Targeted Muscle Reinnervation for a Symptomatic Neuroma in a Traumatic Transmetatarsal Amputee: A Case Report.

Case: An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes.

Challenges for Women in Hand Surgery: Our Perspective.

Over recent decades, the prevalence of women in surgical subspecialties has increased. There has been a significant rise in the percentage of women entering integrated plastic surgery programs and an increase, albeit smaller, in women entering orthopedic surgery training programs. Although female membership in the American Society for Surgery of the Hand has steadily increased, women remain in the vast minority within this professional society and many others within the field of hand surgery.

Open Carpal Tunnel Release With a Z-plasty Rearrangement for Median Nerve Mononeuropathy Secondary to Traumatic Scar Contracture.

We present the case of a 56-year-old woman who developed carpal tunnel syndrome and palmar scar contracture secondary to a left-hand palmar laceration in a pedestrian versus motor vehicle accident. The patient underwent carpal tunnel release and a Z-plasty rearrangement to restore normal thumb movement. The patient reported significant improvement in thumb mobility, resolution of median neuropathy symptoms, and no pain along the scar at her three-month follow-up.

Does resident autonomy in colectomy procedures result in inferior clinical outcomes?

Background: The amount of time surgical trainees spend operating independently has been reduced by work-hour restrictions and shifts in the health care environment that impede autonomy. Few studies evaluate the association between clinical outcome and resident autonomy.

Methods: The Veterans Affairs Surgical Quality Improvement Program database was queried to identify patients undergoing partial colectomy for neoplasm between 2004 and 2019.

Supervised independence in elective inguinal hernia repairs performed by surgical residents is not associated with compromised short clinical outcome or rates of reoperation for recurrence.

Background: We evaluate the association between attending surgeon involvement and clinical outcome in elective inguinal hernia repairs performed by residents.

Methods: Patients undergoing initial elective unilateral inguinal hernia repair between 2004 and 2019 were identified using the Veterans Administration Surgical Quality Improvement Program Database. The level of attending surgeon involvement was categorized as active (attending scrubbed [AS]) or passive (supervising the resident's performance but not scrubbed [ANS]).

Does Pandemic Crisis Mean Education Crisis? The Chicago Academic Plastic Surgery Collaborative Response to COVID-19.

The health care crisis related to the spread of novel coronavirus (severe acute respiratory syndrome coronavirus 2) has created new challenges to plastic surgery education, mostly because of the decreased volume of procedures. The plastic surgery program directors in Chicago decided to act and identify ways to promote surgical education through citywide, multi-institutional, systematic clinical case discussions. Although the initiative has no impact on the surgical skill of the trainees, it was welcomed by residents and faculty and promoted clinical core knowledge in plastic surgery and collaboration among the institutions.

A Leg to Stand on: Trauma Center Designation and Association with Rate of Limb Salvage in Patients Suffering Severe Lower Extremity Injury.

Background: Mangled extremities are one of the most difficult injuries for trauma surgeons to manage. We compare limb salvage rates for a limb-threatening lower extremity injuries managed at Level I vs Level II trauma centers (TCs).

Study Design: We identified all adult patients with a limb-threatening injury who underwent primary amputation or limb salvage (LS) using the American College of Surgeons (ACS) Trauma Quality Improvement Program database at ACS Level I vs II TCs between 2007 and 2017.

Treatment of Nonreplantable Total Thumb Amputation at the CMC Level Using Index Finger Pollicization.

Background: Pollicization of the index finger is a rarely performed reconstructive option for patients with total thumb amputations with nonsalvageable carpometacarpal (CMC) joint and thenar muscles. Successful pollicization can provide basic grasp and pinch to help patients carry out activities of daily living. We present a retrospective review of 4 patients who underwent index finger pollicization for traumatic total thumb amputations.

Positive microscopic surgical margins: Is there an association with survival in resected small gastrointestinal stromal tumors?

Background: Few studies evaluate the relationships between surgical approach, histologic margin, and overall survival in gastrointestinal stromal tumor. We test the hypothesis that margin positive resection is associated with compromised overall survival.

Methods: We queried the National Cancer Data Base to identify patients undergoing resections for gastrointestinal stromal tumors ≤3 cm in size between 2010 and 2015.

The importance of the margin of resection and radiotherapy in retroperitoneal liposarcoma.

Background: Prior studies evaluating the impact of adjuvant or neoadjuvant radiotherapy on clinical outcomes in retroperitoneal liposarcoma have been underpowered.

Methods: We queried the National Cancer Database for patients undergoing resection of retroperitoneal liposarcoma from 2004 to 2016. Cox proportional hazards modeling stratified by tumor size was used to identify factors associated with overall survival.

The importance of the margin of resection and external radiation in non-lipomatous retroperitoneal sarcoma.

Background: Prior studies evaluating the impact of adjuvant or neoadjuvant radiation on clinical outcomes of patients with non-lipomatous retroperitoneal sarcoma have been underpowered.

