Kanghee Lee, Tae-Hee Jo, Woonhyeok Jeong, Junhyung Kim, Daegu Son, Jaehoon Choi
Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.
{"title":"The Use of the Dorsal Metacarpal Artery for Reconstruction of Distal Dorsal Finger Defects: An Anatomic Study and Clinical Experience","authors":"Kanghee Lee, Tae-Hee Jo, Woonhyeok Jeong, Junhyung Kim, Daegu Son, Jaehoon Choi","doi":"10.12790/ahm.21.0128","DOIUrl":"https://doi.org/10.12790/ahm.21.0128","url":null,"abstract":"Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126147264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schwannoma, a benign peripheral nerve tumor, rarely undergoes chronic degenerative changes and progresses to ancient schwannoma. Herein, we report the first case of ulnar nerve-derived multiple ancient schwannomas, which uncommonly developed in the extremities and major nerves. A 76-year-old female patient presented with tingling sensations in her left ring and small fingers. She had a gradually enlarging mass that developed 40 years ago in the proximal upper arm and a new mass growing on the wrist for the past few years. Based on physical examination, ultrasonography, and magnetic resonance imaging, ancient schwannomas of the ulnar nerve were suspected. The older and larger mass of the upper arm was more entangled with nerve fascicles, having necrotic changes. Through meticulous dissection of the nerve fascicles, both masses were successfully enucleated, and pathological examination confirmed ancient schwannoma. As ancient schwannomas grow, they become more entangled with the nerves; thus, early surgical removal is recommended.
{"title":"Multiple Ancient Schwannomas of the Ulnar Nerve at Distant Sites","authors":"Taekeun Yoon, K. Hong","doi":"10.12790/ahm.21.0136","DOIUrl":"https://doi.org/10.12790/ahm.21.0136","url":null,"abstract":"Schwannoma, a benign peripheral nerve tumor, rarely undergoes chronic degenerative changes and progresses to ancient schwannoma. Herein, we report the first case of ulnar nerve-derived multiple ancient schwannomas, which uncommonly developed in the extremities and major nerves. A 76-year-old female patient presented with tingling sensations in her left ring and small fingers. She had a gradually enlarging mass that developed 40 years ago in the proximal upper arm and a new mass growing on the wrist for the past few years. Based on physical examination, ultrasonography, and magnetic resonance imaging, ancient schwannomas of the ulnar nerve were suspected. The older and larger mass of the upper arm was more entangled with nerve fascicles, having necrotic changes. Through meticulous dissection of the nerve fascicles, both masses were successfully enucleated, and pathological examination confirmed ancient schwannoma. As ancient schwannomas grow, they become more entangled with the nerves; thus, early surgical removal is recommended.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116881307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.
目的:局部皮质类固醇注射常规用于一线治疗扳机指。然而，准确地将类固醇注入肌腱鞘对于治疗的有效性和预防并发症是很重要的。本研究旨在介绍我们的类固醇注射技术用于扳机指，该技术利用屈肌腱的肌腱偏移，并评估使用该技术治疗的患者的临床结果。方法:对171例经类固醇注射治疗的扳机指患者进行回顾性分析。观察注射后的疗效及并发症。疗效评价分为“好”、“一般”和“差”。根据手指类型和Quinnell分级系统对结果进行分析。结果:总有效率为83.6%(良好/一般，143位;可怜，28位)。Quinnell IV级治疗成功率为43.8%(7 / 16)，显著低于Quinnell II级和III级治疗成功率分别为88.9%(88 / 99)和87.5% (49 / 56)(II vs. IV, p=0.004;III vs. IV, p=0.010)。四指(不包括拇指)的成功率明显高于拇指(88.2% vs. 75.4%， p=0.048)。结论:经肌腱偏移的类固醇注射技术效果良好，并发症发生率低。特别是，第二到第四指和低级手指显示出更有效的效果。
{"title":"Steroid Injection Using Tendon Excursion for Trigger Finger: Introduction to Injection Methods and Analysis of Treatment Results","authors":"S. Ko, Dong Eun Kim, T. Lee","doi":"10.12790/ahm.21.0134","DOIUrl":"https://doi.org/10.12790/ahm.21.0134","url":null,"abstract":"Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126753992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Seo, Yutaka Dannoura, Rikuto Ishii, Keisuke Tada, Katsumi Horiuchi
Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.
