Journal of Hand and Microsurgery最新文献

{"title":"A case series of arthroscopic distal trapeziectomy and hematoma distraction; clinical and radiological outcomes.","authors":"Mahmoud Abdelghafar, Ahmed Semaya, Mohammed Hasan, Hany Morsy","doi":"10.1016/j.jham.2025.100341","DOIUrl":"10.1016/j.jham.2025.100341","url":null,"abstract":"<p><strong>Purpose: </strong>Trapeziectomy has a particularly significant role in relieving pain in patients with trapeziometacarpal arthritis. With the advantage of arthroscopy combined with hematoma distraction, arthroscopic distal trapeziectomy can achieve good pain relief with minimum wound complications.</p><p><strong>Aim: </strong>Evaluation of the clinical and functional results of arthroscopic distal trapeziectomy and hematoma distraction.</p><p><strong>Patients and methods: </strong>The study included thirty patients with stage II and III trapeziometacarpal arthritis. The articular surface & subchondral bone were resected. Then the joint was distracted using percutaneous Kirschner wires. The mean follow-up period was about 20 months.</p><p><strong>Results: </strong>There was a statistically significant difference in pre- and post-operative pain scores with slight improvement of tip & key pinch strength.</p><p><strong>Conclusion: </strong>According to our study findings, arthroscopic distal trapeziectomy and hematoma distraction can be performed with significant improvements and satisfactory clinical and functional results in patients with stage II and III trapeziometacarpal arthritis.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100341"},"PeriodicalIF":0.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565371","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":"Is AI an advanced intelligence, artificial intelligence, or annoying intelligence in hand and microsurgery?","authors":"J Terrence Jose Jerome","doi":"10.1016/j.jham.2025.100339","DOIUrl":"10.1016/j.jham.2025.100339","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100339"},"PeriodicalIF":0.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973465","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":"Hand reconstruction with multi-pedicled anterolateral thigh flap.","authors":"Trần Thiết Sơn, Phan Tuấn Nghĩa, Phạm Thị Việt Dung, Tạ Thị Hồng Thuý, Đặng Phương Nam, Tahsin Oğuz Acartürk","doi":"10.1016/j.jham.2025.100336","DOIUrl":"10.1016/j.jham.2025.100336","url":null,"abstract":"<p><p>Complex hand defects that involve multiple components present significant challenges for reconstructive surgery. The Anterolateral Thigh (ALT) flap is one of the most versatile options in reconstructive microsurgery, offering numerous advantages. Variations in ALT anatomy enable the creation of different types of multi-pedicle flaps, which aid in addressing complex injuries. This study involved 116 patients treated with the ALT flap for hand lesions, with a focus on 20 patients who received multipedicle flaps for complex hand defects. Among these, ten patients were treated with adipocutaneous multi-pedicled flaps for the coverage of defects, while the remaining ten patients received a combination of adipocutaneous and FL multi-pedicled flaps, which enabled both the covering of the skin and the reconstruction of the extensor tendon. Prior to thinning, the average thickness of the flaps was measured at 21 mm, which was subsequently reduced to an average of 6.5 mm following the thinning procedure. The overall survival rate of the flaps was 97.5 %, and two patients required defatting after one year. Patient satisfaction regarding both functional and aesthetic outcomes was reported to be high. Multi-pedicle flaps that incorporate two skin islands or combinations of skin islands and FL flaps have proven to be highly effective for complex, multi-unit hand reconstruction. The success of this technique is influenced by various factors, including the types and number of perforators, the composition of the flap, the methods used for thinning, and the specific arrangement of flaps tailored to each defect.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100336"},"PeriodicalIF":0.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973528","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":"Challenges and complications of trans-osseous carpal tenodesis for scapholunate ligament tears.","authors":"Mikko P Räisänen, Nicholas C Smith, Fransisco Del Piñal","doi":"10.1016/j.jham.2025.100338","DOIUrl":"10.1016/j.jham.2025.100338","url":null,"abstract":"<p><p>Scapholunate (SL) instability remains a challenging condition with significant possibility of implications for wrist function and long-term outcomes. This review explores the limitations and complications of current trans-osseous scapholunate ligament (SLL) reconstruction techniques, focusing on isometric reconstruction challenges and complications, for example osteonecrosis, tunnel fractures, graft failure, and iatrogenic extrinsic ligament injuries. Through biomechanical analysis and clinical case reviews, we demonstrate that the conventional three-ligament tenodesis (3LT) scaphoid tunnel has high risk of resulting in a non-isometric volar scapho-trapezial (vST) ligament reconstruction, potentially exacerbating carpal instability. Additionally, trans-osseous techniques have risk of osteonecrosis and fracture, which can accelerate degenerative changes and necessitating salvage procedures. This paper will additionally highlight concerns regarding tendon graft viability, anchor failure, and the critical role of extrinsic ligaments in SL stability. It will also be shown that modular arthroscopic approaches, which focus on selective ligament repair, may provide better outcomes with fewer complications and lower morbidity compared to traditional reconstructions. Future advancements probably should prioritise preserving bone vascularity and minimising iatrogenic injury, guiding surgeons toward safer and more effective treatment strategies.