Methods: We queried the National Cancer Database to identify patients undergoing surgical resection of retroperitoneal sarcoma with non-lipomatous histology from 2004 to 2016. Multivariable logistic regression and Cox proportional hazards modelling with patients stratified by tumor size were used to identify factors associated with overall survival.

Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures.

Purpose: To determine the functional outcomes of patients treated with dorsal spanning distraction bridge plate fixation for distal radius fractures.

Methods: All adult patients at our institution who underwent treatment of a unilateral distal radius fracture using a dorsal bridge plate from 2008 to 2012 were identified retrospectively. Patients were enrolled in clinical follow-up to assess function.

Danger zones for flexor tendons in volar plating of distal radius fractures.

Purpose: To define a danger zone for volar plates using magnetic resonance imaging by analyzing the position of the flexor tendons at risk around the watershed line.

Methods: We analyzed 40 wrist magnetic resonance images. The location of the flexor pollicus longus (FPL) and index flexor digitorum profundus (FDPi) tendons was recorded at 3 and 6 mm proximal to the watershed line of the distal radius.

Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth.

Purpose: We hypothesized that the lunate depth as measured on plain lateral radiographs can be used to predict distal radius depth radially and ulnarly and serve as a useful reference for intraoperative screw placement in volar plate fixation of distal radius fractures.

Methods: Plain radiographs and magnetic resonance imaging (MRI) of the wrists of 30 patients were reviewed. The lunate depth and the maximal depth of the distal radius were determined from plain lateral radiographs.

Correlation between preoperative Kimura inching studies and intraoperative findings during endoscopic-assisted decompression of the ulnar nerve at the elbow.

Background: During the evolution of the senior author's technique of ulnar nerve transposition to in situ decompression for ulnar neuropathy at the elbow, nerve conduction studies (NCS) including the Kimura inching method were performed preoperatively in an effort to ensure that all potential sites of compression were investigated intraoperatively. The purpose of this study is to compare the results of the Kimura inching technique with the intraoperative findings noted during decompression of the ulnar nerve at the elbow.

Methods: The medical records of consecutive patients who underwent in situ decompression of their ulnar nerves combined with endoscopic examination between March and December of 2009 were retrospectively reviewed.

Bacteriophage therapy for Staphylococcus aureus biofilm-infected wounds: a new approach to chronic wound care.

Background: Bacterial biofilms, which are critical mediators of chronic wounds, remain difficult to treat with traditional methods. Bacteriophage therapy against biofilm has not been rigorously studied in vivo. The authors evaluate the efficacy of a species-specific bacteriophage against Staphylococcus aureus biofilm-infected wounds using a validated, quantitative, rabbit ear model.

Intrafascicular stimulation of monkey arm nerves evokes coordinated grasp and sensory responses.

High-count microelectrode arrays implanted in peripheral nerves could restore motor function after spinal cord injury or sensory function after limb loss. In this study, we implanted Utah Slanted Electrode Arrays (USEAs) intrafascicularly at the elbow or shoulder in arm nerves of rhesus monkeys (n = 4) under isoflurane anesthesia. Input-output curves indicated that pulse-width-modulated single-electrode stimulation in each arm nerve could recruit single muscles with little or no recruitment of other muscles.

Targeted reinnervation in the transfemoral amputee: a preliminary study of surgical technique.

Background: Lower limb amputation is a common and growing problem in the United States. Current prosthetic technology is insufficient for transfemoral amputees to safely control their prostheses for demanding exercise such as stair climbing. Using a technique called targeted reinnervation, intuitive control of prosthetic devices has been achieved for upper limb amputees.

Limb transplantation and targeted reinnervation: a practical comparison.

Limb transplantation and targeted reinnervation are complimentary but very different approaches for restoring function to an upper limb amputee. This article reviews the advantages and limitations of both of these procedures, and highlights the reconstructive obstacles in the treatment of upper limb amputees.

Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique.

Objective: To assess the effect of components separation on abdominal volume and pulmonary function after repair of hernias with loss of domain.

Summary Of Background Data: Immediate postoperative abdominal compartment syndrome is a feared complication after hernia repair in patients with a "loss of abdominal domain." Replacement of the viscera within an unyielding stiff abdominal wall may compromise the perfusion of the intestines, elevate the diaphragm, and interfere with ventilation.

Technical use of synthetic conduits for nerve repair.

A review of the technique used for conduit repair of short peripheral nerve gaps.

A simple test: please draw the incision. It is not as easy as we may think.

Purpose: Book knowledge and preparation is important to the education of a surgeon. The ability of a trainee to apply book knowledge to the actual performance of a procedure is perhaps underestimated by experienced surgeons, as is the role of the teacher in the translation of this information in the operating theater. The purpose of this study is to reveal some of the obstacles in surgical training and to underscore the importance of attending surgeon guidance in overcoming these hurdles.