From Simple to Complex: Preserving and Reconstructing the Traumatized Thumb.

Traumatic thumb injuries significantly affect overall hand function and may result in considerable disability. Reconstructing the traumatized thumb requires a detailed preoperative assessment of the defect and evaluation of the patient's social history and medical comorbidities. Reconstructive techniques can be stratified by the level of thumb injury.

The Impact of a Breast Cancer Risk Assessment on the Decision for Gender-Affirming Chest Masculinization Surgery in Transgender and Gender-Diverse Individuals: A Pilot Single-Arm Educational Intervention Trial.

Background: Persons assigned female or intersex at birth and identify as transgender and/or gender-diverse (TGD) may undergo gender-affirming chest masculinization surgery (GACMS); however, GACMS is not considered equivalent to risk-reducing mastectomies (RRM). This study aimed to estimate the prevalence of elevated breast cancer (BC) risk in TGD persons, compare self-perceived versus calculated risk, and determine how risk impacts the decision for GACMS versus RRM.

Methods: A prospective single-arm pilot educational intervention trial was conducted in individuals assigned female or intersex at birth, age ≥ 18 years, considering GACMS, without a BC history or a known pathogenic variant.

Surgical Considerations for Flexor Tendon Repair: Timing and Choice of Repair Technique and Rehabilitation.

Flexor tendon injuries are common and occur mostly due to penetrating trauma. Surgical repair is required for complete tendon lacerations, and many techniques exist. This article reviews the principles of tendon structure, function, healing, and anatomy.

Physical Examination and Radiographic Staging of Thumb Carpometacarpal Arthritis.

This article reviews the key components of a complete history and physical examination for a patient presenting with thumb pain. The history should include the location and severity of pain, alleviating and exacerbating factors, and impact of disability. Physical examination consists of joint palpation; assessment for laxity or stiffness; inspection for swelling, subluxation, or deformity; and provocative maneuvers.

Extensor Carpi Ulnaris Subluxation.

Extensor carpi ulnaris tendon subluxation can be a challenging diagnosis as a cause of wrist pain. The tendon is stabilized by a tough subsheath. This subsheath is vulnerable to tears in acute wrist movements, especially those combining supination, flexion, and ulnar deviation.

Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience.

Purpose: Lymphedema is progressive arm swelling from lymphatic dysfunction which can occur in 30% patients undergoing axillary dissection/radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed in an attempt decrease the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). The purpose of this study was to assess the efficacy of ILR in preventing lymphedema rates in ALND patients.

Litigation in Hand Surgery: A 30-Year Review.

Background: Although hand surgery is generally safe and effective, some patients experience complications or poor outcomes prompting them to seek compensation. This study reviews malpractice claims in hand surgery using a national data set to assess reasons for litigation and identify predictors of outcome.

Methods: The Westlaw database was queried for cases related to hand surgery and medical malpractice between 1989 and 2018.

Hand Infections: Epidemiology and Public Health Burden.

Upper extremity infections are common. Most infections can be effectively treated with minor surgical procedures and/or oral antibiotics; however, inappropriate or delayed care can result in significant, long-term morbidity. The basic principles of treating hand infections were described more than a century ago and most remain relevant today.

An Epidemiological Analysis of Pediatric Dog Bite Injuries Over a Decade.

Background: An estimated 800,000 dog bites require medical attention every year. The purpose of this study is to review the characteristics of dog bite injuries in children and examine temporal trends.

Methods: The Kids' Inpatient Database was used to identify pediatric patients with dog bite injuries over a 10-y period.

Upper Extremity Burns in the Developing World: A Neglected Epidemic.

Burns are devastating injuries that cause significant morbidity, emotional distress, and decreased quality of life. Advances in care have improved survival and functional outcomes; however, burns remain a major public health problem in developing countries. More than 95% of burns occur in low- and middle-income countries, where access to basic health care is limited.

Patient satisfaction after treatment of distal radial fractures in older adults.

The Wrist and Radius Injury Surgical Trial (WRIST) collaboration is the largest clinical trial ever conducted in hand surgery. We applied data from this study to examine the relationship between functional outcomes and patient satisfaction after treatment of distal radial fractures. Patients aged 60 years and older with isolated distal radial fractures were enrolled at 24 health systems.

Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer.

This study measures patient-reported outcomes and identifies factors associated with patient satisfaction after excision of facial nonmelanoma skin cancer in the veteran population.

Tourniquet Use in Wide-Awake Carpal Tunnel Release.

Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity.

Scholarly activity in academic plastic surgery: the gender difference.

Background: The number of women in medicine has grown rapidly in recent years. Women constitute over 50% of medical school graduates and hold 38% of faculty positions at United States medical schools. Despite this, gender disparities remain prevalent in most surgical subspecialties, including plastic surgery.

Omental Vascularized Lymph Node Flap: A Radiographic Analysis.

Background:  Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest.

Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases.

Objective: Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis. This condition has clinical features analogous to infectious processes and must be quickly diagnosed to be properly treated. The purpose of this study was to characterise relevant clinical features associated with pyoderma gangrenosum based on a large inpatient cohort.

The Veterans Affairs Medical Center's Contribution to Plastic Surgery Education.

This population-based study evaluates the levels of case minimums met by plastic surgery residents in Veterans Affairs hospitals.

Assessing the Necessity of Stopping Antithrombotic Agents Before Wide-Awake Hand Surgery.

This review of 304 carpal tunnel release procedures examines the necessity of stopping antithrombotic medications prior to carpal tunnel release surgery.

Hand Surgery Resources Exceed American Health Literacy.

Background: The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites.

Methods: An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs.

Pediatric pyoderma gangrenosum: is it just big wounds on little adults?

Background: Pyoderma gangrenosum (PG) is an uncommon, ulcerative, cutaneous condition, often caused by surgical trauma that can masquerade as a pyogenic disease process requiring debridement and antibiotics. Treatment is, however, medical, with delay leading to significant morbidity. In addition, medical workup for coincident disorders has been suggested.