Increasing Prevalence of Xylazine and Worsening Upper-Extremity Wounds in Injection Drug Use: A Local Phenomenon With National Implications.

The rising presence of xylazine in Philadelphia's fentanyl supply has led to various upper-extremity complications in individuals who inject drugs. Sociogeographic trends predict that our current local phenomenon will spread nationally. We aim to discuss the drug's impact on clinical presentation and patient care via a cohort of five patients with upper-extremity wounds related to drug use.

Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function.

Introduction: Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma.

Materials And Methods: A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits.

Extracorporeal Membrane Oxygenation-Associated Compartment Syndrome: Review of a National Database.

Introduction: Extracorporeal membrane oxygenation (ECMO)-associated compartment syndrome (CS) is a rare complication seen in critically ill patients. The epidemiology and management of ECMO-associated CS in the upper extremity (UE) and lower extremity (LE) are poorly defined in the literature. We sought to determine the epidemiology and characterize treatment and outcomes of UE-CS compared to LE-CS in the setting of ECMO therapy.

Surgical Management of Vascular Malformations of the Upper Extremity: A 12-Year Retrospective Cohort Study.

Introduction: Vascular malformations (VMs) typically appear at birth and grow commensurately with patients. They can vary broadly in vessel type and tissue involvement, and upper extremity (UE) VMs can pose unique functional and aesthetic challenges in children. Given the advent of operative and nonoperative technologies like sclerotherapy and medications, a contemporary review of the surgical management of UE VMs is warranted.

Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort.

Purpose: This investigation describes the outcomes of pediatric ganglion cysts in a prospective cohort that elected not to undergo cyst aspiration or surgical treatment. Our primary aim was to investigate the rate of spontaneous resolution over time among the subset of patients who did not undergo specific treatments.

Methods: Children (aged ≤18 years) who presented to the clinic with ganglion cysts of the hand or wrist were enrolled in a prospective two-center registry between 2017 and 2021.

Upper Extremity Prosthetics: Current Options and Future Innovations.

Major upper extremity amputations can have a considerable impact on patients' lives, altering their ability to independently perform activities of daily living and leading to changes in occupations and hobbies. Although upper extremity prosthetics have existed for millennia, recent advances have improved prosthetic motor control and sensory feedback, leading to increased overall satisfaction. The goal of this article was to describe the current options that exist for upper extremity prosthetics and explore the recent advances and future directions in prosthetic technology and surgical techniques.

Does Irreducibility Always Mean a Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations.

Background: Previous failed reduction and certain radiographic indicators historically have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries.

Methods: A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital.

A retrospective case series of Mohs micrographic surgery and interdisciplinary management of female genital skin cancers: Local recurrence rates and patient-reported outcomes.

Background: Conventional excision of female genital skin cancers has high rates of local recurrence and morbidity. Few publications describe local recurrence rates (LRRs) and patient-reported outcomes (PROs) after Mohs micrographic surgery (MMS) for female genital skin cancers.

Objective: To evaluate LRRs, PROs, and interdisciplinary care after MMS for female genital skin cancers.

An Evolution of the Surgical Management of Synpolydactyly: A Case Series of 21 Hands.

Introduction: Synpolydactyly is a rare congenital anomaly characterized by syndactyly and polydactyly in the central hand. Limited treatment guidelines exist for this complex condition.

Methods: A retrospective review of synpolydactyly patients was conducted at a large, tertiary pediatric referral center to describe our surgical experience and evolution of management.

Opportunity Costs of Internal Promotions in Plastic Surgery: Are Women Given a Fair Shot?

Background: Academic advancement in plastic surgery necessitates creation of opportunities for rising faculty, which are pivotal for women in their efforts to close prominent gender gaps in higher ranks. We study positions of academic prestige that benefit from internal nomination as surrogates for opportunities afforded to men and women seeking leadership roles.

Methods: We collected the following datapoints: authors of invited discussions published in from 2010 to 2019; current editorial board members of representative plastic surgery journals; recipients of society-sponsored traveling fellowships; and directors of the American Board of Plastic Surgery.

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery.

Background: Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure.

Methods: We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020.

Factors Influencing Why Children and Their Families Choose Surgery for Ganglion Cysts.

Purpose: Ganglion cysts of the hand/wrist are frequently managed without surgery but can be treated with surgical excision if there is pain or dysfunction. No studies have examined the specific factors predictive of surgical treatment for pediatric patients.

Methods: This was a study of pediatric patients (≤18 years) with ganglion cysts of the hand/wrist seen between 2017 and 2019 at 2 institutions.

Learner Drawing and Sculpting in Surgical Education: A Systematic Review.

Background: Historically, surgery was developed through the visual work of artist-scientists, yet visual art in modern surgical education is rare. The aim of this review is to evaluate the existing literature of learner creation of visual art as an educational tool in surgery and to discuss its potential in augmenting surgical learning.

Method: A systematic review of surgical educational interventions involving learner drawing, painting, and sculpting was conducted in 2020.

Does E-learning Improve Plastic Surgery Education?: A Systematic Review of Asynchronous Resources.

Purpose: E-learning is rapidly growing in medical education, overcoming physical, geographic, and time-related barriers to students. This article critically evaluates the existing research on e-learning in plastic surgery.

Methods: A systematic review of e-learning in plastic surgery was conducted using the PubMed/MEDLINE, Scopus, and Embase databases.

Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children.

Purpose: Ganglion cysts are the most common mass of the hand or wrist. In adults, ganglions have a female predilection and are commonly located in the dorsal wrist. However, their presentation in children has not been well reported.

Effective Reduction in Opioid Prescriptions for Ambulatory Lesion Excisions in Pediatric Patients.

Unlabelled: Childhood opioid consumption is potentially deleterious to cognitive development and may predispose children to later addiction. Opioids are frequently prescribed for outpatient surgery but may not be necessary for adequate pain control. We aimed to reduce opioid prescriptions for outpatient pediatric skin and soft tissue lesion excisions using quality improvement (QI) methods.

Four-Year Follow-Up of the World's First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

Background: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time.

Methods: Forearm and hand radiographs were obtained annually.

Applying Evidence to Inform Carpal Tunnel Syndrome Care.

Carpal tunnel syndrome (CTS) is one of the most common problems treated by hand surgeons. As our understanding of the condition has improved and focus on quality and evidence-based care has evolved, management of CTS has shifted as well. Although for many patients the diagnosis and treatment plan are relatively straightforward, understanding how to decide what diagnostics are appropriate, how to avoid complications especially in high-risk patients, and even which surgical option to offer remains a challenge.

Subungual Schwannoma, a Rare Entity: A Case Report and Literature Review.

We present a case of a 26-year-old right hand dominant male landscaper with a slow growing right ring finger subungual mass. MRI confirmed a 0.9 × 1.

A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic.

Purpose: Limited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery.

Methods: All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers.