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Boretto JG, Holc F, Victorica PB. The Foot as a Donor Site for Reconstruction in the Hand. Hand Clin 2024; 40:249-258. [PMID: 38553096 DOI: 10.1016/j.hcl.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The foot contains a unique collection of tissue types that can be used in the reconstruction of the hand. Numerous reconstructive options have been presented, some of which have been adopted, such as modifications to procedures that have been described in the past or even newly developed options for hand reconstruction. It is possible to reconstruct missing fingers and other hand structures using tissues taken from the foot rather than removing healthy tissue from a hand that has already been injured. This makes it possible to avoid having healthy tissue removed from an injured hand.
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Affiliation(s)
- Jorge G Boretto
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires.
| | - Fernando Holc
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
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Hsieh YH, Wei HI, Hsu CC, Lin CH. Evolution and Diversity of Medial Sural Artery Perforator Flap for Hand Reconstruction. Hand Clin 2024; 40:209-220. [PMID: 38553092 DOI: 10.1016/j.hcl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The free medial sural artery perforator (MSAP) flap is a recently popularized flap. It has evolved from a composite myocutaneous flap to a pedicled perforator flap for lower limb reconstruction. It is also a versatile free perforator flap for extremity and head and neck reconstruction. The diversity of the flap designs with options for harvest of non-vascularized grafts enhances the versatility for hand and upper limb reconstruction. The adjunctive use of endoscopy and indocyanine green fluorescence imaging studies can assist and demystify the flap anatomy. The authors present their experience using free MSAP flaps for complex mutilated hand and upper extremity reconstruction.
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Affiliation(s)
- Yun-Huan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, St. Vincent Private Hospital, East Melbourne, Australia
| | - Hao-I Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.
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Yassin AM, Mohamed M, Elsir K, Ahmed M. Case report of substantial reconstruction of second ray segment by osteo-tendo-cutaneous pedicled radial forearm flap. Int J Surg Case Rep 2024; 118:109646. [PMID: 38643653 PMCID: PMC11046212 DOI: 10.1016/j.ijscr.2024.109646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction and importance: The hand is one of the most vital organ that the surgeon aims to preserve its function and natural appearance. Gunshot injuries are common, especially in a war zone, and unfortunately, they create complex wounds that are hard to reconstruct and infection is very common. In this article, we report rebuilding segment of index finger with a pedicled osteo-tendo-cutaneous radial forearm flap. Case presentation: A 50-year-old man-African with no past medical comorbidities, sustained trauma to his left index finger by high-velocity injury that led to composite tissue loss including metacarpal and proximal phalanx. After applying the initial irrigation and dressing to the wound, his hand was supported by a volar cast then he was referred to the hospital. The hand was examined at the operation room and the index finger was found to be hanged with a medial skin pedicle with necrotic and exposed bone and tendon. He underwent a session of debridement followed by reconstruction using a pedicled osteo-cutaneous radial forearm flap accompanied with metacarpophalangeal joint arthrodesis. Clinical discussion: A significant number of war-related hand injuries resulted in amputations because there were not enough facilities or doctors. While they are alternatives to free flap, abdominal and regional flaps won't yield the same outcomes. The second ray of the hand is reshaped using a radial flap, producing an acceptable result. Conclusion: The Radial forearm flap was used to reconstruct segment of index finger and fulfill our requirements, which include bone, tendon, and skin cover. Additionally, this is a simple and single stage procedure and micro-surgical equipment is not necessary.
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Affiliation(s)
- Amin M Yassin
- Department of Plastic Surgery, Elnou Hospital, Khartoum, Sudan; Sudan Medical Specialization Board (SMSB), Khartoum, Sudan
| | - Momen Mohamed
- Department of Plastic Surgery, Elnou Hospital, Khartoum, Sudan; Sudan Medical Specialization Board (SMSB), Khartoum, Sudan.
| | - Khalid Elsir
- Department of Plastic Surgery, Elnou Hospital, Khartoum, Sudan
| | - Muhnnad Ahmed
- Department of Plastic Surgery, Elnou Hospital, Khartoum, Sudan
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Sơn TT, Dung PTV, Thúy TTH, Nghĩa PT, Chiến VH. Using Free Chimeric Anterolateral Thigh Flap For Reconstruction Of Composite Dorsal Hand Defect. JPRAS Open 2024; 39:106-113. [PMID: 38186380 PMCID: PMC10767008 DOI: 10.1016/j.jpra.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/18/2023] [Indexed: 01/09/2024] Open
Abstract
Background Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL. Methods Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm2. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically. Results The skin paddle size ranged from 12 to 23 cm in length and 6 to 11 cm in width, and the FL flaps ranged from 3 × 5 to 12 × 5 cm. The mean pedicle length was 7.88 cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3-6 mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction. Conclusion The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.
