Hand therapy utilization following digital flexor tendon repair: Trends, timing, predictive factors, and association with reoperation.

Background: Physical rehabilitation is considered an important component of recovery following digital flexor tendon repair (FTR), but no studies have thoroughly characterized nationwide therapy utilization in the United States.

Purpose: The current study characterized national trends in the timing and amount of hand therapy utilization following FTR and assessed factors associated with the lack of postoperative hand therapy.

Study Design: Retrospective cohort study.

A Nationwide Analysis of Complications, Reoperations and Cost of Wide-Awake Flexor Tendon Repairs.

Introduction: Some papers suggest that wide-awake flexor tendon repair (FTR) may reduce rates of postoperative tendon gapping and rupture due to improved intraoperative testing of the repair. The current study is a nationwide cohort study comparing FTRs performed wide-awake and with traditional anesthesia.

Methods: Patients undergoing zone II FTR between 2010-2022 were identified in PearlDiver.

The Association of Surgical Setting With Opioid Prescribing Patterns Following Wide-Awake Trigger Finger Release.

Introduction: Wide-awake and office-based hand surgeries are increasingly common. The association of these techniques with postoperative pain and pain control has garnered recent attention. A prior study demonstrated that office-based trigger finger release (TFR) were associated with decreased perioperative opioid prescriptions compared to those performed in the operating room.

The Correlation of Surgical Setting With Perioperative Opioid Prescriptions for Wide-Awake Carpal Tunnel Release.

Background: Prior studies have compared perioperative opioid prescriptions between carpal tunnel release (CTR) performed wide-awake and with traditional anesthetic techniques, but the association of opioid prescriptions with surgical setting has not been fully explored. The current study assessed the association of opioid prescriptions with surgical setting (office or operating room) for wide-awake CTR.

Methods: Patients with open CTR were identified in an administrative claims database (PearlDiver).

Informed Consent and Digit Replantation: Current State and Recommendations for Ethical Patient Care.

The importance of informed consent and the value of shared decision-making in hand surgery are well-established and particularly critical in the setting of digit amputation when considering replantation. Informed consent requires an understanding of not only the immediate and long-term risks and benefits of surgery, as well as the risks and alternatives involved, but also the capacity of the patient to make a medical decision. However, patients who have acutely sustained a disfiguring trauma are often in distress and may not fully process the consent discussion.

Wide-Awake Carpal Tunnel Release in the United States: Trends in Volume and Reimbursement by Operative Setting.

Background: Office-based surgery can increase logistical and financial efficiency for patients and surgeons. The current study compares wide-awake, office-based carpal tunnel release to wide-awake operations performed in the operating room in terms of volume, financial burden, narcotic prescriptions, and adverse events.

Methods: Operations performed under local-only anesthesia from 2010 to 2020 were identified in a national administrative database (PearlDiver).

Wide Awake Trigger Finger Releases Performed in the United States: Trends in Volume, Operative Setting, and Reimbursement.

Background: Trigger finger release (TFR) has traditionally been performed in outpatient operating rooms. More recently, TFR may be performed in the office setting to achieve greater efficiency and cost savings.

Methods: The 2010-2020 Q2 PearlDiver M91Ortho data set was analyzed for cases of TFR.

The Medial Femoral Condyle Flap in the Pediatric Patient.

Background: The use of free flaps from the medial femoral condyle has grown in popularity and is now a workhorse in the reconstruction of skeletal defects. The utility of this technique has not yet been described for the pediatric patient population. The authors present their series of pediatric patients who underwent surgery using a medial femoral condyle free flap or a variant thereof in skeletal reconstruction and demonstrate the efficacy of this technique in this population.

Soft-Tissue Reconstruction of Complicated Total Ankle Arthroplasty.

Background: Total ankle arthroplasty (TAA) is a popular modality to treat end-stage arthritis or internal ankle derangement. Unfortunately, failure rates remain undesirably high, with severe complications, including prosthesis failure, ankle fusion, and amputation. The importance of a stable soft-tissue envelope for coverage of implant compromise has been previously described, but the predictive factors for successful salvage of complicated TAA remain poorly understood.

Toxic Shock Syndrome after Surgery: Case Presentation and Systematic Review of the Literature.

Unlabelled: Toxic shock syndrome (TSS) is an underrecognized but highly fatal cause of septic shock in postoperative patients. Although it may present with no overt source of infection, its course is devastating and rapidly progressive. Surgeon awareness is needed to recognize and treat this condition appropriately.

The Role of Cadaver-Based Flap Course in Microsurgical Education and Practice Patterns of Attendees: A Survey Study.

Background:  In 2017, our institution initiated a cadaver laboratory-based course dedicated to teaching reconstructive microsurgery indications, preoperative planning, and flap dissection. The goals of this study are to describe the demographics and experience of participants/instructors and to evaluate the learning objectives and effectiveness of the course.