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100338"},"PeriodicalIF":0.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12390943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973468","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":"The vascularized iliac crest bone graft: An often forgotten long bone alternative-Now remembered a half-century later.","authors":"Geoffrey G Hallock","doi":"10.1016/j.jham.2025.100334","DOIUrl":"10.1016/j.jham.2025.100334","url":null,"abstract":"<p><strong>Purpose: </strong>For long bone large segmental defects, and especially for the tibia, the vascularized fibula osseous flap has been proven around the world to be the ideal and reliable solution. Yet if congenital, traumatic, oncologic, anatomical anomalies or even aesthetic reasons preclude this choice, a second tier alternative that is also reliable need be considered.</p><p><strong>Method: </strong>A unique 40⁺ year follow-up for an infected non-union of a right tibia fracture, initially slated for limb amputation, was instead salvaged using a vascularized iliac crest bone graft [VICBG]. An updated focus on this event, the evolution of the VICBG surgical anatomy, and a concise description of a pragmatic dissection approach for this flap harvest is intended.</p><p><strong>Result: </strong>A composite free groin flap and vascularized iliac crest bone graft pedicled by the deep circumflex iliac vessels proved to be a reasonable solution for a concomitant large lower limb soft tissue deficiency and tibial segmental defect. Now for more than 40 years the patient has retained a functional limb with no restrictions in ambulatory prowess.</p><p><strong>Conclusion: </strong>Over the past half-century, numerous donor sites for vascularized bone grafts have been identified. Some are primarily cortical, some cancellous; some tubular, some convoluted; some minute, some gargantuan; some rarely used, some often. Depending on the circumstances, a vascularized iliac crest bone graft can be a potential alternative where here demonstrated extremely long term success can be expected. This alternative should not be overlooked as a potential solution for what otherwise can be a demanding dilemma.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100334"},"PeriodicalIF":0.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973507","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":"Effect of end-to-side anterior interosseous nerve transfer in proximal ulnar nerve injuries: A comparative study.","authors":"Yener Yoğun, Uğur Bezirgan, Mehmet Batu Ertan, Yusuf Kıratlıoğlu, Osman Talha Nergizal, Mehmet Armangil","doi":"10.1016/j.jham.2025.100335","DOIUrl":"10.1016/j.jham.2025.100335","url":null,"abstract":"<p><strong>Background: </strong>Few studies have described the efficacy of end-to-side (ETS) nerve transfer for high ulnar nerve injuries. This study aimed to compare the intrinsic functional outcomes of patients who underwent ETS nerve transfer for proximal ulnar nerve transection injuries and those of patients who did not.</p><p><strong>Materials and methods: </strong>We retrospectively evaluated 15 patients who underwent primary repair of proximal ulnar nerve injuries. Patients were divided into groups based on whether ETS nerve transfer was performed. Postoperative intrinsic atrophy, clawing, ability cross finger Froment sign, Wartenberg sign, and Disabilities of Arm, Shoulder, and Hand (DASH) scores were evaluated and compared between groups. Additionally, two-point discrimination, grip strength, pinch strength, and intrinsic muscle strength of the hand were evaluated and compared between groups.</p><p><strong>Results: </strong>Nine patients comprised the ulnar nerve repair (UNR) group and six patients comprised the UNR with SETS (UNR + ETS) group. No significant differences in intrinsic atrophy, clawing, ability to cross finger, Froment sign, Wartenberg sign, and DASH scores were observed between groups. No significant differences in the strength of the abductor digiti minimi, grip strength, pinch strength, and two-point discrimination were observed between groups. A statistically significant difference only in the strength of the first dorsal interosseous muscle was observed between groups.</p><p><strong>Conclusion: </strong>Our comparative study showed little or no benefit of ETS-AIN transfer for high ulnar nerve injuries.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100335"},"PeriodicalIF":0.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856655","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":"The osteocutaneous superficial circumflex iliac artery (SCIP) flap in extremity reconstruction.","authors":"Cédric Zubler, Mihai A Constantinescu, Ioana Lese, Radu Olariu","doi":"10.1016/j.jham.2025.100337","DOIUrl":"10.1016/j.jham.2025.100337","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable.</p><p><strong>Results: </strong>Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months.</p><p><strong>Conclusion: </strong>The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100337"},"PeriodicalIF":0.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875832","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":"Outcomes of the Starfish procedure using muscle transfer for independent digital control of a myoelectric prosthesis.","authors":"Keith M Nord, Casey M Sabbag, Sahitya K Denduluri, Bryan J Loeffler, R Glenn Gaston","doi":"10.1016/j.jham.2025.100333","DOIUrl":"10.1016/j.jham.2025.100333","url":null,"abstract":"<p><strong>Background: </strong>Surgical and technological advancements have revolutionized myoelectric prosthetic options for patients with upper extremity amputations, but partial hand amputations have remained a challenge. The Starfish procedure is a novel surgical technique that involves transferring intrinsic hand muscles to a subcutaneous location to allow immediate signal detection and independent digital control of a myoelectric prosthesis. We report the outcomes of our cohort of patients treated with this procedure.