{"title":"Direction Change in Distal Bypass Graft due to Increased Collateral Perfusion after the Free Flap Transfer","authors":"D. Seo, Yutaka Dannoura, Rikuto Ishii, Keisuke Tada, Katsumi Horiuchi","doi":"10.12790/ahm.21.0107","DOIUrl":"https://doi.org/10.12790/ahm.21.0107","url":null,"abstract":"Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"176 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121258831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yong-Gil Jo, Yohan Lee, Joonha Lee, K. J. Bae, M. B. Kim, Y. H. Lee
Purpose: Hamate coronal body fracture is a rare injury and often associated with dislocation of the carpometacarpal joint. For preserving the carpometacarpal joint, open reduction and rigid internal fixation is needed to displaced fracture. The purpose of this study was to evaluate the outcome of treating hamate coronal fracture with the screw fixation method through a temporary Kirschner wire (K-wire) fixation hole.Methods: From August 2016 to January 2021, eight patients who had displaced coronal hamate body fractures were enrolled. All patients were performed open reduction and multiple K-wires fixations. After that, the cortical screws were then inserted directly into the holes made by removing the K-wires one by one. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue scale (VAS) scores.Results: The average follow-up period was 11.5 months (range, 5–8 months) after surgery, and the bone union was observed at the 8 weeks after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that the average DASH score was 3.95 (range, 0–8.3) and VAS score was 0.8 (range, 0–3).Conclusion: In coronal hamate body fractures, open reduction and screw fixation method through temporary K-wire fixation hole is simple and effective treatment technique.
{"title":"Screw Fixation Method through Temporary Kirschner Wire Hole for Coronal Hamate Fracture","authors":"Yong-Gil Jo, Yohan Lee, Joonha Lee, K. J. Bae, M. B. Kim, Y. H. Lee","doi":"10.12790/ahm.21.0121","DOIUrl":"https://doi.org/10.12790/ahm.21.0121","url":null,"abstract":"Purpose: Hamate coronal body fracture is a rare injury and often associated with dislocation of the carpometacarpal joint. For preserving the carpometacarpal joint, open reduction and rigid internal fixation is needed to displaced fracture. The purpose of this study was to evaluate the outcome of treating hamate coronal fracture with the screw fixation method through a temporary Kirschner wire (K-wire) fixation hole.Methods: From August 2016 to January 2021, eight patients who had displaced coronal hamate body fractures were enrolled. All patients were performed open reduction and multiple K-wires fixations. After that, the cortical screws were then inserted directly into the holes made by removing the K-wires one by one. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue scale (VAS) scores.Results: The average follow-up period was 11.5 months (range, 5–8 months) after surgery, and the bone union was observed at the 8 weeks after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that the average DASH score was 3.95 (range, 0–8.3) and VAS score was 0.8 (range, 0–3).Conclusion: In coronal hamate body fractures, open reduction and screw fixation method through temporary K-wire fixation hole is simple and effective treatment technique.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124665615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dongkeun Jun, Mi-Rae Jeong, D. Shin, H. Choi, Jeenam Kim, Myungchul Lee
Purpose: Proximal phalangeal bone fractures with displacement are treated using operative procedures. These fractures can cause stiffness of the interphalangeal or metacarpophalangeal joints, which can be relieved using various operative and nonoperative techniques. This study analyzed the range of motion (ROM) and pain after a combination therapy to treat finger stiffness following proximal phalangeal fractures.Methods: Fifty-two patients who underwent operative procedures for proximal phalangeal fractures and showed finger stiffness from March 2015 to January 2021 were included in this retrospective study. The patients in group 1 (n=24) performed elastic resistance exercises, while those in group 2 (n=28) underwent conventional exercise. ROM and pain score were measured at 5, 8, and 12 weeks postoperatively. Furthermore, a patient with a swan-neck deformity and intractable stiffness was treated using partial translocation of the extensor apparatus, and the postoperative outcome is presented.Results: Group 1 showed a larger ROM and less pain than group 2 at 12 weeks postoperatively (p<0.05). Patients in both groups exhibited notable improvements with regard to ROM and pain during the study period (p<0.05). In addition, the swan-neck deformity accompanying hyperextension of the proximal interphalangeal joint was significantly relieved.Conclusion: Proximal phalangeal bone fractures can lead to stiffness of the interphalangeal and metacarpophalangeal joints. Joint stiffness was relieved using an elastic resistance exercise protocol in the early postoperative period. Intractable stiffness showing a fixed joint angle can be treated with thorough tenolysis and corrective surgery.
