Measuring Functional Outcomes After Bilateral Vascularized Composite Hand Allotransplantation: A Report of 3 Cases.

Purpose: Currently, numerous assessment tools are available to measure functional outcomes after bilateral hand transplantation. The purpose of this article is to present our experience utilizing quantitative assessment tools for functional evaluation and to describe our results after bilateral hand transplantation.

Methods: A single surgeon's experience with bilateral hand transplantation from 2011 to 2016 was retrospectively reviewed.

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology.

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone.

Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed.

A Review on the Orthoplastic Approach to Lower Limb Reconstruction.

Just as in the craft of carpentry, a stable foundation and framework are absolutely essential to the final function of a building, but no more important than the drywall, trim, and paint that make the building functional, durable, and livable. Reconstruction of the lower extremity is similar; the orthopaedic surgeon must obtain stable fixation of the damaged or diseased bone once a thorough debridement of nonviable bone is performed, while the plastic or orthopaedic soft tissue surgeon must provide vascularized, stable coverage. These two components are complementary and both contribute to the success or failure of functional limb restoration.

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 use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long-term clinical and ultrasonographic evaluation.

The canine common calcanean tendon can be repaired successfully using a modified Kessler knotless barbed technique. A long-term ultrasound follow-up showed improved and increased normal tendon fibrillar echotexture and homogeneity.

A Subperiosteal Proximal Phalanx Osteoid Osteoma: A Challenging Diagnosis.

A relatively rare tumor, osteoid osteoma most commonly affects the lower extremity. In 10% of the cases, it can affect the hand and wrist. We present a case of osteoid osteoma in the proximal phalanx of ring finger that was initially misdiagnosed as a soft tissue lesion.

Arthroscopic Ganglionectomy in the Pediatric Population.

Background: Arthroscopic dorsal wrist ganglionectomy is an established alternative to open excision in the adult population. The purpose of this study was to retrospectively compare outcomes of arthroscopic and open dorsal wrist ganglionectomy in the pediatric population.

Methods: All patients who underwent arthroscopic or open dorsal wrist ganglionectomy at a single pediatric institution between 2011 and 2014 were retrospectively evaluated by chart review and telephone interview.

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation.

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program.

The Chimeric Myo-Osseous Medial Femoral Condyle Flap for Tibial Nonunion: A Case Report.

The descending genicular artery provides the dominant pedicle for the medial femoral condyle and medial femoral trochlear free flaps. Variations of the flap include using a skin paddle for monitoring, a vastus medialis muscle component, and the medial superior geniculate artery for the pedicle. We present a case of a 49-year-old man with a distal tibial fracture from a motor vehicle accident complicated by chronic osteomyelitis, poor soft tissue envelope, and tibial nonunion.

Ankle Arthrodesis with Free Vascularized Fibula Autograft Using Saphenous Vein Grafts: A Case Series.

Background: In select high-risk cases of ankle arthrodesis, conventional techniques may lead to a high incidence of failure because of a combination of multiple operations; high risk of infection; avascular, often bulky allografts; and poor soft-tissue quality. In high-risk distal limb salvage, the authors have performed ankle arthrodesis using a free vascularized fibula graft from the ipsilateral limb with saphenous vein grafts.

Methods: The authors present data from six patients.

Comparison of Fracture Location and Extent of Comminution in Isolated Scaphoid Fractures Versus Transscaphoid Fracture-Dislocations.

Isolated scaphoid fractures (ISFs) are common, whereas transscaphoid fracture-dislocations (TSFDs) are not. Scaphoid fracture location and the extent of comminution are factors that affect treatment and outcome. The purpose of this study is to compare the radiographic characteristics of ISFs with TSFDs associated with greater arc injury.

Building a Hand and Upper Extremity Transplantation Program: Lessons Learned From the First 20 Years of Vascularized Composite Allotransplantation.

Upper extremity transplantation is a quality-of-life enhancing treatment for select patients with upper extremity loss. This article reviews the preoperative, intraoperative, and postoperative challenges in the upper extremity transplantation process and the lessons learned from the first 2 decades of hand transplantation. Key components of the author's hand transplantation protocol including patient selection, donor screening, surgical rehearsal, donor procurement, transplantation, immunosuppression, and patient outcome reporting/follow-up are reported to assist other teams who wish to establish a hand transplantation program.

Logistics in Coordinating the First Adult Transatlantic Bilateral Hand Transplant: Lessons Learned.