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Affiliation(s)
- Trần Thiết Sơn
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
- Department of Plastic and Aesthetic Surgery, University of Medicine and Pharmacy, Vietnam National University
| | - Phạm Thị Việt Dung
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
| | - Tạ Thị Hồng Thúy
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
| | - Phan Tuấn Nghĩa
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Vũ Hồng Chiến
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
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Leow MEL, DAS DE S, Puhaindran ME, Chong AKS. Challenges and Solutions in Prosthetic Fitting of Digits after Flap Reconstruction. J Hand Surg Asian Pac Vol 2024; 29:69-74. [PMID: 38299242 DOI: 10.1142/s2424835524720032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Surgical reconstruction can restore length and function, but cannot adequately resolve the problem of disfigurement. Prosthetic fitting can play a complementary role in enhancing the aesthetic outcomes post reconstruction. However, complex reconstruction involving flaps coupled with the surgical imperative for limb length preservation can lead to outcomes where the reconstructed stumps are challenging to fit with prosthesis. This article describes how prosthetic fitting was tackled in a case of a triple-digit amputation after reconstruction that presented with finger stumps that were bulky, long and stiff in extension contracture, compounded by the presence of substantive scar tissues. We discuss major prosthesis modifications that were unconventional but necessary to enable fitting, the techniques involved, as well as the aesthetic and functional considerations behind the modifications. The results showed that enhanced aesthetic appearance, together with a marginal improvement in hand function, was achieved post-prosthetically, meeting the patient's and the clinical team's fitting objective. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Michael E L Leow
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Soumen DAS DE
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Alphonsus K S Chong
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Meirizal, Muhammad H, Guntoro BD, Magetsari R. Neglected bilateral triphalangeal of the thumb delta type in adult case: A case report. Int J Surg Case Rep 2024; 114:109087. [PMID: 38016377 PMCID: PMC10711151 DOI: 10.1016/j.ijscr.2023.109087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION In rare case, thumb has extra phalanges known as triphalangeal of the thumb (TPT). Patients with TPT can have difficulty doing work/activities that require high precision. Therefore, surgical intervention is essential. This report provides an approach for a patient with TPT. PRESENTATION OF CASE A patient with TPT who underwent removal of extra phalanges and arthrodesis of interphalangeal (IP) joints is presented. The left thumb deviated 25o to ulnar while the contralateral part deviated 15o to radial. X-ray revealed both thumbs had extra delta-shaped middle phalanges. Complete excision of extra phalanges and simple arthrodesis of IP joints with two K-wires in 10° to 15° flexion was performed. Healing process ended without any complications and the patient had an improvement. DISCUSSION Productive-age patients with TPT can have difficulty doing work and activities that require high precision, especially in the non-opposable type of the right hand. Furthermore, the female patient is highly emphasizing the cosmetics of her hand to increase her self-confidence. Therefore, surgical intervention is essential for this patient. We performed complete excision of extra phalanges and simple arthrodesis of IP joints with two K-wires in 10° to 20° flexion. The first K-wire is introduced intramedullary as a primary fixator for longitudinal alignment, and the second wire is inserted obliquely as an anti-rotation wire. Functional outcome was assessed after 6 months post-removal of the wire which gave a satisfying result. CONCLUSION TPT is a rare anomaly which surgical intervention can improve the appearance and the precision of the hand.
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Affiliation(s)
- Meirizal
- Dept. of Orthopedic and Traumatology Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Hilmi Muhammad
- Dept. of Orthopedic and Traumatology Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Brahmantyo Danang Guntoro
- Dept. of Orthopedic and Traumatology Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- Dept. of Orthopedic and Traumatology Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Khan M, Hayat W, ullah H, Khan NH. Reconstruction of soft tissue defects of hand: A systematic approach. Pak J Med Sci 2024; 40:36-40. [PMID: 38196456 PMCID: PMC10772424 DOI: 10.12669/pjms.40.1.7484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/09/2023] [Accepted: 08/28/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. Methods This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. Results The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). Conclusion This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.