</p><p><strong>Methods: </strong>Twenty-one patients underwent the Starfish procedure between 2015 and 2021. All patients had a postoperative evaluation with an Ottobock Myoboy to determine if they had viable signals from interossei transfers. All patients completed a specialized survey for amputees, depression, and PTSD surveys.</p><p><strong>Results: </strong>All patients had recordable myoelectric signals at each muscle transfer. Three patients were lost to follow-up and three patients were multi-extremity amputees and therefore their DASH scores were not included given the confounding associated injuries thus 15 patients were available for outcomes data. 14 out of 15 remaining patients (93 %) obtained a myoelectric prosthesis. Patients reported using their prosthesis an average of 5.5 h per day and 5.5 days per week. The average DASH score prior to surgery was 67.9 and after surgery was 40.5 (p = 0.014). VAS Pain scores were 3.8 for residual limb pain and 2.7 for phantom pain. Mean follow-up was 2.1 years. 71 % of patients reported being \"extremely\" or \"very\" satisfied with the overall function of their prosthesis. The most common functional activities that the prosthesis allowed patients to perform include dressing, housework, meal preparation and eating. 73 % of previously working patients were able to return to employment.</p><p><strong>Conclusions: </strong>The Starfish procedure provides immediately detectable superficial myoelectric signals that allow intuitive and independent finger control. At 2-year follow up, patients have a high satisfaction rate, consistent myoelectric prosthetic use, improved DASH scores, and a high rate of return to work.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100333"},"PeriodicalIF":0.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849344","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":"Robotic-assisted technique in plastic and reconstructive surgery: Experience in Taiwan.","authors":"Yi-Chia Chen, Ming-Hsien Chung, Chieh-Kai Chang, Cheng-Yeu Wu, Yi-Ling Lin, Yueh-Chi Tsai, Chen-Te Lu, I-Chen Chen, Chih-Sheng Lai","doi":"10.1016/j.jham.2025.100332","DOIUrl":"10.1016/j.jham.2025.100332","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review summarizes Taiwan's pioneering experience with robotic-assisted techniques in this specialty, with an emphasis on clinical applications, educational models, and future directions.</p><p><strong>Methods: </strong>A narrative literature review was conducted focusing on robotic-assisted plastic and reconstructive surgery with relevance to Taiwanese clinical practice. Articles published between January 2000 and April 2024 were considered. Searches were performed in PubMed, Google Scholar, and Cochrane Library using the keywords: \"robotic surgery,\" \"plastic surgery,\" \"reconstructive surgery,\" \"Taiwan,\" and \"microsurgery.\" Inclusion criteria were: (1) studies involving robotic-assisted surgical techniques, (2) relevance to plastic and reconstructive surgery, (3) Taiwanese institutional or clinical context, and (4) availability of clinical or technical outcome data. Articles not published in English, lacking original data, or unrelated to the Taiwan context were excluded.</p><p><strong>Results: </strong>Robotic-assisted techniques were successfully applied in various reconstructive domains, notably in microsurgical anastomosis for free flap procedures, nerve transfers, and minimally invasive mastectomies. These approaches demonstrated favorable outcomes in terms of operative precision, reduced complications, and patient satisfaction. Taiwan's major medical centers, including Chang Gung Memorial Hospital and Taichung Veterans General Hospital, have been instrumental in driving these innovations. Furthermore, robotic training models facilitated the learning curve for microsurgeons and supported the integration of robotic platforms into surgical education.</p><p><strong>Conclusions: </strong>Taiwan's experience underscores the feasibility and clinical value of robotic-assisted techniques in plastic and reconstructive surgery. Robotic platforms not only improve surgical outcomes but also expand the scope of reconstructive options. Ongoing research and educational efforts are crucial to optimizing technique standardization and surgeon training in this rapidly evolving field.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100332"},"PeriodicalIF":0.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838146","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":"The subacromial balloon spacer: Adhering to indications and clinical outcomes.","authors":"Peter Boufadel, Akshay Khanna, Joyce D Suarez, Ryan D Stadler, Mohamad Y Fares, Joseph A Abboud","doi":"10.1016/j.jham.2025.100330","DOIUrl":"10.1016/j.jham.2025.100330","url":null,"abstract":"<p><p>The subacromial balloon spacer has emerged as a viable treatment option for patients with massive, irreparable rotator cuff tears. Acting as a temporary interpositional device, the subacromial balloon reduces acromiohumeral impingement and redistributes forces across the shoulder, leading to pain relief and improved function. Achieving optimal outcomes requires adherence to appropriate surgical indications and the implementation of a structured postoperative rehabilitation protocol. This review provides a comprehensive overview of the subacromial balloon spacer's biomechanical function, clinical indications, surgical technique, postoperative rehabilitation, and outcomes from recent trials and meta-analyses. While short-term outcomes are promising, further large-scale, long-term studies are needed to refine its indications and define its role in shoulder surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100330"},"PeriodicalIF":0.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790260","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}