The Relationship Between Hemihamate Graft Size and Proximal Interphalangeal Joint Flexion for Reconstruction of Fracture-Dislocations: A Biomechanical Study.

Purpose: The purpose of this study was to determine the relationship between hemihamate graft size and proximal interphalangeal (PIP) joint flexion in a biomechanical fracture-dislocation model.

Methods: We simulated middle finger PIP fracture-dislocations in 5 cadaver hands by resecting 50% of the palmar articular surface of the middle phalanx (P2) base. Fluoroscopy was used to confirm dorsal subluxation of the middle phalanx base after resection.

Ulnar Thumb Pulp Reconstruction Using the Anterograde Homodigital Neurovascular Island Flap.

The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks.

Upper extremity transplantation: current concepts and challenges in an emerging field.

Loss of an isolated upper limb is an emotionally and physically devastating event that results in significant impairment. Patients who lose both upper extremities experience profound disability that affects nearly every aspect of their lives. While prosthetics and surgery can eventually provide the single limb amputee with a suitable assisting hand, limited utility, minimal haptic feedback, weight, and discomfort are persistent problems with these techniques that contribute to high rates of prosthetic rejection.

Free function muscle transfers for upper extremity reconstruction: a review of indications, techniques, and outcomes.

Free functional muscle transfer (FFMT) replaces destroyed, denervated, or resected skeletal muscle units in the upper extremity with functioning skeletal muscle from other locations in the body. Common indications for FFMT include brachial plexus injuries, ischemic contracture, tumor resection, and extensive direct muscle trauma. Recent studies have focused on improving patient outcomes through refinements in muscle flap harvest and inset, donor nerve selection, and postoperative management.

Does conventional posterior vault remodeling alter endocranial morphology in patients with true lambdoid synostosis?

Background: True lambdoid synostosis (TLS) produces a consistent morphology that includes occipital flattening, an ipsilateral occipitomastoid prominence, and a mild contralateral hemifacial deficiency that minimally improves with surgery. Prior studies have demonstrated that dysmorphic middle and posterior cranial fossae contribute to the craniofacial scoliosis characteristic of TLS. We hypothesize that these endocranial features remain after surgery, causing the persistent hemifacial deficiency seen in these patients.

The impact of residency and fellowship training on the practice of microsurgery by members of the american society for surgery of the hand.

Purpose: The purpose of this study was to assess the microsurgical training background of current members of the American Society for Surgery of the Hand (ASSH) and then determine the impact that prior training had on current microsurgical practice.

Methods: A 174-item anonymous Web-based survey was sent to all active ASSH members. Items addressed prior residency and fellowship training, practice setting, and training, comfort, and practice of specific microsurgical procedures.

The history and evolution of hand transplantation.

Hand transplantation has proven itself to be a viable treatment option for upper extremity reconstruction. It has grown through advancements in several critical areas: microsurgery, transplant immunology, and hand surgery. The field has also benefited from a global effort with active transplant centers in 3 different continents.

Microsurgery of the upper extremity.

In the past 50 years, hand surgeons have made considerable contributions to microsurgery. The unique demands of complex upper extremity care have driven many of the technical and scientific advances of this discipline, including functional muscle transfers, nerve transfers, and composite tissue allotransplantation. The purpose of this article was to review the current applications of microsurgery to the upper extremity.

Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification system and algorithm.

Background: Composite defects resulting from total parotidectomy present unique reconstructive challenges. This study reviews our experience using the anterolateral thigh (ALT) flap with adjacent fascia and nerve grafts to reconstruct these defects, and establishes a classification system and treatment algorithm that simplifies reconstruction.

Methods: Between July 2005 and November 2009, 22 patients underwent total parotidectomy and immediate reconstruction with the extended ALT flap.

Analysis of differences in the cranial base and facial skeleton of patients with lambdoid synostosis and deformational plagiocephaly.

Background: Earlier investigations suggest that the morphologic features of patients with lambdoid synostosis include ipsilateral occipital flattening, an ipsilateral mastoid prominence, downward cant of the posterior skull base to the affected side, and contralateral hemifacial deficiency. These features are absent in patients with deformational plagiocephaly. The authors hypothesize that significant differences in craniofacial morphology exist between patients with lambdoid synostosis and those with deformational plagiocephaly.