Exploring New Frontiers of Microsurgery

Surgeon level of expertise reported in Journal of Hand Surgery (American Volume) and (European Volume) publications

The purpose of the study was to evaluate the trend in documentation of surgeon level of expertise among the Journal of Hand Surgery (American Volume) and the Journal of Hand Surgery (European Volume) publications. A review of Journal of Hand Surgery (American Volume) and Journal of Hand Surgery (European Volume) databases for level of expertise between January 2015 and October 2019 was performed. Of 1042 articles identified, all 115 (20%) reporting level of expertise were published in Journal of Hand Surgery (European Volume). Since 2015, there has been an increase in reported level of expertise in Journal of Hand Surgery (European Volume) (2015: 8 (7%); 2016: 15 (13%); 2017: 22 (19%); 2018: 28 (24%); 2019: 42 (37%)). In the same period, no publications have reported level of expertise in Journal of Hand Surgery (American Volume). Documenting level of expertise may provide readers with additional information for incorporation of novel techniques into their practices. It may identify procedures that require a baseline level of expertise for effective performance. Further evaluation of level of expertise criteria may improve the reliability of the numeric scale, while widespread adoption of this scale will allow future outcome analysis by level of expertise.

Vascularized flap transfer to fingers with volar digital veins as recipient vessels

Traditionally free vascularized flap transfers to the fingers connect to the proper digital artery and dorsal veins. We report our experience using the volar digital veins as recipient veins for free vascularized flap transfers in 14 fingers of 12 patients. One or two veins (three flaps with two veins, 11 flaps with one vein) of the flap were anastomosed to volar digital veins in the recipient site. The arteries of these flaps were connected to the proper digital arteries. All the transferred flaps survived. No vessel crisis occurred. Our patients demonstrated that volar veins can be the recipient veins for free flap transfers in the fingers without increased risk of venous crisis and flap loss. Level of evidence: IV.

Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap

OBJECTIVE

In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases.

PATIENTS AND METHODS

From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24-33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap.

RESULTS

All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16-163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200-230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet.

CONCLUSIONS

The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.

Microsurgical Flaps in Repair and Reconstruction of the Hand

The authors' strategy for soft-tissue coverage of the hand is presented. The concept of replacing like with like and reconstruction with similar adjacent tissue enhances functional and aesthetic outcomes. In this viewpoint, the pedicle perforator flap is an ideal flap. A decision-making algorithm to select an ideal flap for a particular hand defect is challenging, requiring experiential consideration of functional outcome, appearance, donor-site morbidity, and patient satisfaction. To assist surgeons in determining the most appropriate flap with more evidence, studies are necessary to compare the outcomes of each flap by evaluating hand function, aesthetics, donor site morbidity, and patient satisfaction.

Technical Points of 5 Free Vascularized Flaps for the Hand Repairs

In this article, we present the experiences from Chinese microsurgeons on 5 less commonly used free vascularized flaps in hand reconstruction. In many units in China, these flaps have become the mainstays of treatment; they are routinely used for fingertip and thumb reconstruction. Their combined experience has demonstrated the reliability and versatility of these flaps for hand reconstruction, as well as their cosmetic value.