Posterior Interosseous Nerve Graft: Utilizing External Landmarks and Anthropometric Ratios to Predict Available Length for Digital Nerve Reconstruction in a Cadaveric Study.

Objective: In digital nerve defects that require grafting, autografts remain the efficacious option. The sensory posterior interosseous nerve (PIN) is an ideal choice as it is of similar caliber to digital nerves and leaves no donor morbidity upon resection. However, a finite length of harvestable PIN exists, and considerable variations of this length have been reported in the literature.

Wine, Honey, and Boiling Oil: A Modern Understanding of Ancient Wound Care Practices.

The origins of wound care date back to ancient civilizations. From boiling oil to honey to wine, healers and caregivers have adopted a fascinating array of items to cleanse, dress, and bandage wounds over the ages. While wound care practices have developed over time, the physicians and surgeons of ancient times and the Middle Ages helped build the foundation for present-day wound care.

Surface Landmarks to Provide a Safe Ulnar Nerve Block in the Wrist: Anatomical Study and Literature Review.

Use of local anesthesia in awake patients undergoing hand surgery has become increasingly popular. A thorough understanding of local anatomy, such as the distal wrist for ulnar nerve block, is required to provide safe blockade. We sought to conduct an anatomic study of the distal wrist and review cadaveric studies describing various techniques for ulnar nerve block.

Anatomic surface landmarks to guide injection for posterior interosseous nerve block.

Proper injection of the posterior interosseous nerve (PIN) is important for both the therapeutic and diagnostic management of wrist pain. However, no anatomical study exists describing the site of injection based on individual wrist width. We sought to develop a reproducible anthropometric ratio utilizing external wrist surface anatomy to predict a safe and accurate injection site for the PIN.

Students teaching students: A survey of a medical student led surgical skills workshop - A prospective cohort study.

Background: Surgical skills training is a recognized vital component of medical education, yet a standardized curriculum does not exist. Early opportunities for skills development and mentorship may increase student interest in pursuing surgery. We evaluated the effects of a student-led, faculty-supervised suture clinic on student comfort level with basic surgical skills and interest in surgery.

Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study.

Background: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure.

Material And Methods: Instructional videos were created by the senior faculty (R.

Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection.

Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/injection location have not been defined, especially in relation to diminishment of iatrogenic injury to the median nerve.

Preservation of the Sterile Matrix, Hyponychium, and Fingertip Pad in Fingertip Reconstruction With Composite Fingertip and Nail Bed Graft and Volar V-Y Advancement Flap.

The goals of fingertip reconstruction are to achieve adequate soft-tissue coverage and a functional nail plate and to maintain sensation, proprioception, and cosmesis. We present a composite tissue graft and volar V-Y advancement flap for reconstruction of a traumatic amputation of a fingertip, which provided optimal preservation of the hyponychium and the volar pad for prevention of a hook nail. Historically, composite fingertip grafts have not been recommended for adults with large defects.

The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture.

Background: To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature.

Methods: The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment.

The Unexpected Hand Patient.

Objective: Physicians should be aware of patients trying to obtain a diagnosis for secondary gain. Malingering is a diagnosis that should be suspected when objective findings do not support the subjective symptoms and there is secondary gain.

Methods: A series of 21 cases are presented that support this position.

Iatrogenic Injury to the Median Nerve During Palmaris Longus Harvest: An Overview of Safe Harvesting Techniques.

A rare and disastrous complication of harvesting a tendon graft is the misidentification of the median nerve for the palmaris longus. The authors report a referred case in which the median nerve was harvested as a free tendon graft. Few reports of this complication are found in the literature despite the frequency of palmaris longus tendon grafting and the proximity of the palmaris tendon to the median nerve.

Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

Background: The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function.

An Inexpensive Suture Practice Board.

Objective: We provide a design for an effective suture practice board for surgical instruction that is both easily assembled and repaired.

Methods: This model's design is achieved through inexpensive materials that do not compromise adequate simulation through repetitive use. We used a wooden board, synthetic microfiber cloth, and metal plates and screws to create the suture board.

Photo-documentation of thumbnail regrowth after surgical avulsion: case report and literature review.

Objective: We present a case of thumbnail regrowth and photo-documentation after a complete surgical avulsion and nail bed biopsy.

Methods: A complete surgical avulsion of the right thumbnail was performed and the regrowth was photo-documented.

Results: Complete regrowth was achieved by 33 weeks after avulsion, and the photos were compiled into a time-lapse video.

Giant cell tumor of the tendon sheath: experience with 65 cases.

Objective: No consensus exists on the etiology, prognostic factors, or recurrence rate of giant cell tumors of the tendon sheath. This article presents a series of 65 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of giant cell tumor of the tendon sheath.

Methods: The authors completed a retrospective review of one surgeon's practice from 1976 to 2001, evaluating 65 cases of giant cell tumor of the tendon sheath.

Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I.

Purpose: To compare the effectiveness of imaging techniques in aiding and confirming the diagnosis of complex regional pain syndrome (CRPS) type I.

Methods: We conducted a meta-analysis of randomized controlled studies that evaluated the effectiveness of 3 different imaging techniques in aiding the diagnosis of CRPS type I. A systematic search in bibliographical databases resulted in 24 studies with 1,916 participants.

Synchronous squamous cell carcinoma in multiple digits.

Cancers of the perionychium are relatively rare occurrences and are often related to chronic inflammation associated with trauma, infection, exposure to ultraviolet radiation, or other carcinogens. Squamous cell carcinoma is the most common tumor reported of the nail bed. Synchronous squamous cell carcinomas of the perionychium have been rarely reported.