{"title":"Treatment of Phalangeal Joint Stiffness Related to Proximal Phalangeal Bone Fractures: Therapeutic Effects on the Range of Motion and Finger Pain","authors":"Dongkeun Jun, Mi-Rae Jeong, D. Shin, H. Choi, Jeenam Kim, Myungchul Lee","doi":"10.12790/ahm.21.0123","DOIUrl":"https://doi.org/10.12790/ahm.21.0123","url":null,"abstract":"Purpose: Proximal phalangeal bone fractures with displacement are treated using operative procedures. These fractures can cause stiffness of the interphalangeal or metacarpophalangeal joints, which can be relieved using various operative and nonoperative techniques. This study analyzed the range of motion (ROM) and pain after a combination therapy to treat finger stiffness following proximal phalangeal fractures.Methods: Fifty-two patients who underwent operative procedures for proximal phalangeal fractures and showed finger stiffness from March 2015 to January 2021 were included in this retrospective study. The patients in group 1 (n=24) performed elastic resistance exercises, while those in group 2 (n=28) underwent conventional exercise. ROM and pain score were measured at 5, 8, and 12 weeks postoperatively. Furthermore, a patient with a swan-neck deformity and intractable stiffness was treated using partial translocation of the extensor apparatus, and the postoperative outcome is presented.Results: Group 1 showed a larger ROM and less pain than group 2 at 12 weeks postoperatively (p<0.05). Patients in both groups exhibited notable improvements with regard to ROM and pain during the study period (p<0.05). In addition, the swan-neck deformity accompanying hyperextension of the proximal interphalangeal joint was significantly relieved.Conclusion: Proximal phalangeal bone fractures can lead to stiffness of the interphalangeal and metacarpophalangeal joints. Joint stiffness was relieved using an elastic resistance exercise protocol in the early postoperative period. Intractable stiffness showing a fixed joint angle can be treated with thorough tenolysis and corrective surgery.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127131422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Lee, Cheon Ho Song, Jin Soo Kim, S. Koh, Dong Chul Lee, S. Roh, Jung Hyun Park
Purpose: The indications for surgery in patients with acute closed sagittal band injuries are still undecided. The purpose of this study is to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injury, and to present treatment plans and surgical methods.Methods: Twenty-five patients who had undergone surgical exploration for closed sagittal band injury between January 2011 and December 2020 were included in the study, comprising of 17 patients with acute injury within 3 weeks, four patients with chronic injury, and four patients who underwent surgery because symptoms did not improve during conservative treatment were included. Patients with laceration, fracture, and rheumatoid arthritis were excluded. Results: Sagittal band injury was classified into two groups: superficial sagittal band (SSB) injury and proper sagittal band (PSB) injury. SSB injury was observed in 75.0% of spontaneous rupture cases and PSB injury was observed in 66.7% of traumatic rupture cases. SSB injury was observed in 83.3% of Rayan and Murray classification type II cases and PSB injury was observed in 61.5% of type III cases (p=0.041). All four patients who failed conservative treatment and underwent surgery had PSB injuries.Conclusion: We successfully corrected the sagittal band injury with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injury can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. Surgical method and treatment plan can be chosen based on this.
{"title":"Surgical treatment of sagittal band injury and classification according to operative findings","authors":"K. Lee, Cheon Ho Song, Jin Soo Kim, S. Koh, Dong Chul Lee, S. Roh, Jung Hyun Park","doi":"10.12790/ahm.21.0135","DOIUrl":"https://doi.org/10.12790/ahm.21.0135","url":null,"abstract":"Purpose: The indications for surgery in patients with acute closed sagittal band injuries are still undecided. The purpose of this study is to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injury, and to present treatment plans and surgical methods.Methods: Twenty-five patients who had undergone surgical exploration for closed sagittal band injury between January 2011 and December 2020 were included in the study, comprising of 17 patients with acute injury within 3 weeks, four patients with chronic injury, and four patients who underwent surgery because symptoms did not improve during conservative treatment were included. Patients with laceration, fracture, and rheumatoid arthritis were excluded. Results: Sagittal band injury was classified into two groups: superficial sagittal band (SSB) injury and proper sagittal band (PSB) injury. SSB injury was observed in 75.0% of spontaneous rupture cases and PSB injury was observed in 66.7% of traumatic rupture cases. SSB injury was observed in 83.3% of Rayan and Murray classification type II cases and PSB injury was observed in 61.5% of type III cases (p=0.041). All four patients who failed conservative treatment and underwent surgery had PSB injuries.Conclusion: We successfully corrected the sagittal band injury with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injury can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. Surgical method and treatment plan can be chosen based on this.