Future directions in transmasculine genital gender-affirming surgery: tissue substitutes and transplant.

Purpose Of Review: The present study reviews contemporary literature focused on transplantation and tissue substitutes for the purposes of masculinizing genital gender affirming surgery. Additional background is provided for both topics to provide a more comprehensive understanding of the modern applications.

Recent Findings: Genitourinary vascularized composite allotransplantation has become a reality in recent years with several cases reported worldwide in cisgender men with promising reports of urinary and sexual function.

Combined Targeted Muscle Reinnervation With Regenerative Peripheral Nerve Interfaces Decreases Long-Term Narcotic Use in Amputees: A Case Control Study.

Purpose: Combined targeted muscle reinnervation with regenerative peripheral nerve interfaces ("TMRpni") is a recently described nerve management strategy that leverages beneficial elements of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) techniques. This study aimed to evaluate the effect of TMRpni on long-term opioid consumption after amputation. We hypothesize that TMRpni decreases chronic opioid consumption in amputees.

Childhood growth outcomes 2 years after hypertensive versus normotensive pregnancy: a P4 study.

Background: Intrauterine exposure to hypertensive disorders of pregnancy, including gestational hypertension (GH) and preeclampsia (PE), may influence infant growth and have long-term health implications. This study aimed to compare growth outcomes of infants exposed to a normotensive pregnancy (NTP), GH, or PE from birth to 2 years.

Methods: Infants were children of women enroled in the prospective Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTP, GH or PE.

Growth from birth to 6 months of infants with and without intrauterine preeclampsia exposure.

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study.

Proopiomelanocortin deficiency diagnosed in infancy in two boys and a review of the known cases.

Proopiomelanocortin (POMC) deficiency is a rare monogenic disorder characterised by adrenocorticotropic hormone (ACTH) deficiency, red hair and hyperphagic obesity. Two unrelated cases presented with hypoglycaemia due to isolated ACTH deficiency in the neonatal period. POMC deficiency was suspected at age 2 years (c.

ACTA2 Mutation: Microsurgeon Beware!

Patients with the alpha actin 2 genetic mutation suffer early onset aneurismal and vascular-occlusive conditions due to dysfunctional smooth muscle contractility. Outcomes of free flap reconstruction in this patient population are unknown. Here we report the case of a 21-year-old woman with alpha actin 2 mutation who required decompressive hemicraniectomy following an acute stroke.

TMRpni: Combining Two Peripheral Nerve Management Techniques.

Amputee patients suffer high rates of chronic neuropathic pain, residual limb dysfunction, and disability. Recently, targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are 2 techniques that have been advocated for such patients, given their ability to maximize intuitive prosthetic function while also minimizing neuropathic pain, such as residual and phantom limb pain. However, there remains room to further improve outcomes for our residual limb patients and patients suffering from symptomatic end neuromas.

Pulley Release and Reconstruction With Acellular Dermal Matrix After Zone 2 Flexor Tendon Injury.

Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pulley release and pulley reconstruction with acellular dermal matrix. This technique leverages the antiadhesive properties and high tensile strength of acellular dermal matrix to maximize gliding and prevent bowstringing.

Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures.

 To evaluate the outcomes and complication rate of surgical management in adolescent patients with Kienböck's disease and compare lunate offloading and revascularization procedures.  We performed a retrospective chart review to evaluate adolescent patients with Kienböck's disease between 1990 and 2016 who were surgically managed. Charts were reviewed for demographic information, presence of trauma, range of motion, grip strength, and radiographic parameters pre- and postoperative.

The Index Finger Metacarpal Tubercle.

Purpose: The region of the index finger metacarpophalangeal joint is a common source of hand pain with variable, well-known etiologies. We have identified the tubercle at the dorsoradial neck of the index finger metacarpal as a distinct and specific site of pain in a subset of patients who presented with a chief report of index finger pain. Although experienced hand surgeons may recognize this clinical entity, we found no previous description within the literature.

Outcomes of the Adams-Berger Ligament Reconstruction for the Distal Radioulnar Joint Instability in 95 Consecutive Cases.

 The objective of this article is to evaluate the outcomes and complication rate for Adams-Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure.  We conducted a retrospective chart review to evaluate adult patients that had undergone reconstruction of the DRUJ for instability with the Adams-Berger procedure between 1998 and 2015 within our institution with > 24 months follow-up. Charts were reviewed for patient demographics, mechanism of injury, outcome, and complications.

Comparison of Vickers' Physiolysis With Osteotomy for Primary Correction of Clinodactyly.

