Bercu C, Rosner B, Korah H
… +2 more, Thomas W, Berger A
J Hand Microsurg
· 2025 May · PMID 40224953
·
Full text
PURPOSE: Index finger pollicization is a surgical technique used for Blauth Types IIIB and IV thumb hypoplasia reconstruction. Traditionally, index finger pollicization techniques have not addressed management of the rud...PURPOSE: Index finger pollicization is a surgical technique used for Blauth Types IIIB and IV thumb hypoplasia reconstruction. Traditionally, index finger pollicization techniques have not addressed management of the rudimentary thumb/pouce flottant; with no improvements made to the thenar eminence, it often remains flat and hypoplastic. This case series aims to contribute to the body of literature supporting the technique of index finger pollicization with use of the pouce flottant to create a vascularized adipofascial flap for reconstruction of the thenar eminence. METHODS: From 2018 to 2024, a single surgeon performed a modified index finger pollicization technique on seven patients with Blauth Type IIIB and IV thumb hypoplasia. The skin incision technique incorporates the vascular pedicle to the pouce flottant to allow for creation of a vascularized adipofascial flap. This approach utilizes the soft tissue components of the remnant thumb to reconstruct the thenar eminence with a filet flap derived from portions of the typically discarded hypoplastic thumb. Cosmetic and functional outcomes were evaluated by the surgeon, the occupational therapist and the patients' parents. Functional outcomes assessed include evaluation of thumb opposition, stability, and pinch. RESULTS: The use of an adipofascial flap from the rudimentary thumb provided sufficient bulk to improve the appearance of the thenar eminence and hand without complications. All patients achieved satisfactory cosmetic results. All the parents were satisfied with the appearance of the hand. Two patients initially showed disfavor to utilizing the newly created thumb and restraint therapy was successfully employed to encourage use of the new thumb. The thenar eminence was maintained at latest follow-up for all patients. At one-year follow-up, all seven patients demonstrated opposition, strong pinch, flexion, and extension with continued satisfactory cosmetic results. CONCLUSION: For patients with Type IIIB and IV thumb hypoplasia, soft tissue components of the remnant thumb/pouce flottant can be used as an adipofascial flap to improve the cosmetic result of pollicization. All patients demonstrated satisfactory functional and cosmetic results with improved appearance of the thenar eminence. The technique was reproducible, suggesting its implementation should be incorporated into standard practice for treatment of Types IIIB and IV thumb hypoplasia.
Esmaeil A, Al-Naseem AO, Lari A
… +1 more, Prada C
J Hand Microsurg
· 2025 May · PMID 40182737
·
Full text
BACKGROUND: Fingertip amputations can be managed using a number of surgical and nonsurgical techniques including semi-occlusive dressings. AIM: The aim of this systematic review is to assess the efficacy and safety of se...BACKGROUND: Fingertip amputations can be managed using a number of surgical and nonsurgical techniques including semi-occlusive dressings. AIM: The aim of this systematic review is to assess the efficacy and safety of semi-occlusive dressings for fingertip amputations. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The following databases were searched: Medline, Embase and CINAHL. The primary outcomes included healing rate and time to epithelialization. Secondary outcomes included patient satisfaction, finger range of motion (ROM), patient reported outcome measures (PROMs), fingertip sensitivity, need for surgical intervention and complications. RESULTS: A total of 15 studies met the inclusion criteria with a total of 611 fingertip amputations. The mean overall healing rate was 97.4 % and the mean time to complete epithelialization was 30 days. Ninety three percent of patients achieved full ROM. A 96.5 % of patients reported being either satisfied or very satisfied with their outcome. Mean time to return to work was 22.3 days. Complications were reported in 31 % of patients, most of which were considered minor. Only 1.5 % of patients required surgical intervention. CONCLUSION: Semi-occlusive dressing therapy is a safe and effective treatment modality for patients with fingertip amputations without bone exposure. Further comparative studies are needed to outline the role and protocols of semi-occlusive dressings in fingertip amputations.
J Hand Microsurg
· 2025 May · PMID 40182736
·
Full text
Functionally, the thumb is the most important digit of the hand, allowing for numerous precise movements used in daily life. The thumb is a key factor in our ability to have a prehensile hand, the cornerstone of human ev...Functionally, the thumb is the most important digit of the hand, allowing for numerous precise movements used in daily life. The thumb is a key factor in our ability to have a prehensile hand, the cornerstone of human evolution. The prehensile hand provides a variety of fine movements allowing for grasp, pinch, and the manipulation of objects. However, children with congenital anomaly of the hand, specifically thumb hypoplasia, have suboptimal thumb functioning. Depending on the severity of thumb hypoplasia, children may have hypoplastic or absent structures and joint instability. Many surgeons, including our practice, opt for early intervention to reconstruct the prehensile hand prior to developmental thumb use. Treatment of mild hypoplasia (types IIa, IIb, and IIIa) focuses on restoring thumb function and prehension, deepening the thumb-index webspace, and stabilizing the metacarpophalangeal joint. Herein we focus on our approach to creating a prehensile hand whilst specifically utilizing the abductor digiti minimi transfer.
J Hand Microsurg
· 2025 May · PMID 40182735
·
Full text
In Germany and other European countries, pollicization is still indicated for thumb hypoplasia Manske type IIIB, IV and V. The one-stage procedure is well established and only the details have been refined over the years...In Germany and other European countries, pollicization is still indicated for thumb hypoplasia Manske type IIIB, IV and V. The one-stage procedure is well established and only the details have been refined over the years. In experienced hands, it is a safe operation with few complications. European surgeons focus on overall function combined with the best possible appearance when treating congenital malformations. With pollicization, we can create a thumb that looks and works like a thumb, that can spread, pinch and grasp objects. The function of a Manske type IV with pollicization is better than that of a thumb reconstruction. The European centres for congenital malformations prefer pollicization of the index finger for Manske type IIIB due to good function, growth and having experienced disappointing results after reconstruction with an avascular toe phalanx transfer. The benefit of the complex reconstruction technique with a vascularized hemimetatarsal has not yet been demonstrated. For a fair comparison, we need more data on adult patients with a long follow-up and using the same evaluation scores to determine the correlation between function, appearance, and health-related quality of life in both techniques.
Hill JR, Jackson GR, To W
… +3 more, Zmistowski B, Movassaghi A, Sabesan VJ
J Hand Microsurg
· 2025 May · PMID 40170673
·
Full text
UNLABELLED: The volume of shoulder arthroplasty (SA) procedures has increased significantly in recent years, outpacing the growth of hip and knee arthroplasty. As a relatively young area in orthopedics, shoulder arthropl...UNLABELLED: The volume of shoulder arthroplasty (SA) procedures has increased significantly in recent years, outpacing the growth of hip and knee arthroplasty. As a relatively young area in orthopedics, shoulder arthroplasty offers many opportunities for innovation, often borrowing from established practices in other subspecialties. Degenerative shoulder pathology presents unique challenges that can be difficult to adequately address with conventional reconstructive methods alone. Currently, three-dimensional preoperative planning is the most widely utilized technology in shoulder arthroplasty. Implementation of patient-specific instrumentation is increasing, primarily for patients with severe deformity. Computer-assisted navigation, widely used in hip and knee reconstruction, is gaining traction. These technologies have demonstrated increased accuracy and precision in correcting glenoid deformity and implant positioning, which are known to influence the long-term performance of SA. However, studies specifically evaluating the long-term clinical benefits of these innovations are lacking. In the near future, the application of robotic and immersive technologies like augmented reality for SA demonstrates promise for enhancing the surgeon's ability to address glenoid deformity intraoperatively. These advancements provide exciting opportunities to transform the field of shoulder arthroplasty, yet they must be critically evaluated for their cost and impact to outcomes clinical cohorts with long-term follow-up. LEVEL OF EVIDENCE: Level V; Narrative Review.
