Intensive hands-on microsurgery course provides a solid foundation for performing clinical microvascular surgery.

Purpose: Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching expertise and/or facilities. The aim of this manuscript was to describe the methodology and clinical effectiveness of an international microsurgery course, currently taught year-round in eight countries.

Methods: In the 5-day microsurgery course trainees perform arterial and venous end-to-end, end-to-side, one-way-up, and continuous suture anastomoses and vein graft techniques in live animals, supported by video demonstrations and hands-on guidance by a full-time instructor.

Rupture Rate, Functional Outcome and Patient Satisfaction after Primary Flexor Tendon Repair with the Modified 4-Strand Core Suture Technique by Tsuge and Using the Arthrex FiberLoop with Early Motion Rehabilitation.

Purpose: Our hypothesis was that the rupture rate after primary flexor tendon repair in the modified 4-strand core suture technique using the FiberLoop (Arthrex, Munich, Germany) is lower than in other suture materials and functional outcome and patient satisfaction are superior compared to the current literature.

Patients And Methods: A 2-stage retrospective, randomized follow-up study of 143 patients treated with the Arthrex FiberLoop after flexor tendon injury in zones 2 or 3 from May 2013 to May 2017 was performed. In the 1 stage, the rupture rate of all patients was assessed after a follow-up of at least one year by interview to exclude revision surgery.

Inter-Rater Reliability of Magnetic Resonance Imaging in Comparison to Computed Tomography and Wrist Arthroscopy in SLAC and SNAC Wrist.

The aim of the study was to assess the inter-rater reliability of magnetic resonance imaging (MRI) in comparison to computed tomography (CT) and wrist arthroscopy in patients with scapholunate (SLAC) or scaphoid non-union advanced collapse (SNAC) as well as to evaluate a grading score of cartilage lesions. A total of 42 patients (36 male, 6 female) at a mean age of 45 years (range: 19-65 years) with a SLAC or SNAC wrist who had a preoperative MRI and CT scan as well as underwent arthroscopy of the wrist between 2013 and 2018 were included in this study. Cartilage lesions, as assessed by MRI, CT and wrist arthroscopy, were classified by two hand surgeons in three stages.

Evaluation of the American Society of Anesthesiologists Physical Status Classification System in Risk Assessment for Lower Extremity Reconstruction with Free Tissue Transfer.

Background:  The applicability of free flap reconstruction for lower extremity (LE) defects in high-risk patients continues to require ongoing review. The aim of this study was to analyze the risk factors, management, and outcome of LE free flap reconstruction in high-risk (American Society of Anesthesiologists [ASA] class 3 or 4) patients.

Methods:  A retrospective chart review was performed for all patients who underwent LE reconstruction in our Institution (Level I Trauma Center) from 2013 to 2019.

[The distally based dorsal metacarpal artery flap (DMCA)].

Objective: Regional flap for the reconstruction of combined skin and soft-tissue defects of the fingers or the distal parts of the palm.

Indications: Full-thickness soft-tissue defects of the fingers dorsally up to the distal interphalangeal joint, of the fingers palmarly up to the middle phalanx, or of the distal parts of the palm.

Contraindications: Damage of the dorsal metacarpal artery or of the distal anastomosis by trauma or previous operation.

[Possible applications of free microsurgical fibula transplantation in the reconstruction of complex bone defects in the extremities: review of the literature and case series].

Background:  Extensive osseous defects of the extremities following trauma and tumour resection represent a major challenge for plasticreconstructive surgical teams. Defect reconstruction by free microsurgical fibula transplantation has become a standard method but is associated with a considerable rate of complications. The aim of the present work is to provide an up-to-date overview of the various reconstruction methods and to report our personal experiences with free fibula transplantation in a case series.

Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft.

Large bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise.

"Cat and dog bite injuries of the hand: early versus late treatment".

Introduction: Animal bites of the hand are common injuries in the emergency department. Serious complications may occur if those injuries are not treated adequately. The purpose of the study was to examine if there is a difference between the treatment of animal bite injuries at an early stage (first treatment within the first 24 h after injury, group I) versus a later stage (first treatment more than 24 h after injury, group II) retrospectively.

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures.

A malunited distal radius fracture can lead to symptomatic ulnar impaction syndrome, which is a common cause for ulnar-sided wrist pain. If conservative treatment fails and symptoms persist after an arthroscopic ulnocarpal debridement, ulnar shortening osteotomy (USO) is the treatment of choice. Since the first USO described by Milch in 1941 after a malunited Colles fracture, many techniques have been described varying in surgical approach, type of osteotomy and osteosynthesis material used.

Impact of microbial findings on plastic reconstructive surgery outcomes in patients with deep sternal wound infection after cardiac surgery.

