Enhanced Recovery After Surgery in Immediate DIEP Flap Breast Reconstruction: Reducing Length of Stay and Opioid Use.

To improve patient outcomes amid reduced healthcare resources during the COVID-19 pandemic, a single Canadian cancer center implemented an Enhanced Recovery After Surgery (ERAS) protocol for autologous DIEP flap breast reconstruction. This retrospective cohort study included 100 consecutive patients undergoing microsurgical breast reconstruction with DIEP flaps using the ERAS protocol and 100 patients using a standard protocol. Primary outcomes were the hospital length of stay and opioid use.

Staged Mastopexy before Nipple-Sparing Mastectomy: Improving Safety and Appearance in Breast Reconstruction.

Background: Breast reconstruction following nipple-sparing mastectomy (NSM) in patients with large or ptotic breasts remains challenging because of the risk of ischemic complications and the difficulty in managing the redundant skin envelope. Staged mastopexy or breast reduction before the mastectomy/reconstruction has been shown to decrease the risk of complications and improve clinical outcomes.

Methods: A retrospective analysis was conducted of patients with a genetic predisposition to breast cancer who underwent staged breast reduction/mastopexy before NSM and reconstruction in the authors' institution.

Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management.

Background: Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.

Purpose: This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities.

Study Design: Cross-sectional.

Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review.

Purpose: This systematic review (SR) aimed to identify the surgical interventions available for trapeziometacarpal osteoarthritis and document their efficacy on pain, physical function, psychological well-being, quality of life, treatment satisfaction, and/or adverse events.

Methods: This PROSPERO-registered SR's protocol was developed based on the Cochrane intervention review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Among 9049 potential studies identified, 1 SR, 18 randomized controlled trials, and 40 nonrandomized controlled trials were included.

High-Fidelity Microsurgical Simulation: The Thiel Cadaveric Nerve Model and Evaluation Instrument.

With surgical education moving from a time-based to a competency-based model, developing high-fidelity simulation models has become a priority. The Thiel cadaveric model has previously been used for a number of medical and surgical simulations, including microvascular simulation. We aim to investigate the use of the Thiel model in peripheral nerve simulation and validate a novel evaluation instrument.

Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review.

Objective: To synthesize the literature on the efficacy of existing nonsurgical interventions for trapeziometacarpal (TM) osteoarthritis (TMO).

Methods: A medical librarian conducted an electronic search in 16 databases. Two authors independently carried out study selection, data extraction, and risk-of-bias assessment.

Bilateral sensory and motor as well as cognitive differences between persons with and without musculoskeletal disorders of the wrist and hand.

Background: Sensory and motor disturbances are characteristic of musculoskeletal injuries and conditions. Rehabilitation interventions aimed at remediating these disturbances are traditionally exclusively targeted to the affected area. However, there is some evidence of bilateral changes in sensory and motor function associated with unilateral injuries and conditions suggesting central changes.

Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture.

Study Design: This is a cross-sectional clinical measurement.

Introduction: There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities.

Purpose Of The Study: The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO.

Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain.

Study Design: Cross-sectional.

Introduction: Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain.

Purpose Of The Study: The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand.

High Fidelity Microsurgical Simulation: The Thiel Model and Evaluation Instrument.

Background: The Thiel embalmment method has recently been used in a number of medical simulation fields. The authors investigate the use of Thiel vessels as a high fidelity model for microvascular simulation and propose a new checklist-based evaluation instrument for microsurgical training.

Methods: Thirteen residents and 2 attending microsurgeons performed video recorded microvascular anastomoses on Thiel embalmed arteries that were evaluated using a new evaluation instrument (Microvascular Evaluation Scale) by 4 fellowship trained microsurgeons.

Left Right Judgement Task and Sensory, Motor, and Cognitive Assessment in Participants with Wrist/Hand Pain.

The Left Right Judgement Task (LRJT) involves determining if an image of the body part is of the left or right side. The LRJT has been utilized as part of rehabilitation treatment programs for persons with pain associated with musculoskeletal injuries and conditions. Although studies often attribute changes and improvement in LRJT performance to an altered body schema, imaging studies suggest that the LRJT implicates other cortical regions.

Investigating Patients' Perception of Microvascular Free Toe Flap for Reconstruction of Amputated Thumbs: A Guide for Surgeons during Informed Consent.

Background:  After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent.

Duration and cessation characteristics of heparinization after finger replantation: A retrospective analysis of outcomes.

Background: To prevent postoperative thrombosis, indications for anticoagulation in finger replantation have been described, but no consensus has yet been found for cessation protocols. The aim of this study is to investigate cessation methods of intravenous anticoagulation after finger replantation.

Methods: A retrospective review of all patients treated for a finger replantation between December 2014 and July 2016 was performed.

Microvascular replantation of head and neck amputated parts: A systematic review.

Background: As opposed to upper and lower extremity amputations representing a considerable volume of admissions, the prowess of microsurgeons is seldom solicited in complex cases of head and neck replantation. Our aim was to determine the rate of successful replantation of craniofacial parts in a systematic review of the literature.

Methods: We performed a systematic review of English literature using PubMed/MEDLINE for every replantation of a head and neck parts.

Free Transfer of a Paralyzed Contralateral Little Finger for Total Thumb Reconstruction in an Electrical Burn Patient: A Case Report and Literature Review.

The authors report the case of a 30-year-old male with 52% TBSA high-voltage electrical injury of the upper half of the body. Injuries included a cervical burn with associated alteration of the left brachial plexus as well as extensive soft tissue burn of the right hand. Three months later, he developed osteomyelitis of the right thumb metacarpal bone requiring amputation proximal to the metacarpophalangeal joint.

Arteriovenous fistulas for microvascular head and neck reconstruction.

Background: In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks.

The double capsules in macro-textured breast implants.

Breast implants are amongst the most widely used types of permanent implants in modern medicine and have both aesthetic and reconstructive applications with excellent biocompatibility. The double capsule is a complication associated with textured prostheses that leads to implant displacement; however, its etiology has yet to be elucidated. In this study, 10 double capsules were sampled from breast expander implants for in-depth analysis; histologically, the inner capsular layer demonstrated highly organized collagen in sheets with delamination of fibers.

Intra-arterial Thrombolysis for Postoperative Digital Ischemia: A Case Report.

Objective: Surgical repair of digital flexion deformities can result in vascular injuries threatening the viability of the affected digit. While uncommon, these injuries are reported to have a rate as high as 0.8% following palmo-digital fasciectomy for Dupuytren's disease.

A new microsurgical research model using Thiel-embalmed arteries and comparison of two suture techniques.

Purpose: To assess the utility of the Thiel arterial model in microsurgical research, we compared interrupted horizontal mattress (HM) sutures to simple interrupted (SI) sutures in human vessels.

Methods: A microsurgical set-up using an operating microscope and Thiel-embalmed arteries was used to practice ten SI and HM anastomoses. Vessel patency, leak and stricture were evaluated using angiography, and vessel wall architecture was evaluated using light microscopy and scanning electron microscopy (SEM).

Decreasing the pain of finger block injection: level II evidence.

Background: There is level II evidence that volunteers prefer the single subcutaneous injection in the midline of the proximal phalanx with lidocaine and epinephrine (SIMPLE) finger block over the classic two dorsal injection block technique. The purpose of this study was to possibly further decrease the pain of digital block injection by examining the effect of the duration of injection on the pain felt by volunteers receiving the SIMPLE block at two different injection rates.

Methods: Forty healthy blinded volunteers were injected 2 mL of lidocaine 1 % and epinephrine 1/100,000 in the digital palmar crease of both long fingers, one at a time.

A review of 105 subscapular-based flaps harvested using a new dorsal decubitus position: how far can we go?

Objective: Interest in flaps based on the subscapular vascular system has decreased because of the need for intraoperative patient repositioning and the inability to employ a simultaneous 2-team approach. The aims of this study are to review our experience using dorsal decubitus patient positioning for subscapular-based flap harvest and to demonstrate the effectiveness and safety of this approach.

Methods: A retrospective review of all subscapular-based flap cases performed by the senior author at 2 hospital centers from 1995 to 2010 was conducted.

A new dorsal decubitus position for raising subscapular-based flaps.

Flaps based on the subscapular vascular system are reliable and versatile tools that provide excellent coverage for a wide range of tissue deficits. Raising these flaps in the described dorsal decubitus position permits two surgical teams to work simultaneously while obviating the need for intra-operative position changes. In cases where a subscapular-based flap is deemed the most suitable option for reconstruction, the dorsal decubitus technique eliminates many of the limitations associated with the traditional lateral decubitus approach without compromising the range of tissue obtainable.

Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction.

The latissimus dorsi, whether taken as a muscle or with a skin paddle, is one of the most useful flaps in the reconstructive surgeon's arsenal. With its predictable type V vascular pedicle, this broad muscle can be elevated on its dominant thoracodorsal pedicle or used in a reverse manner on its secondary thoracic and lumbar perforators. Traditionally harvested in a lateral decubitus position, over the last 10 years we have chosen to elevate this muscle in a dorsal decubitus position, enabling 2 surgical teams to operate simultaneously.

Intravenous heparin use in digital replantation and revascularization: The Quebec Provincial Replantation program experience.

Background: No consensus exists among microsurgeons regarding the role of intravenous (IV) heparin in digital replantation/revascularization. The current experience of the Provincial Replantation Center in Quebec was reviewed over a 4-year period.

Methods: An initial retrospective review of all revascularized or reimplanted digits at our Replantation Center from April 2004 to April 2006 was conducted.

Wound healing assessment: does the ideal methodology for a research setting exist?

Introduction: Studies on dressings frequently measure wound healing to demonstrate performance. Knowledge of existing methodologies available for wound healing assessment, including their advantages and limitations, is paramount when evaluating the literature on dressings.

Methodology: Medline and Cochrane databases were searched for wound healing assessment methodologies used in research or in clinical practice.