The purpose of this study was to compare the Vickers physiolysis procedure with osteotomy for correction of digital clinodactyly and determine which method provides better correction at final follow-up or whether the patient's age, preoperative angulation, or presence of syndactyly affects final outcomes. All patients of skeletal immaturity who underwent surgical correction of clinodactyly were evaluated with clinical examination and radiographs to determine the percentage and absolute change in the degree of clinodactyly pre- versus postoperatively, in addition to stratification based on the degree of deformity, age, and presence of syndactyly. Vickers' physiolysis and osteotomy were undertaken in 30 and 11 digits, respectively.

Outcomes of shoulder abduction after nerve surgery in patients over 50 years following traumatic brachial plexus injury.

Purpose: There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients, as outcomes are thought to be poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 years and factors related to success.

Methods: Forty patients over the age of 50 years underwent nerve surgery to improve shoulder function after a traumatic brachial plexus injury.

Redefining the Rectus Sheath: Implications for Abdominal Wall Repair.

Background: The abdominal wall is frequently manipulated in a variety of reconstructive procedures, and its anatomy is well described. The authors' clinical observations, however, contradict the standard depiction of the components of the abdominal wall at various levels-particularly regarding the course of the transversus abdominis muscle. Therefore, the authors sought to characterize the components of the rectus sheath at various surgical landmarks to define anatomic points important to abdominal wall repair.

Management of Scaphoid Fractures.

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the epidemiology, classification, and anatomy pertinent to the scaphoid. 2.

#Cleft: The use of Social Media Amongst Parents of Infants with Clefts.

Introduction: Many societies and organizations are using social media to reach their target audience. The extent to which parents of patients with craniofacial anomalies use social media has yet to be determined. The goal of this study is to characterize and describe the use of social media by the parents of children with cleft lip and palate as it pertains to the care of their child.

Pedicled Flap Closure as an Adjunct for Infected Ventricular Assist Devices.

Purpose: End-stage cardiac disease has resulted in an increased utilization of cardiac transplantation or long-term mechanical assistance to sustain life. Though left ventricular assist devices (LVAD) have revolutionized the treatment algorithm for these patients, these devices carry a substantial infection rate, ranging from 30% to 50%. We report our institution's experience with attempted flap salvage for infected and exposed LVADs.

Distal metaphyseal ulnar shortening osteotomy: technique, pearls, and outcomes.

Background Ulnar sided wrist pain is a commonly encountered complaint of the hand surgeon, and ulnar impaction is a common cause. Surgical treatment aims to reduce the force transmitted through the ulna and traditionally includes diaphyseal ulnar shortening osteotomy and the "wafer" procedure. These procedures have known shortcomings.

Current trends in the management of proximal interphalangeal joint injuries of the hand.

Injuries to the proximal interphalangeal joint are commonly encountered by the hand surgeon. Proper diagnosis and treatment are vital for optimal outcomes. Proper treatment of these injuries requires a working knowledge of the anatomy of the joint and an appreciation for principles for reduction, stabilization, and early rehabilitation to provide the best outcomes possible.

Current concepts in the evaluation and treatment of mallet finger injury.

The mallet finger is a frequently encountered fingertip injury that leads to extensor lag of the distal phalanx. Classification systems stratify these injuries as ranging from soft-tissue disruption of the extensor mechanism alone to those that have articular involvement and volar subluxation. The management of mallet finger injuries varies based on injury pattern and surgeon preference.

Note: Effects of adding a viscosity-increasing 2 nm-size molecule on dielectric relaxation features and the dynamic heterogeneity view.

To investigate the extent to which dynamic heterogeneity determines the relaxation features, we studied the effect of adding a viscosity-increasing, ∼2 nm size polyhederal oligomeric silsesquioxane (POSS) molecule on dielectric relaxation. Addition of POSS increased the relaxation time of the α-process, τ(m,α), and decreased the non-exponential response parameter, β, which is compatible with the dynamic heterogeneity view. But β varied monotonically with the composition, and there was little variation of β with the temperature, which seems incompatible with that view.

Kinetics of polymerization of a liquid with nanosize structural heterogeneities.

We report the effects of chemically reacting, nanometer-size structural heterogeneity on a polymerization process. Heterogeneity is introduced by adding 2 nm size molecules of polyhedral oligomeric silsesquioxane with multiepoxide groups (POSS) while maintaining stoichiometry of a polymerizing triamine-diepoxide mixture. Calorimetric studies show that POSS addition first increases the polymerization rate and then decreases it progressively more.