Deep sternal wound infection (DSWI) is a life threatening complication after cardiac surgery. In severe cases, flaps are needed to cover the wound. However, it is controversial if an aseptic environment is necessary at the time of wound closure.

[Plastic surgery in the German second medical licensing examination].

Background:  There are 230 defined objectives in the national competency-based catalogue of learning goals in surgery (NKLC) for undergraduate surgical education in Germany. These teaching objectives should be met by the students at the end of their undergraduate education, regardless of their career choice afterward. Assessment drives learning, and thus, alignment of the second state examination and the learning objectives of the NKLC seems reasonable.

[Treatment of Metacarpal and Phalangeal Fractures].

Metacarpal and phalangeal fractures are the second most frequent fractures of the upper extremity. Treatment goal is to restore the function of the injured hand. Due to better understanding of anatomy and biomechanics as well as the development of locking and low-profile implants for osteosynthesis of such fractures, there is a growing safety when choosing the operative treatment for the correct indication.

Analysis of #PlasticSurgery in Europe: An Opportunity for Education and Leadership.

Background: Prior studies demonstrate that social media are used by plastic surgeons to educate and engage. The hashtag #PlasticSurgery has been studied previously and is embraced by American plastic surgeons and journals; however, no studies have examined its use or adoption across Europe.

Methods: A retrospective analysis of 800 tweets containing the words "plastic surgery" or the hashtag #PlasticSurgery in four of the most spoken European languages worldwide excluding English (Spanish, #CirugiaPlastica; French, #ChirurgiePlastique; Portuguese, #CirurgiaPlastica; and German, #PlastischeChirurgie) was performed.

Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures.

The purpose of this study was to evaluate flexor tendon injuries following palmar plating of distal radial fractures relative to the Soong grade. This retrospective cohort study included 113 patients who underwent palmar plate removal after a distal radial fracture between 2010 and 2016. In 13 patients, a greater than 50% injury of the flexor pollicis longus tendon was observed.

Risk factors for reoperation in primary hand infections: a multivariate analysis.

Introduction: Severe hand infection might cause severe morbidity including stiffness, contracture and possibly amputation. The purpose of this study was to analyse the current epidemiology of adult acute hand infections in a European Hand Surgery Centre and to identify risk factors for secondary surgery.

Materials And Methods: We retrospectively analyzed a cohort of 369 consecutive patients with primary infection of the hand that were admitted to our department and required operative treatment.

Exploration of the axillary nerve through an open posterior endoscopic-assisted (OPEA) approach: First clinical experience.

Introduction: Previous studies have described a segment of the axillary nerve (AN) that cannot be surgically explored through the deltopectoral and posterior surgical open approaches (blind zone). We present the first two cases using an endoscopic-assisted approach to explore the AN through a posterior approach.

Material And Methods: Two patients were evaluated, in whom clinical, electrodiagnostic testing, and MRI could not localize the level of the AN dysfunction.

[Palmar angular stable plate fixation of nonunions and comminuted fractures of the scaphoid].

Objective: Stabilization of comminuted fractures and nonunions of the scaphoid with an angular stable low-profile scaphoid plate.

Indications: Scaphoid nonunions with a large palmar defect, second and third surgical procedure after previous stabilization by headless compression screw (HCS). Comminuted fractures of the scaphoid that cannot be sufficiently stabilized by screws.

The activin-follistatin anti-inflammatory cycle is deregulated in synovial fibroblasts.

Background: Activin A and follistatin exhibit immunomodulatory functions, thus affecting autoinflammatory processes as found in rheumatoid arthritis (RA). The impact of both proteins on the behavior of synovial fibroblasts (SF) in RA as well as in osteoarthritis (OA) is unknown.

Methods: Immunohistochemical analyses of synovial tissue for expression of activin A and follistatin were performed.

[Surgical treatment of ulnar impaction syndrome : Ulnar shortening osteotomy through the ulnopalmar approach using a low-profile, locking plate].

Objective: Extra-articular shortening of the distal ulna in order to decompress the ulnocarpal joint.

Indications: Congenital or posttraumatic, symptomatic ulnar impaction syndrome.

Contraindications: Osteoarthritis or deformation of the distal radioulnar joint.

[The importance of hand surgery in the German Medical Licensing Examination].

Background: The national competency-based catalogue of learning objectives in surgery (NKLC) for undergraduate surgical education in Germany consists of 230 objectives and defines competence levels for each objective. These levels range from "competence level 1: factual knowledge" to "competence level 3: independent action". The German second state examination is not based on these objectives, although it is known that assessment drives learning.

Practicability of a locking plate for difficult pathologies of the scaphoid.

Introduction: Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies.

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap.

Introduction: Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries.