Limb Salvage and Treatment of Posttraumatic Lymphedema in a Mangled Lower Extremity.

Post traumatic lymphedema (PTL) is a known complication of extremity trauma that is detrimental to limb form and function, healing, and quality of life. In cases of complex lower extremity trauma with vascular and extensive soft tissue injury, the risk of PTL is increased. However, many trauma patients are lost to follow-up, making the risk and potential management of these patients' lymphedema difficult to characterize.

Imaging the Nerve "Allograft to Muscle Target" Technique in Neuroma Management.

Neuroma management has gained significant attention in the peripheral nerve literature in the past decade. Alongside techniques such as targeted muscle reinnervation and regenerative peripheral nerve interface, another technique known as the "allograft to nowhere" has emerged. This approach involves the placement of an extended allograft at the end of a nerve, creating a regrowth zone in cases where muscle or nerve targets are not available.

Surgical Management in Isolated Squamosal Craniosynostosis: A Systematic Review.

Background: Although craniosynostoses involving the major sutures have been well described, the frequency of isolated minor suture craniosynostoses is much lower. Squamosal craniosynostosis (SQS) is a rare form of cranial synostosis, and the paucity of literature has made the creation of a standardized treatment plan difficult. We present a systematic review of the literature on isolated SQS to identify disease characteristics that lead to a need for operative intervention and to delineate patterns in surgical management.

Skin Popping for the Hand Surgeon: A Case Report and Review.

Introduction: Subcutaneous injection of illicit drugs, colloquially known as skin popping, is associated with skin and soft tissue infections of the upper extremity. Sequelae of these infections often present to hand surgeons in the late stages of disease, are associated with challenging clinical scenarios, and are a significant burden to both patients and providers. The authors present an illustrative case and review the literature regarding this growing phenomenon in upper extremity surgery.

Microaggressions and Implicit Bias in Hand Surgery.

Implicit bias and microaggressions are well-known phenomenon and have recently been acknowledged as contributing to health care disparities. Within Hand Surgery, implicit bias and microaggressions occur in patient-surgeon, surgeon-peer, surgeon-staff, and training environment interactions. Although racial and gender biases are well studied, biases can also be based on age, sexual orientation, socioeconomic background, and/or hierarchal rank.

Spare Part Reconstruction of Distal Pediatric Thumb Amputation.

Thumb tip amputations can be reconstructive challenges, particularly in pediatric patients. Reconstruction using composite grafting and local flap options has been described for tip amputations in the adult population. The authors describe the use of a spare part reconstruction using autologous bone graft and a reverse cross finger flap to preserve length and function for a distal thumb tip amputation in a young man.

Compression Screw Fixation of Lunate Fracture: Case Report and Review of the Literature.

 Isolated traumatic lunate fractures without other surgical carpal bone or ligamentous injuries are extremely rare, with few published reports available to guide management. Lunate fracture management is controversial, and depends on concurrent injuries of adjacent carpal bones, ligaments, risk of ischemia, and displacement.  A 48-year-old right hand dominant man suffered a crush injury to the left hand caught between a forklift and a metal shelf.

The Use of Arteriovenous Bundle Interposition Grafts in Microsurgical Reconstruction: A Systematic Review of the Literature.

Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction.

Common Hand Conditions: A Review.

Importance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability.

Observations: Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools.

Serratus Anterior-rib Composite Flap Partial Thumb Reconstruction.

The serratus anterior-rib composite flap is a well described and versatile flap used for reconstruction in a variety of anatomical regions. However, reconstruction of a thumb defect using this flap has not been well described since first mentioned in the literature by the Buncke et al group 20 years ago. The authors describe the use of this technique for thumb reconstruction in a complex defect from a gunshot wound.

Efficacy of Microsurgical Treatment of Primary Lymphedema: A Systematic Review.

Introduction: Treatment of lymphedema remains a challenging clinical problem. Lymphatic surgery has recently gained momentum as an effective method to treat both early- and late-stage disease. In particular, "physiologic" microsurgical techniques including vascularized lymph node transplant and lymphovenous bypass/anastomosis have been shown to be effective in treating even advanced lymphedema.

Pediatric Trigger Digit Presenting in the Setting of Trauma.

Background: Pediatric trigger digit is a relatively rare condition with incompletely understood etiology. In our practice, we noted a series of children presenting with pediatric trigger digit after an associated local trauma to the hand, which has not been previously described. The aim of this study was to analyze the nature of presentation of trigger digits, the accuracy of initial diagnosis, and the impact on treatment strategies used.

Lymphovenous Bypass Using Indocyanine Green Mapping for Successful Treatment of Penile and Scrotal Lymphedema.

Male genital lymphedema is a debilitating condition with significant physiologic and psychologic ramifications. Classical surgical treatments for male genital lymphedema include primarily ablative procedures through removal of excess soft tissue, which often have poor aesthetic and functional outcomes. Super microsurgical techniques (including lymphovenous bypass and lymph node transfers) are promising contemporary interventions.

Temporomandibular Joint Septic Arthritis.

Infection of the temporomandibular joint (TMJ) is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy.

Squamosal Craniosynostosis: Defining the Phenotype and Indications for Surgical Management.

Background: Squamosal craniosynostosis is seldom reported in the craniofacial literature. Given that this is an uncommon diagnosis, phenotype and management remain unclear. The authors present a case series and review the literature to define the phenotype and management of these patients.

The Plastic Surgery Match: A Quantitative Analysis of Applicant Impressions From the Interview Visit.

Background: The integrated plastic surgery match is a competitive process not only for applicants but also for programs vying for highly qualified candidates. Interactions between applicants and program constituents are limited to a single interview visit. The authors aimed to identify components of the interview visit that influence applicant decision making when determining a final program rank list.

The Simultaneous Use of Breast Reduction and Internal Mammary Artery Perforator Flap in Sternal Wound Reconstruction.

Internal mammary artery perforator (IMAP)-based fasciocutaneous flaps have recently gained popularity in sternal wound reconstruction due to their decreased donor site morbidity. However, patients with significant macromastia or who are obese present a challenge when using these flaps due to their anatomy and associated comorbid conditions. Despite the prevalence of this population, there is a relative paucity of data on the use of local fasciocutaneous flaps and techniques to close sternotomy wounds in the obese population with hypertrophic or ptotic breasts.

Who is Publishing in Facial Cosmetic Surgery? A Citation Analysis Across Specialties Over Five Decades.

Background: Competition among our sister cosmetic specialties continues to increase. Once a field dominated by plastic surgeons, there is a clear trend toward increased competition from core and non-core disciplines. While these marketplace trends are obvious, how such competition has affected academia or peer reviewed publications is less clear.

Applying to Integrated Plastic Surgery Residency Programs: Trends in the Past 5 Years of the Match.

Background: The average integrated plastic surgery applicant spends over $6000 for interviews. The average program director reviews over 200 applications per cycle. It is important to make the application process efficient and cost effective for both applicants and programs.

Milestones Contributing to the Evolution of Craniofacial Surgery.

Craniofacial surgery (CFS) has a rich history of collaboration with a wide variety of surgical and nonsurgical specialties. This has resulted in a large volume of publications across this spectrum of subspecialties cataloging the advancements across the field. The authors aim to analyze the characteristics of the most cited articles in CFS.