Manes T, Hedbany D, Patel H
… +5 more, Okoro S, Anderson M, Gupta N, Turnow M, Beutel BG
J Hand Microsurg
· 2025 May · PMID 40124739
·
Full text
PURPOSE: Osteoarthritis (OA) of the first carpometacarpal (CMC) joint, or basilar thumb arthritis, is the most common symptomatic hand arthritis, leading to significant healthcare costs. This study analyzed trends in man...PURPOSE: Osteoarthritis (OA) of the first carpometacarpal (CMC) joint, or basilar thumb arthritis, is the most common symptomatic hand arthritis, leading to significant healthcare costs. This study analyzed trends in managing basilar thumb arthritis and determined approaches linked to favorable outcomes to guide future treatments. METHODS: This retrospective cohort study queried the TriNetX United States Collaborative Network from 2013 to 2023. Patients with primary OA of the first CMC joint were identified using International Classification of Diseases-10 codes, and surgical interventions were classified using Current Procedural Terminology codes. Patients were stratified by surgical status and age groups (18-59 years and 60 years or older). Baseline demographic characteristics, risk factors, and mortality rates were compared between surgical and non-surgical cohorts. The incidence and prevalence of surgical interventions for basilar thumb arthritis were also determined. RESULTS: The study included 213,881 patients with primary basilar thumb arthritis (12,923 in the operative group and 195,820 in the non-operative cohort). Obesity (BMI 30-39), nicotine dependence, and Type 2 diabetes mellitus were more prevalent in the operative group (p < 0.01). The non-operative cohort had a lower average BMI (20-29, p = 0.04). Surgery incidence rose from 0.13 % in 2013 to 1.13 % by 2023, while prevalence increased from 0.45 % to 5.93 %. The matched odds ratios were 0.652 for 1-year, 0.763 for 3-year, and 0.818 for 5-year mortality. CONCLUSIONS: Management of basilar thumb arthritis is shifting towards more surgical interventions. Identifying optimal patient profiles for surgery will refine management strategies for this condition.
Karuppiah Kumar K, Chandy T, Prasad K
… +1 more, Ganesh T
J Hand Microsurg
· 2025 May · PMID 40098771
·
Full text
BACKGROUND: Elbow flexion restoration is one of the most important objectives of brachial plexus surgery in upper root injuries. Many authors have shown very good results with double fascicular nerve transfers and it has...BACKGROUND: Elbow flexion restoration is one of the most important objectives of brachial plexus surgery in upper root injuries. Many authors have shown very good results with double fascicular nerve transfers and it has become the mainstay of nerve transfers for elbow flexion restoration. We present the results of a modified version of this double fascicular transfer. METHODS: A retrospective study of 32 patients who underwent the modified double fascicular nerve transfer(i.e median n to n to biceps and ulnar n to n to brachialis) was done. The average duration for delay in surgery from the time of injury was 5.6 months. The average age of the patients was 35.84. The average follow up of the patients was 39.3months. RESULTS: All patients had M0 or M1 power preoperatively. Eight patients had M3 power and 22 patients had M4 or M4+ power post operatively. Two patients did not recover meaningful elbow flexion. The results were similar to the original double fascicular nerve transfer for elbow flexion. CONCLUSION: The modified version of the double fascicular nerve transfer is as reliable and produces similar results to the original double fascicular transfer. The theoretical advantages include the ease of doing the operation - (i) The n to biceps and median n are closer. (ii) The length of the n to brachialis allows it to be swung across the arm to reach the more posterior and medial ulnar nerve.
De Francesco F, Marzella L, De Vitis R
… +3 more, Lazzerini A, Caruso G, Riccio M
J Hand Microsurg
· 2025 May · PMID 40051826
·
Full text
Anatomy is vital for integrating basic science with clinical practice, particularly for surgeons specializing in hand, orthopedic, and plastic surgery. Traditional teaching methods often lack the hands-on experience need...Anatomy is vital for integrating basic science with clinical practice, particularly for surgeons specializing in hand, orthopedic, and plastic surgery. Traditional teaching methods often lack the hands-on experience needed for a thorough understanding. To address this issue, the Italian Society of Hand Surgery (SICM) designed a course focused on cadaveric dissection aimed at enhancing anatomical knowledge and surgical skills. This study assessed the perceptions and knowledge gains of medical residents and specialists in a 4-day intensive course, which included 21 h of dissections, 9 h of video demonstrations, and 4 h of lectures. Participants were evaluated through pre- and post-course exams and a survey using a five-point Likert scale. Out of 280 participants, post-course scores improved significantly (mean increase of 11.14 points, p < 0.00001), with 85 % finding the practical dissection approach most effective. The course was particularly beneficial for those with lower initial scores, indicating the need for tailored instruction for varying specialties.