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Affiliation(s)
- Mansoor Khan
- Mansoor Khan, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Waqas Hayat
- Waqas Hayat, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Hidayat ullah
- Hidayat ullah, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nasir Hayat Khan
- Nasir Hayat Khan, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
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Amadei F, Fozzato S, Prevot LB, Ciccarelli A, Bruno M, Basile G. The posterior interosseus artery flap (piaf) in reconstructive surgery of the hand: strategies of use and medico-legal implications. Clin Ter 2023; 174:498-502. [PMID: 38048112 DOI: 10.7417/ct.2023.5016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background and aim The fascio-cutaneous posterior interosseus artery flap (PIAF) is used in hand reconstruction, especially to repair skin or tissue defects such as burn injuries, open fractures, gunshot wounds or traumatic amputations. The aim of this study is to examine the anatomical features of this flap, to describe the surgical harvesting technique and the difficulties associated with the dissection. Methods From January 2016 to January 2022, we performed PIAF in 10 patients (3 women and 7 men) with a mean age of 28 years (range 22-44). This flap is taken from the back of the forearm, between the extensor carpi ulnaris (ECU) muscle and the extensor digitorum common (EDC) muscle. Results We analyzed retrospectively our patients indicating the failures of this reconstructive surgery, the complications that have arisen and the results using DASH score with the related clinical and medico-legal implications. Conclusions Due to its location and structure, PIAF is one of the most versatile fascio-cutaneous flaps in upper limb reconstructive surgery and can be used to reconstruct parts of the hand, wrist, or elbow, allowing to restore limb function and improve the quality of life of patients even if there could be some medico-legal implications.
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Affiliation(s)
- F Amadei
- Hand and Peripheral Nerve Center, C.O.F. Lanzo Hospital, Italy
| | - S Fozzato
- Trauma Surgery IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - L B Prevot
- Trauma Surgery IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - A Ciccarelli
- Department of Movement, Human and Health Sciences University of Rome Foro Italico, Rome, Italy
| | - M Bruno
- Consultant Hand Surge-ry Villa Stuart Rome
| | - G Basile
- Trauma Surgery IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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Adani R, Petrella G, Corain M, Pantaleoni F. Shape-modified radial forearm flap: does it still have a role in upper extremity reconstruction? Hand Surg Rehabil 2023; 42:208-213. [PMID: 36907274 DOI: 10.1016/j.hansur.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To carry out a radial forearm flap, the radial artery is usually harvested, incurring severe donor site morbidity. Advances in anatomical knowledge discovered constant radial artery perforating vessels, enabling the subdivision of the flap into smaller components suitable for a wide range of differently shaped recipient sites, with marked reduction of downsides. MATERIAL AND METHODS Eight pedicled or free shape-modified radial forearm flaps were used to reconstruct upper extremity defects between 2014 and 2018. Surgical technique and prognosis were examined. Skin texture and scar quality were assessed on the Vancouver Scar Scale while function and symptoms on the Disabilities of the Arm, Shoulder and Hand score. RESULTS At a mean follow-up of 39 months, no cases of flap necrosis, impaired hand circulation or cold intolerance were found. CONCLUSION The shape-modified radial forearm flap is not a new technique, but is poorly known by hand surgeons; in contrast, our experience showed it to be reliable, with acceptable functional and esthetic outcomes in selected cases.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanna Petrella
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Corain
- Department of Hand Surgery, University of Verona, Verona, Italy
| | - Filippo Pantaleoni
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy.
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Plotsker E, Wolfe EM, Slavin BR, White N, Cook J, Panthaki ZJ. A characterization of home maintenance equipment-related hand and lower arm injuries. J Clin Orthop Trauma 2022; 31:101943. [PMID: 35844978 PMCID: PMC9278494 DOI: 10.1016/j.jcot.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/23/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade. METHODS The National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019. Our analysis grouped patients into 10-year age groups. We defined types of appliances and injuries Chi-square tests were used to compare the most common injury mechanisms by age group. RESULTS Between 2010 and 2019, 30,336 total cases of home workshop equipment-related upper extremity injuries were recorded; 2,574 (8.48%) of these affected females, compared to 27,762 (91.52%) of the cases affecting males. Across all age groups, males were between 6 and 13 more times likely to be injured than females (p < 0.001). Between 2010 and 2019, we recorded a decline in total injuries from 168,795 to 147,584, with a Pearson correlation coefficient of -0.68 (p = 0.031). The appliances most likely to injure those in their 10s through 40s were mechanical tools such as screwdrivers. Meanwhile, those in their 50s through 70s were most likely to be injured by saws. Both amputations and avulsions were found to significantly increase with age (p = 0.038, p = 0.027, respectively). Most injuries result from manual tools and saws. DISCUSSION Males are significantly more likely to incur injuries than females from maintenance equipment, and risk of avulsions and amputations increase significantly with age. This aligns with previous research which also suggested that older saws were most likely to injure older individuals; namely, following new regulations on saws, older adults were more likely to be affected. This is especially worrisome in light of recent research showing that older adults with amputations are less likely to be offered replantations. Overall, these results can continue to guide and optimize community interventions on an epidemiological basis.