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121144740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: We investigated what changes occurred at single hand surgery center during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, Korea using patient data of 4 years (2018–2021).Methods: This is a single-center retrospective study of patients visiting our center during the COVID-19 pandemic for 4 years (January 22 to May 6). Service volumes (SVs) including the number of in/outpatient, emergency room, elective, and emergency surgery were analyzed. During the peak period of the COVID-19 (February 24 to March 9, 2020), patient’s demographics, injury mechanism, and place of injury of hand trauma were analyzed.Results: SVs were significantly reduced in 2020 as compared with other years. The SVs except for the number of emergency surgeries have recovered after 2 months from the first confirmed case of COVID-19 in Daegu, Korea. At the peak period, the effect of COVID-19 was weak on emergency room-related SVs. In addition, a daily number of in/outpatients and elective surgeries had a statistically significant negative correlation with the number of COVID-19 confirmed (p<0.05). During the peak period, superficial laceration increased and finger and wrist fractures decreased. The number of cases occurring in workplace increased, however, occurring outside during daily life decreased.Conclusion: COVID-19 pandemic greatly reduces service volume in our center. Thorough protective strategy from COVID-19 such as personal protective equipment was essential for early recovery of hospital functions during the pandemic. In addition, manpower for the emergency room must be preserved during the pandemic. The results of our study, which reported SVs through the pandemic will help maintain the function of hand surgery centers.
{"title":"Impact on the Service Volume of a Single Hand Surgery Center during the COVID-19 Pandemic Period in Daegu","authors":"S. Oh, Young Woo Kim, Sang Hyun Woo","doi":"10.12790/ahm.21.0120","DOIUrl":"https://doi.org/10.12790/ahm.21.0120","url":null,"abstract":"Purpose: We investigated what changes occurred at single hand surgery center during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, Korea using patient data of 4 years (2018–2021).Methods: This is a single-center retrospective study of patients visiting our center during the COVID-19 pandemic for 4 years (January 22 to May 6). Service volumes (SVs) including the number of in/outpatient, emergency room, elective, and emergency surgery were analyzed. During the peak period of the COVID-19 (February 24 to March 9, 2020), patient’s demographics, injury mechanism, and place of injury of hand trauma were analyzed.Results: SVs were significantly reduced in 2020 as compared with other years. The SVs except for the number of emergency surgeries have recovered after 2 months from the first confirmed case of COVID-19 in Daegu, Korea. At the peak period, the effect of COVID-19 was weak on emergency room-related SVs. In addition, a daily number of in/outpatients and elective surgeries had a statistically significant negative correlation with the number of COVID-19 confirmed (p<0.05). During the peak period, superficial laceration increased and finger and wrist fractures decreased. The number of cases occurring in workplace increased, however, occurring outside during daily life decreased.Conclusion: COVID-19 pandemic greatly reduces service volume in our center. Thorough protective strategy from COVID-19 such as personal protective equipment was essential for early recovery of hospital functions during the pandemic. In addition, manpower for the emergency room must be preserved during the pandemic. The results of our study, which reported SVs through the pandemic will help maintain the function of hand surgery centers.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126491802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gyeonghyeon Doh, BumSik Kim, DongYun Lee, J. Yoon, SooA Lim, Y. Han, Surak Eo
Purpose: Various factors such as blood velocity, turbulent flow,and intimal injury are the most basic elements in free tissue transfers. However, how blood flow is reestablished, maintained, and changed after vascular anastomosis has rarely been studied.Methods: A 54-year-old male sustained an unreplantable severe crushing injury to his right hand. The middle finger was transferred to the thumb as an ectopic replantation using an anastomosis between the radial and digital arteries. However, secondary reconstruction for the first web space defect was inevitable and an anteromedial thigh free flap procedure was performed 2 months later using the previously anastomosed vessels. During the procedures, we noted morphologic changes in the microvessels and tried to explain those phenomena by applying the principles of hemodynamics.Results: Due to the discrepancy in vascular size between the radial and digital arteries, the velocity of the blood flow in the post-anastomotic site, which was the digital artery, must have been increased by Poiseuille’s law. Supposing that the velocity through the post-anastomotic site of the digital artery was increased, the pressure exerted by that flow decreased, resulting in more shrinkage of the vessel lumen of the digital artery by Bernoulli’s principle. Pascal’s law could also be applied in confined spaces with a static flow; where there is a constant pressure, as the radius of the post-anastomotic digital artery diminishes, the tension within the digital artery’s wall also simultaneously decreases. By Laplace’s law, the post-anastomotic digital artery’s wall thickens as less tension is exerted on the wall.Conclusion: Understanding these simple flow mechanics will enable microsurgeons to better avoid the risk factors causing thrombosis, which is related to flap failure.