El Sewify O, Datta S, Legler J
… +3 more, Sylvain M, Cheah A, Efanov JI
J Hand Microsurg
· 2025 May · PMID 40034242
·
Full text
Nonsurgical therapeutic approaches for thumb carpometacarpal (CMC) osteoarthritis (OA) often offer only inconsistent symptom relief and fail to restore hand function. Intra-articular platelet-rich plasma (PRP) injections...Nonsurgical therapeutic approaches for thumb carpometacarpal (CMC) osteoarthritis (OA) often offer only inconsistent symptom relief and fail to restore hand function. Intra-articular platelet-rich plasma (PRP) injections have recently emerged as a promising alternative, with encouraging outcomes in knees and hips. This systematic review and meta-analysis aims to highlight the safety and efficacy of PRP injections in thumb CMC OA. A systematic review was completed using Medline, Embase, and Cochrane. Primary outcomes focused on patients with basal thumb osteoarthritis treated with intra-articular PRP injections. Patient characteristics, product administration, functional outcomes and complications were analyzed as means of central tendency. A meta-analysis was performed focusing on pain relief and improvement in hand function. Seven articles were included, comprising 115 patients with an average age of 62.6 years, predominantly female (67.0 %). Patients received an average of 1.4 PRP injections per joint, with an average follow-up of 14.1 months. Control groups were administered corticosteroids, normal saline, and hyaluronic acid. All PRP-treated patients resumed their prior activities of daily living with a satisfaction rate at 73.7 % (n = 76). Statistically significant pain reduction (n = 98) and improvement in pinch strength were reported, while no statistically significant improvement in grip strength was observed (n = 39). No adverse events occurred, with only one complication (a palmar wrist ganglion) reported. Intra-articular PRP injections in thumb CMC OA yields favorable outcomes for pain relief and hand function without major complications. However, procedural and data heterogeneity affect reliability. Further randomized controlled trials comparing PRP and cortisone injections are needed.
Baba PUF, Kulkarni OS, Rasool A
… +9 more, Mir M, Rashid Zargar H, Mir Y, Ahmad Shah R, Jayapalan E, Gundavarappu A, Khurshid J, Bashir Sheikh A, Hafeez Wani A
J Hand Microsurg
· 2025 May · PMID 40034241
·
Full text
J Hand Microsurg
· 2025 May · PMID 40027888
·
Full text
Fasciectomy is a surgical procedure frequently used for the treatment of Dupuytren's disease. The WALANT (Wide-Awake Local Anesthesia No-Tourniquet) anesthesia technique has gained popularity for its advantages over gene...Fasciectomy is a surgical procedure frequently used for the treatment of Dupuytren's disease. The WALANT (Wide-Awake Local Anesthesia No-Tourniquet) anesthesia technique has gained popularity for its advantages over general anesthesia, such as risk reduction and cost savings. However, one of the main challenges is pain management and anesthetic efficacy during surgery. This study aims to evaluate the feasibility of this technique in pain management, patient experience, and cost savings in surgery for Dupuytren's disease. Prospective study that included patients treated surgically for Dupuytren's disease under WALANT anesthesia. Clinical history, number of affected fingers, and joint contracture were recorded, classifying them according to Tubiana. Anesthesia consisted of a mixture of 20 ml of 2 % lidocaine with epinephrine, 20 ml of 0.5 % bupivacaine, and 40 ml of saline solution, administered by ulnar nerve block and over the area of the cord to be resected, without using a hemostatic cuff. Variables such as pain during infiltration and surgical procedure, anxiety, surgery time, postoperative range of motion, and incidence of complications and recurrences were evaluated. The data were analyzed using descriptive methods and statistical analysis. 17 patients were prospectively evaluated. 64.7 % of patients managed to recover a full range of motion in the first four postoperative weeks, while 35.2 % had a partial range. Immediate complications were minimal, with only 5.8 % of patients developing local infections or minor hematomas, successfully resolved with conservative treatment. The recurrence rate was 11.7 % at six months. A cost analysis showed that the use of WALANT resulted in a cost saving of 60.6 % compared to general or regional anesthesia, making the technique an attractive option in healthcare systems with limited resources. The study reveals that the WALANT anesthetic technique for surgery for Dupuytren's disease provides effective pain management both during the injection and during the surgical procedure. This technique facilitates a relatively quick and comfortable recovery, offering an overall positive experience for patients. results suggest that WALANT may be an effective and precise option for the surgical procedure in Dupuytren's disease, with advantages in terms of pain control, cost savings, and favorable postoperative outcomes. Furthermore, it allows surgeons and patients to obtain immediate feedback on the dynamic outcome of cord release, which may improve subsequent dissection and rehabilitation.
