss of full fist muscle strength and restricted activities of daily living were the most evident factors leading to perceived disabilities, at long term follow-up of 16 (range-10 to 22) years after the onset of complex regional pain syndrome. Pain was the most important factor contributing to handicap. This study supports with strong evidence for long term loss of productive effort with prolonged treatment period having most unpredictable functional impairment.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100317"},"PeriodicalIF":0.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709363","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":"Uses of constraint-induced movement therapy (CIMT) in patients with brachial plexus birth injuries (BPBI).","authors":"Megan Gotlieb-Horowitz, Victoria Robbins, Victoria Ferrante, Tara M DeRosa, Mandana Behbahani, Steven M Koehler","doi":"10.1016/j.jham.2025.100316","DOIUrl":"10.1016/j.jham.2025.100316","url":null,"abstract":"<p><p>Constraint-induced movement therapy (CIMT) was originally implemented to address limb non-use in stroke recovery, and has more recently become a mainstay, evidence-based treatment approach to decrease developmental disregard in children. In addition to combating developmental disregard in the BPBI patient with residual deficit(s), CIMT can be applied in various ways across diverse cases in brachial plexus practice, including post-surgical use to aid in the activation of nerve transfers and/or tendon transfers. The timing, dosage, and setting of CIMT will vary depending on the patient's case and individual needs. This paper highlights how the individuality of CIMT implementation, when tailored to each patient's developmental stage and specific needs and circumstances outside of the clinic, contributes to its success. Rather than presenting the routine use of CIMT for BPBI developmental disregard, sample cases are presented to outline the variety of uses for CIMT in the surgical BPBI patient. Practical tips and clinical strategies are provided to support other clinicians in effectively incorporating CIMT in their care of children in this vulnerable population.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100316"},"PeriodicalIF":0.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676103","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":"Use of the trans-scaphoid portal for the arthroscopic treatment of scaphoid nonunion in the middle third with flexion deformity: technique description and patient series.","authors":"Ricardo Kaempf, Paula Fischer, Ahlam Arnaout, Lucian Lior Marchovich, Pedro J Delgado","doi":"10.1016/j.jham.2025.100324","DOIUrl":"10.1016/j.jham.2025.100324","url":null,"abstract":"<p><p>Nonunion is one of the main complications associated with scaphoid fractures. Over the past decades, the use of arthroscopy in the treatment of scaphoid nonunion has proven to be a valuable technique, even in cases presenting deformity and carpal instability. This approach facilitates rapid consolidation while minimizing damage to the joint capsule and ligaments, thereby preserving the already compromised vascular supply of the scaphoid. Due to their simpler anatomy, dorsal portals are commonly employed in wrist arthroscopy, reducing the risk of injury to neurovascular structures during joint access. Initial descriptions of arthroscopic treatment for scaphoid nonunion (SNU) used only dorsal portals throughout the procedure. However, correcting the scaphoid's flexion deformity caused the dorsal cortex to close and created a defect in the volar portion, introducing a technical challenge. Herein, we describe a novel access portal to assist in the arthroscopic treatment of mid-third scaphoid nonunion, which we have termed the trans-scaphoid portal. Located volar and distal to portal 1/2, just volar to the first extensor tendon compartment, it allows direct lateral access to the nonunion site. We used this portal in 10 patients with excellent results, observing that it simplified the correction of the scaphoid flexion deformity and allowed for direct placement of the bone graft in the volar region. The trans-scaphoid portal was developed to overcome the limitations of dorsal portals, enabling safe and straightforward debridement of the lesion, correction of deformity, and easier graft placement into the volar defect.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100324"},"PeriodicalIF":0.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676102","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":"Blauth and Manske classifications for thumb hypoplasia.","authors":"Takehiko Takagi","doi":"10.1016/j.jham.2025.100323","DOIUrl":"10.1016/j.jham.2025.100323","url":null,"abstract":"<p><p>Blauth's and Manske's classifications of thumb hypoplasia are widely known. Although both are used, confusion has arisen-particularly regarding the term \"Blauth Type IIIB.\" Manske did not subdivide Blauth's Grade III; instead, he developed an independent classification system (Types I-V). Within this, Manske's Type III, defined as partial first metacarpal aplasia, was further divided into IIIA and IIIB. Blauth himself never used these subclassifications. In fact, Blauth's Grade II more closely corresponds to Manske's Type IIIA, and Blauth's Grade III to Manske's Type IIIB. Thus, the correct terminology is \"Manske Type IIIB,\" not \"Blauth Type IIIB,\" as the two systems are distinct. Since IIIA and IIIB imply different treatment strategies, they must be clearly distinguished. Surgeons must evaluate each case individually, as no classification is definitive, and future systems may better integrate both bony and soft tissue considerations.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100323"},"PeriodicalIF":0.