{"title":"Hemodynamic Principles in Free Tissue Transfer: Vascular Changes at the Anastomosis Site","authors":"Gyeonghyeon Doh, BumSik Kim, DongYun Lee, J. Yoon, SooA Lim, Y. Han, Surak Eo","doi":"10.12790/ahm.21.0118","DOIUrl":"https://doi.org/10.12790/ahm.21.0118","url":null,"abstract":"Purpose: Various factors such as blood velocity, turbulent flow,and intimal injury are the most basic elements in free tissue transfers. However, how blood flow is reestablished, maintained, and changed after vascular anastomosis has rarely been studied.Methods: A 54-year-old male sustained an unreplantable severe crushing injury to his right hand. The middle finger was transferred to the thumb as an ectopic replantation using an anastomosis between the radial and digital arteries. However, secondary reconstruction for the first web space defect was inevitable and an anteromedial thigh free flap procedure was performed 2 months later using the previously anastomosed vessels. During the procedures, we noted morphologic changes in the microvessels and tried to explain those phenomena by applying the principles of hemodynamics.Results: Due to the discrepancy in vascular size between the radial and digital arteries, the velocity of the blood flow in the post-anastomotic site, which was the digital artery, must have been increased by Poiseuille’s law. Supposing that the velocity through the post-anastomotic site of the digital artery was increased, the pressure exerted by that flow decreased, resulting in more shrinkage of the vessel lumen of the digital artery by Bernoulli’s principle. Pascal’s law could also be applied in confined spaces with a static flow; where there is a constant pressure, as the radius of the post-anastomotic digital artery diminishes, the tension within the digital artery’s wall also simultaneously decreases. By Laplace’s law, the post-anastomotic digital artery’s wall thickens as less tension is exerted on the wall.Conclusion: Understanding these simple flow mechanics will enable microsurgeons to better avoid the risk factors causing thrombosis, which is related to flap failure.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"192 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124267814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bu Hyeon Choi, Lan Sook Chang, Seong Oh. Park, Youn Hwan Kim
Although traumatic popliteal artery injury is uncommon, it can significantly increase the risk of limb amputation because of the anatomical complexity and delayed diagnosis and treatment. Various tools are available for treatment. Recently, an endovascular approach has been attempted for such injuries; however, open surgical repair remains the standard treatment. An integrated and stepwise procedure involving multidisciplinary specialists, including emergency department personnel for initial evaluation, orthopedic surgeons for treating accompanying fractures or dislocations, vascular and plastic surgeons for vessel repair, and interventional radiologists for immediate diagnosis and implementation of the endovascular approach, is needed. Covering wound defects due to skin and soft tissue necrosis and irreversible ischemic damage remains difficult despite successfully revascularizing the injured vessels. Here, we describe a case of revascularization after popliteal artery injury along with successful reconstruction of a complex defect with a thoracodorsal artery perforator chimeric free flap when recipient vessel selection was limited.
{"title":"Microsurgical Reconstruction of Lower Limb Using Thoracodorsal Artery Perforator Chimeric Free Flap after Popliteal Artery Revascularization: A Case Report","authors":"Bu Hyeon Choi, Lan Sook Chang, Seong Oh. Park, Youn Hwan Kim","doi":"10.12790/ahm.21.0130","DOIUrl":"https://doi.org/10.12790/ahm.21.0130","url":null,"abstract":"Although traumatic popliteal artery injury is uncommon, it can significantly increase the risk of limb amputation because of the anatomical complexity and delayed diagnosis and treatment. Various tools are available for treatment. Recently, an endovascular approach has been attempted for such injuries; however, open surgical repair remains the standard treatment. An integrated and stepwise procedure involving multidisciplinary specialists, including emergency department personnel for initial evaluation, orthopedic surgeons for treating accompanying fractures or dislocations, vascular and plastic surgeons for vessel repair, and interventional radiologists for immediate diagnosis and implementation of the endovascular approach, is needed. Covering wound defects due to skin and soft tissue necrosis and irreversible ischemic damage remains difficult despite successfully revascularizing the injured vessels. Here, we describe a case of revascularization after popliteal artery injury along with successful reconstruction of a complex defect with a thoracodorsal artery perforator chimeric free flap when recipient vessel selection was limited.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128090446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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