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Barret H, Remy H, Piereschi S, Camuzard O. [Medial femoral condyle free flap for reconstruction of carpometacarpal bone defect after giant cell tumour of tendon synovial sheath resection]. ANN CHIR PLAST ESTH 2020; 66:86-92. [PMID: 32854971 DOI: 10.1016/j.anplas.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
We report the case of a 23-year-old patient treated for a large giant cell tumour of the synovial sheaths of the ulnar edge of the hand and wrist invading the triquetrum, the hamatum, the ulnar part of the capitate as well as the bases of the 3rd, 4th and 5th metacarpals and the floor of the Guyon's canal and the carpal tunnel. A monobloc resection was performed in a healthy margin ; the loss of bone substance was 7×3.5cm. We performed a bone reconstruction using a cortico-cancellous medial femoral condyle free flap of 8×4cm. Postoperative follow-up was uneventful and bone consolidation was achieved at 2,5 months postoperatively. The cortico-cancellous medial femoral condyle free flap is an interesting option for treating small and medium size bone loss in the hand and wrist. Its use in its pure bone form or in its chimeric form with muscle, cartilage or skin opens up a wide range of choices for the reconstructive surgeon.
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Affiliation(s)
- H Barret
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - H Remy
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - S Piereschi
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - O Camuzard
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France; Laboratoire d'anatomie humaine, faculté de médecine de Nice, Université Côte d'Azur, 28, avenue de Valombrose, 06107 Nice cedex 2, France.
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Abstract
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. The upper extremity is involved in the majority of severe burn injuries. The purpose of this article is to review upper extremity burn epidemiology, risk factors, prevention strategies, and treatment options in resource-limited settings.
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Affiliation(s)
- Sarah E. Sasor
- Hand Surgery Fellow, Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin C. Chung
- Professor of Surgery, Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Abstract
Secondary surgery following digital replantation and revascularization is common and is often performed to improve range of motion, tendon gliding, sensibility, and/or contour. In this article, the authors present the most common secondary procedures performed after digital replantation or revascularization and discuss current techniques. The importance of patient selection and postoperative compliance with ongoing hand therapy is paramount to achieving good outcomes.
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Abstract
Care of the reconstructed hand following mutilating injury is akin to the care of a vintage car. Its mechanisms are delicate, spare parts are limited, touch-ups are required often, and a major overhaul is indicated rarely. Secondary interventions are indicated for completion of staged primary procedures, management of complications, targeted improvement of function, and enhancement of appearance of the reconstructed hand. The approach to secondary reconstruction depends on the patient's age, and vocational and recreational requirements. It is also influenced by the constant evolution of surgeons' reconstructive philosophy, experience, and technology.
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Affiliation(s)
- Anthony Foo
- Department of Hand & Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Sandeep J Sebastin
- Department of Hand & Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
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Giesen T, Adani R, Carmes S, Dumontier C, Elliot D, Calcagni M. IFSSH scientific committee on skin coverage: 2015 report. Hand Surg Rehabil 2016; 35:307-319. [PMID: 27781975 DOI: 10.1016/j.hansur.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 05/15/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022]
Abstract
Skin coverage in hand reconstruction is a challenging and vast chapter in hand surgery; covering every aspect of it in a report is simply not feasible. Therefore, this report focuses on a few specific topics. The coverage of anatomical regions like the fingertips is common ground for hand surgeons worldwide, but in the last 10 years, various refinements have been published in order to optimize the reconstruction of this organ. Nevertheless, in many emergency departments, the amputation of badly injured fingertips, including the thumb, remains the preferred treatment. The main focus of this report is to counter this tendency by providing alternatives to surgeons. Large defects in the fingers involving more than one segment, defects in the palm and in the dorsum of the hand are currently debated in international meetings. The use of skin substitutes vs. the use of extremely refined microsurgical procedures vs. classic island flaps has generated animated discussions, which are also influenced by cultural and socioeconomic factors around the world. This report offers the views of six surgeons from four different countries, in the hope of animating discussions and suggesting new approaches.