Unadkat KD, Abdulwadood I, Hiredesai AN
… +3 more, Howlett CP, Geldmaker LE, Noland SS
J Hand Microsurg
· 2025 May · PMID 40007763
·
Full text
BACKGROUND: With advancements in artificial intelligence, patients increasingly turn to generative AI models like ChatGPT for medical advice. This study explores the utility of ChatGPT 4.0 (GPT-4.0), the most recent vers...BACKGROUND: With advancements in artificial intelligence, patients increasingly turn to generative AI models like ChatGPT for medical advice. This study explores the utility of ChatGPT 4.0 (GPT-4.0), the most recent version of ChatGPT, as an interim diagnostician for common hand conditions. Secondarily, the study evaluates the terminology GPT-4.0 associates with each condition by assessing its ability to generate condition-specific questions from a patient's perspective. METHODS: Five common hand conditions were identified: trigger finger (TF), Dupuytren's Contracture (DC), carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DQT), and thumb carpometacarpal osteoarthritis (CMC). GPT-4.0 was queried with author-generated questions. The frequency of correct diagnoses, differential diagnoses, and recommendations were recorded. Chi-squared and pairwise Fisher's exact tests were used to compare response accuracy between conditions. GPT-4.0 was prompted to produce its own questions. Common terms in responses were recorded. RESULTS: GPT-4.0's diagnostic accuracy significantly differed between conditions (p < 0.005). While GPT-4.0 diagnosed CTS, TF, DQT, and DC with >95 % accuracy, 60 % (n = 15) of CMC queries were correctly diagnosed. Additionally, there were significant differences in providing of differential diagnoses (p < 0.005), diagnostic tests (p < 0.005), and risk factors (p < 0.05). GPT-4.0 recommended visiting a healthcare provider for 97 % (n = 121) of the questions. Analysis of ChatGPT-generated questions showed four of the ten most used terms were shared between DQT and CMC. CONCLUSIONS: The results suggest that GPT-4.0 has potential preliminary diagnostic utility. Future studies should further investigate factors that improve or worsen AI's diagnostic power and consider the implications of patient utilization.
J Hand Microsurg
· 2025 Mar · PMID 39944599
·
Full text
INTRODUCTION: Nail-bed grafting is an accepted treatment for nail-bed defects of the fingernail. This study summarizes and analyses recent data on the outcomes associated with nail-bed grafting for nail-bed injuries at v...INTRODUCTION: Nail-bed grafting is an accepted treatment for nail-bed defects of the fingernail. This study summarizes and analyses recent data on the outcomes associated with nail-bed grafting for nail-bed injuries at varying degrees of severity. MATERIALS AND METHODS: A literature search was conducted in the electronic databases(PubMed, MEDINE, EMBASE, SCOPUS) to extract articles published from March 1985 to March 2023. Studies reporting data on nail-bed injury treated with full or split thickness nail-bed grafting was included in the study. Extracted data consisted of demographic data, surgical technique, follow-up, outcomes and complications. RESULTS: A total of 107 articles were identified, of which 6 studies were eligible for final inclusion comprising a total of 84 patients. The average age of patients was 28.87 years. The mean length of follow-up was 17 months. 2 studies reported excellent outcome in 12 patients as per Zook's criteria. The first nail appeared 3 weeks to 4 months after the surgery. 4 studies mentioned use of nail splint after the surgery reflecting the current practice trends. No major complications were reported in the studies. CONCLUSION: Nail-bed grafting can be a safe, effective technique for the treatment of nail-bed injuries in immediate and delayed setting. Results of nail-bed grafting indicate satisfactory outcome in carefully selected cohort of nail-bed injury patients.LEVEL OF EVIDENCE.V.