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700019","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":"An unusual presentation of thumb hypoplasia.","authors":"Soumen Das De","doi":"10.1016/j.jham.2025.100322","DOIUrl":"10.1016/j.jham.2025.100322","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100322"},"PeriodicalIF":0.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683345","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 systematic review of surgical management for open fractures of the distal phalanx: What is the evidence?","authors":"Omar El Sewify, Gabriel Bouhadana, Elisabeth Lorange, Marion Sylvain, Panu H Nordback, Soumen Das De, Johnny I Efanov","doi":"10.1016/j.jham.2025.100318","DOIUrl":"10.1016/j.jham.2025.100318","url":null,"abstract":"<p><strong>Purpose: </strong>Open fractures of the distal phalanx are common injuries with the potential for significant complications, yet standardized treatment guidelines remain lacking. Surgical debridement and antibiotic administration are crucial steps in the management of open fractures, but the optimal timing and combination of these interventions remain uncertain. This systematic review evaluates the impact of surgical debridement timing and antibiotic administration on complications, including infections, malunion and non-union, physeal closure disturbances, and nail deformities, with a focus on differences between adult and pediatric population.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, a comprehensive literature search of Medline, Embase, and Cochrane Library was conducted. Studies examining open distal phalanx fractures treated with surgical debridement, with or without antibiotics, were included. Pediatric (<18 years) and adult (≥18 years) populations were analyzed separately, and subgroup analyses were performed based on treatment timing. Statistical comparisons utilized chi-squared tests with significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 24 studies, including 915 fractures, were analyzed. The average patient age was 16.48 years, with males comprising 78.1 %. Early debridement (<24 h) was performed in 91.0 % of cases. Pediatric patients had significantly higher complication rates than adults, particularly for infections and malunion/non-union. Infections rates were lowest when debridement occurred within 8 h and increased significantly with delays beyond 24 h (p < 0.00001). Antibiotic administration with surgical debridement was associated with lower infection rates, particularly in pediatric patients. Among pediatric fractures treated with delayed debridement (>24 h), those receiving antibiotics alone had significantly lower infection rates than those receiving both debridement and antibiotics (p = 0.009), suggesting potential preselection bias. Malunion/non-union was more frequent in pediatric patients and strongly associated with delayed intervention (>24 h). Nail deformities were most commonly seen in debrided fractures, emphasizing the importance of meticulous surgical technique.</p><p><strong>Conclusions: </strong>Early surgical debridement (<8 h) as the preferred management strategy for open distal phalanx fractures, minimizing infection and complication rates. Delayed debridement (>24 h) significantly worsened outcomes, particularly in pediatric patients. Antibiotic administration reduced infection rates but was not a substitute for timely debridement. These findings highlight the need for standardized treatment protocols and further comparative studies to optimize management strategies across different age groups.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100318"},"PeriodicalIF":0.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676081","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":"Preoperative cardiac evaluation in elective non-cardiac surgery in India: Routine ECG, echocardiography, and angiography are not mandatory.","authors":"Narayanee Rajasekaran, Shivanand S Patil","doi":"10.1016/j.jham.2025.100321","DOIUrl":"10.1016/j.jham.2025.100321","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preoperative cardiac testing aims to identify patients at risk of perioperative cardiovascular complications, but indiscriminate use of tests like electrocardiograms (ECGs), echocardiography (ECHO), and even coronary angiography in low-risk patients often provides little benefit. International guidelines (2024 American College of Cardiology/American Heart Association and 2022 European Society of Cardiology) now emphasize a selective, risk-based approach rather than routine screening. In India, clinicians face pressure - including medicolegal concerns - to order extensive preoperative investigations. This article provides an evidence-based framework, from an Indian perspective, to guide when preoperative ECG, transthoracic echocardiography (TTE), or angiographic evaluation are truly warranted for elective non-cardiac surgeries, strongly emphasizing that these tests are &lt;b&gt;not mandatory&lt;/b&gt; in every case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative review was conducted, synthesizing recommendations from the 2024 ACC/AHA Guideline for perioperative cardiovascular evaluation and the 2022 ESC Guideline on non-cardiac surgery, along with key studies and Indian practice insights. We focused on guideline-directed indications for preoperative ECG and ECHO, highlighting Class III recommendations (tests not recommended) versus scenarios where testing is appropriate. Evidence from randomized trials (e.g., CARP trial) and observational cohorts was reviewed to assess outcome impact of routine testing. Consideration was given to India-specific factors such as higher prevalence of cardiovascular disease and defensive medical practices. The findings were distilled into a decision algorithm and summary tables stratified by surgical risk and patient factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Routine preoperative