Hand transplantation requires precise preoperative planning and surgical execution. Coordinating a transplant team-including surgeons, anesthesiologists, nurses, and supporting staff-is a time-sensitive challenge when a donor-recipient match is confirmed. International human limb transplantation occurs when the recipient and donor are in separate countries.

Pediatric burns in Israeli natives versus asylum seekers living in Israel: Lessons learned.

Background: Burn injuries are one of the leading causes of morbidity and mortality in the pediatric population. In early childhood, burns have a wide range of adverse long-term consequences ranging from functional impairment to psychological implications. Children from low-income and middle-income countries are at a higher risk of suffering from burn injuries.

Body Builder's Nightmare: Black Market Steroid Injection Gone Wrong: a Case Report.

In the pursuit of success in sports, some athletes are not deterred by health risks associated with the (mis)use of black market preparations of dubious origin as performance-enhancing agents. Several studies published in the recent years demonstrated that anabolic-androgenic steroids, but also stimulants and growth hormones, are misused by numerous recreational athletes from all over the world. Trenbolone is an anabolic steroid routinely used in the finishing phase of beef production to improve animal performance and feed efficiency.

Delayed Wound Healing in Heat Stable Antigen (HSA/CD24)-Deficient Mice.

Background: Healthy individuals rarely have problems with wound healing. Most skin lesions heal rapidly and efficiently within one to two weeks. However, many medical and surgical complications can be attributed to deficiencies in wound repair.

Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report.

Background: The medial femoral condyle vascularized bone graft has grown in popularity for treating recalcitrant fracture non-unions and has become particularly useful in treating scaphoid non-union with avascular necrosis of the proximal pole. The medial femoral condyle is an excellent source of dense, well-vascularized bone and results in minimal donor site morbidity.

Methods: We describe an unusual case of chronic scaphoid non-union and total scaphoid avascular necrosis in a skeletally immature patient.

Practical Management of Metacarpal Fractures.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the indications for metacarpal fixation. 2.

Salvage Operations for Wrist Ligament Injuries with Secondary Arthrosis.

Wrist ligamentous injuries can be challenging to treat successfully. In some cases the ligament repair or reconstruction fails, resulting in instability and progressive degenerative changes. In other cases the original injury is missed, and the patient presents for the first time with established wrist arthritis.

Free fibula reconstruction of distal tibial defects after sarcoma surgery.

Distal tibial tumor ablation results in combined soft tissue and bone defect that involves the ankle joint. This area is unique and problematic because it combines low caliber limb size, relatively soft tissue deficiency, suboptimal bone and soft tissue healing ability, and the need to sustain increased mechanical loads. The management is difficult, controversial, and traditionally was treated by primary amputation.

The effect of barbed suture tendon repair on work of flexion.

Purpose: To compare the work of flexion, ultimate strength, and gap resistance of a conventional 4-strand tendon repair to a knotless barbed-suture 4-strand tendon repair.

Methods: Tendon repairs were performed on 16 cadaver flexor digitorum profundus tendons using either a 4-strand double Kessler repair or a similar but knotless 4-strand repair with a unidirectional barbed suture. Work of flexion, gap resistance during cyclical loading, and ultimate strength of both techniques were determined and their means compared.

Methicillin-resistant Staphylococcus aureus infection in the hand.

Background: Methicillin-resistant Staphylococcus aureus has become an increasingly common cause of skin and soft-issue infections. The purpose of this study was to review and summarize the most recent literature on methicillin-resistant S. aureus infections of the hand.

Complications related to harvest of the proximal end of the fibula: a systematic review.

Background: The fibula is a common source of bone graft used in skeletal reconstruction. Although in most cases only the diaphysis of the fibula is used, there are clinical scenarios in which the proximal end of the fibula and fibular head are harvested for use in articular reconstruction. The purpose of this systematic review is to determine the incidence of knee instability and peroneal nerve motor dysfunction associated with removal of the proximal end of the fibula and fibular head.

Colorectal cancer chemoprevention: the potential of a selective approach.

Colorectal cancer (CRC) is a leading cause of cancer death, and therefore demands special attention. Novel recent approaches for the chemoprevention of CRC focus on selective targeting of key pathways. We review the study by Zhang and colleagues, evaluating a selective approach targeting APC-deficient premalignant cells using retinoid-based therapy and TNF-related apoptosis-inducing ligand (TRAIL).