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Affiliation(s)
- T Giesen
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - R Adani
- Department of Hand Surgery, University Hospital of Modena, Modena, Italy
| | - S Carmes
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - C Dumontier
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Abstract
Soft tissue reconstruction of the upper extremity is a complex topic because every defect has multiple potential solutions. Whereas the often-cited reconstructive ladder advised selection of the simplest reconstruction of the defect, the newer concept of the reconstructive elevator allows freedom to choose a more complex reconstruction to account for specialized function and aesthetic outcome. An algorithm for assessment of the defect is presented and demonstrated in this review, using 6 case examples to highlight key concepts. Representative flaps are presented and a discussion of functional and aesthetic outcomes is undertaken to provide a framework for achieving the patient's and surgeon's goals of reconstruction.
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Affiliation(s)
- Erin Anne Miller
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Jeffrey Friedrich
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA.
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17
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Sunil NP, Ahmed F, Jash PK, Gupta M, Suba S. Study on Surgical Management of Post Burn Hand Deformities. J Clin Diagn Res 2015; 9:PC06-10. [PMID: 26435994 PMCID: PMC4576587 DOI: 10.7860/jcdr/2015/13316.6347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/20/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. AIM The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. SETTINGS AND DESIGN It's a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. MATERIALS AND METHODS Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. RESULTS Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. CONCLUSION Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.
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Affiliation(s)
| | - Firdos Ahmed
- Professor and Head of Department, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Prabir Kumar Jash
- Associate Professor, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Madhumita Gupta
- Assistant Professor, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Santanu Suba
- Resident, Department of Plastic Surgery, Medical College, Kolkata, India
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18
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Abstract
BACKGROUND Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand. The purpose of this study is to describe the rationale, indications, methods and outcomes of combined pedicled ALT and groin flap reconstruction of the degloved hand. METHODS Five injuries were treated at this center between 2011 and 2014. Charts were retrospectively reviewed and outcomes evaluated. Four ALT-groin flaps were performed in a single stage for degloving, crush and combined injuries. In one case, partial necrosis of a tight groin flap necessitated secondary ALT coverage at a second stage. RESULTS Flaps survived after division at 4 weeks, and venous congestion was not observed at any point. Debulking, syndactyly release and toe transfer followed reconstruction to enhance outcomes. CONCLUSIONS The combined ALT-groin flap is safe and feasible for the reconstruction of the degloved or mutilated hand when replantation is not an option. It is attractive for familiar donor anatomy, donor-site morbidity and the quantity and composition of the tissue it provides.
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Affiliation(s)
- Jonathan A Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Nai-jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Fu-chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Cheng-hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
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Adani R, Tarallo L, Caccese AF, Delcroix L, Cardin-Langlois E, Innocenti M. Microsurgical soft tissue and bone transfers in complex hand trauma. Clin Plast Surg 2014; 41:361-83. [PMID: 24996459 DOI: 10.1016/j.cps.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Treatment of complex hand trauma includes adequate debridement of nonviable tissue, early reconstruction, and careful selection of various available surgical procedures tailored to patients' needs and requests. Debridement of all necrotic tissue is crucial before any attempt at reconstruction. Surgeons should also consider cosmetic outcomes of the reconstructed hand and donor-site morbidity. For best results reconstruction should be performed early, with proper early postoperative therapy. This article reviews the principles and surgical options in the management of complex hand injuries involving the dorsal and the palmar aspects of the hand, and the different types of tissue in the hand.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37126, Italy.
| | - Luigi Tarallo
- Department of Orthopedic Surgery, University of Modena and Reggio Emilia, Policlinico, Largo del Pozzo 71, Modena 41100, Italy
| | - Armando Fonzone Caccese
- Department of Hand Surgery, Ospedale dei Pellegrini, Via Portamedina alla Pignasecca 41, Naples 80134, Italy
| | - Luca Delcroix
- Department of Plastic and Microsurgery, Careggi University Hospital, Palagi 1, Florence 50139, Italy
| | - Etienne Cardin-Langlois
- Department of Hand Surgery and Microsurgery, University Hospital of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37126, Italy
| | - Marco Innocenti
- Department of Plastic and Microsurgery, Careggi University Hospital, Palagi 1, Florence 50139, Italy
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