Methods:  Penn Flap Course (PFC) participants were sent an anonymous survey at the inaugural PFC 2017.

Microvascular free flap coverage for salvage of the infected total knee arthroplasty.

Aims: The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA.

Methods: We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA.

Pediatric Hand and Upper Extremity Injuries Presenting to Emergency Departments in the United States: Epidemiology and Health Care-Associated Costs.

Upper extremity injuries represent one of the most common pediatric conditions presenting to emergency departments (EDs) in the United States. We aim to describe the epidemiology, trends, and costs of pediatric patients who present to US EDs with upper extremity injuries. Using the National Emergency Department Sample, we identified all ED encounters by patients aged <18 years associated with a primary diagnosis involving the upper extremity from 2008 to 2012.

Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series.

Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization.

The Independent Plastic Surgery Match (2010-2018): Applicant and Program Trends, Predictors of a Successful Match, and Future Directions.

Objectives: Changes were made to the independent plastic surgery residency in 2009 to 2010 that included full prerequisite training and increased from 2 to 3 years of independent residency. The authors sought to determine subsequent match trends and predictors of a successful match.

Methods: With American Council of Academic Plastic Surgeons approval, the San Francisco Match provided data for the independent match (2010-2018).

Soft-Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage.

Background: Total knee arthroplasty is a common orthopedic procedure in the United States and complications can be devastating. Soft-tissue compromise or joint infection may cause failure of prosthesis requiring knee fusion or amputation. The role of a plastic surgeon in total knee arthroplasty is critical for cases requiring optimization of the soft-tissue envelope.

Godina's Principles in the Twenty-First Century and the Evolution of Lower Extremity Trauma Reconstruction.

Background:  February of 2016 marked 30 years since the passing of Marko Godina, a pioneer and prodigy in the field of reconstructive microsurgery. Most noteworthy among his many contributions was his method of radical debridement of contaminated compound fractures followed by early free tissue transfer for wound closure. In the last three decades, the landscape of reconstructive surgery has undergone significant transformation owing to advances in reconstructive techniques and wound care technology, as well as new data.

Burden of Hand Maladies in US Emergency Departments.

Background: Hand conditions commonly present to the emergency department (ED), yet data are lacking regarding the magnitude of hand-related conditions in the emergency setting. The purpose of this study is to describe the burden and quantify the health care resource utilization of hand conditions seen in EDs across the United States.

Methods: Using the National Emergency Department Sample, we identified all ED encounters by patients at least 18 years of age that were associated with a hand condition in 2009 to 2012.

Management of Infected Mesh After Abdominal Hernia Repair: Systematic Review and Single-Institution Experience.

Background: Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem.

Methods: Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients.

Radial Longitudinal Deficiency: Recent Developments, Controversies, and an Evidence-Based Guide to Treatment.

Radial longitudinal deficiency (RLD) is the most common congenital longitudinal deficiency at birth and represents a wide spectrum of upper extremity anomalies, from mild thumb hypoplasia to absent radius. Radial dysplasia may be isolated or associated with an array of systemic anomalies that should be familiar to pediatric hand surgeons. The management of RLD has evolved greatly since its inception in the late 19th century, largely due to decades of innovation that followed the thalidomide catastrophe of the 1960s.

Anatomical Basis and Clinical Application of Synovial Flaps in the Wrist and Distal Forearm.

Background: Neuropathic symptoms after median nerve repair at the wrist or secondary to refractory carpal tunnel syndrome may become debilitating. These symptoms develop because of perineural adhesions, intraneural fibrosis, and fixation of the nerve to the transverse carpal ligament after surgery, and often require neurolysis. Interposition of vascularized soft tissue over the median nerve at the time of neurolysis prevents recurrence of such adhesions.

Colovesical fistula caused by an ingested chicken bone.

Colovesical fistula involving the sigmoid colon is the most common fistulous communication between the gastrointestinal tract and the urinary bladder. These tracts are most commonly associated with diverticulitis but might arise secondary to a neoplasm, inflammatory bowel disease, iatrogenic injuries, radiation therapy, trauma, or foreign bodies. We describe a patient who developed a fistula between the sigmoid colon and bladder secondary to an ingested chicken bone that lodged in a colonic diverticulum.

Reduction mammoplasty operative techniques for improved outcomes in the treatment of gigantomastia.

Objective: Gigantomastia, or excessive breast hypertrophy, which is broadly defined as macromastia requiring a surgical reduction of more than 1500 g of breast tissue per breast, poses a unique problem to the reconstructive surgeon. Various procedures have been described for reduction mammoplasty with specific skin incisions, patterns of breast parenchymal resection, and blood supply to the nipple-areolar complex; however, not all of these techniques can be directly applied in the setting of gigantomastia. We outline a simplified method for preoperative evaluation and operative technique, which has been optimized for the management of gigantomastia.