Chaturvedi G, Singh A, Prakash Rao Cheruvu V
… +3 more, Gupta AK, Khan MM, Suhag K
J Hand Microsurg
· 2025 Mar · PMID 39944598
·
Full text
AIM: The study aimed to evaluate the effectiveness of the interrupted horizontal micro mattress suturing technique in anastomosing size-mismatched vessels during free flap surgeries. MATERIAL & METHOD: The study included...AIM: The study aimed to evaluate the effectiveness of the interrupted horizontal micro mattress suturing technique in anastomosing size-mismatched vessels during free flap surgeries. MATERIAL & METHOD: The study included patients who underwent free flap surgery and encountered size disparities in vessels intraoperatively. The technique was applied to 24 patients with 28 mismatched blood vessels. Interrupted horizontal micro-mattress sutures were utilized to adjust the diameter mismatch between incongruent vessels. Each suture aimed to reduce the diameter of the larger vessel in comparison to the smaller vessel. RESULTS: During free flap surgeries, the technique was successfully applied across various body regions, from head to toe. Out of the 28 vessels where anastomosis was performed using this technique, two patients experienced thrombosis. This technique enabled anastomosis of vessels with a size mismatched ratio up to 2:1. CONCLUSION: The interrupted micro mattress suturing technique proves to be a straightforward, secure, and dependable for addressing vessel size discrepancy up to 2:1. An additional benefit of this technique is its ability to circumvent the need for end-to-side repair, enhancing its utility in eversion of margins of repaired blood vessels and practicality in free flap surgeries.
Delgado F, Príncipe F, Alfie VA
… +5 more, Abrego MO, Holc F, Bronenberg Victoria P, Boretto JG, Rellan I
J Hand Microsurg
· 2025 Mar · PMID 39895906
·
Full text
PURPOSE: To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a convention...PURPOSE: To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a conventional operating room (OR) with sedation. Additionally, we aimed to assess the anesthetic preferences of the Argentine Association of Hand and Upper Limb Reconstructive Surgery (AACM) members regarding CTR. MATERIAL AND METHODS: This cross-sectional, single-center study involved analyzing specific hospital costs associated with each anesthesia technique in both surgical settings. A report was obtained from the OR chief of our institution. Additionally, an anonymous survey was conducted among certified and main AACM members, gathering data on: (1) practice location, (2) preferred anesthesia type for CTR and reasons for not using WALANT/AL-T regularly, (3) years of practice, (4) preferred CTR surgical technique, and (5) willingness to change anesthesia preference if offered differential fees. RESULTS: Performing CTR with WALANT and AL-T in a procedure room resulted in cost savings of 64 % and 65 %, respectively, compared to sedation in a conventional OR. The average duration for CTR, including cleaning and turnover time, was 34 min (±3) for WALANT, 33 min (±4) for AL-T, and 55 min (±8) for sedation in a conventional operating room.Out of 226 AACM members, 95 (42 %) responded to the survey. Among them, 42 % practiced in Buenos Aires (CABA), and only 35 % preferred using local anesthesia for CTR (16 % WALANT, 19 % AL-T). Nearly half (49 %) had over 16 years of experience. All respondents favored open or mini-approach techniques for CTR. Those who did not use WALANT or AL-T cited discomfort with patient interaction and perceived lack of benefits as reasons. However, 31 % indicated they would change their anesthesia preference if offered differential fees. CONCLUSIONS: CTR with WALANT or AL-T in a procedure room reduces costs by over 65 % compared to sedation in a conventional OR. Despite cost benefits, sedation remains the predominant practice in Argentina, hindered by a lack of consensus and institutional incentives.