ECG or ECHO in asymptomatic patients undergoing low-risk surgery (expected &lt;1 % 30-day Major Adverse Cardiac event risk) is not recommended (Class III, no benefit). The 2022 ESC guidelines do not recommend ECG even for intermediate risk surgeries in those who are asymptomatic and do not have pre existing heart disease (Class III). Unnecessary testing in low-risk situations did not improve outcomes and can lead to delays. For intermediate- or high-risk surgeries, a baseline ECG is reasonable, especially in patients with known cardiovascular disease (ACC/AHA Class IIa; ESC Class I). However, even for intermediate risk surgeries, an ECG is &lt;b&gt;not mandatory&lt;/b&gt; if the patient is asymptomatic and has good functional capacity and has no pre existing heart disease, aligning with 2024 ACC AHA and 2022 ESC guidance (Class III for low-risk patients) and a judicious approach. Preoperative TTE is indicated (Class I) for patients with active cardiac symptoms - for example, new or worsening heart failure signs, or a murmur suggestive of significant valvular disease. Patients with known cardiac dysfunction should have TTE only if there is a c","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100321"},"PeriodicalIF":0.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676087","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":"Thumb tip reconstruction for apical substance loss using a bipedunculated homodigital V-Y advancement FLAP: OUR experiences.","authors":"Francesco De Francesco, Andrea Marchesini, Olimpia Mani, Nicola Zingaretti, Pier Camillo Parodi, Michele Riccio","doi":"10.1016/j.jham.2025.100319","DOIUrl":"10.1016/j.jham.2025.100319","url":null,"abstract":"<p><strong>Introduction: </strong>The thumb plays a crucial role in hand biomechanics, particularly in fine and forceful grips. Due to its functional importance, trauma involving the thumb is frequent. In cases of pulp tissue loss, Moberg's 1964 principles for functional thumb reconstruction remain a cornerstone in hand surgery. Among the available techniques, the bipedunculated V-Y advancement flap, described by D. Elliot in 1993, offers a reliable solution for preserving length, restoring sensation, ensuring grip stability, and maintaining an aesthetically acceptable outcome.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 54 cases of thumb tip reconstruction using the bipedunculated V-Y advancement flap for apical substance loss ranging from 1.0 to 2.5 cm in length. Patients had a mean follow-up of two and five years. Functional and aesthetic outcomes were assessed using the Pinch Test, Weber and Semmens Test, Vancouver Scar Scale, QuickDASH questionnaire and Fingertip Injury Outcome Score. <i>Results</i>: Our statistical analysis confirms the reliability and versatility of this flap. No major or minor complications were recorded. The flap effectively addressed transverse and oblique defects up to 1.5 cm, providing excellent functional and cosmetic results.</p><p><strong>Conclusions: </strong>This study validates the bipedunculated V-Y advancement flap as an effective technique for thumb tip reconstruction, emphasizing the importance of adhering to fundamental principles of digital reconstruction. The procedure ensures excellent functional outcomes and high patient satisfaction.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100319"},"PeriodicalIF":0.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676089","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":"Association Between Area Deprivation Index and Narcotic Prescriptions, Wound Complications, and Reoperation Rates after Soft Tissue Hand and Wrist Surgery.","authors":"Arman Tabarestani, Marco Foreman, Oluwaferanmi Dada, Kevin A Hao, Keegan M Hones, Anton Khlopas, Jongmin Kim, Thomas W Wright","doi":"10.1016/j.jham.2025.100300","DOIUrl":"10.1016/j.jham.2025.100300","url":null,"abstract":"<p><strong>Background: </strong>The area deprivation index (ADI) is an outcome metric that quantifies socioeconomic status by stratifying neighborhoods based on zip code. The purpose of this study was to investigate the effect of national ADI rank on the amount of narcotics prescribed, wound complications, and reoperations after routine hand or wrist surgery.</p><p><strong>Methods: </strong>We conducted a retrospective review of adult patients undergoing routine hand or wrist soft tissue surgery between 2013 and 2022. Patients were included if they underwent routine hand or wrist surgeries. Patients were excluded for having concomitant lacerations, penetrating injuries, or fractures. Multivariable logistic regression was performed to determine whether national ADI is associated with the amount of narcotics prescribed, the incidence of wound complications, and reoperation rates after routine hand and wrist procedures independent of covariates.</p><p><strong>Results: </strong>We included 1389 patients. The mean age was 55 years and 65 % were female. The average national ADI rank was 65.6. The largest ADI decile group that was categorized was in the 70-79 rank (consistent with a highly economically disadvantaged group), with the national median being set at 50. Wound complications occurred in 2.9 % of patients (n = 40) and reoperations occurred in 2.5 % of patients (n = 35). Multivariable regression determined that national ADI rank was not associated with a difference in the amount of narcotics prescribed (P = .141), wound complications (P = .599), or reoperation rates (P = .141).</p><p><strong>Conclusions: </strong>National ADI rank was not associated with a significant difference in the amount of narcotics prescribed, wound complications, or reoperation rates.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100300"},"PeriodicalIF":0.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576608","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}