Journal of Hand and Microsurgery最新文献

[This corrects the article DOI: 10.1016/j.jham.2025.100288.].

Background: Fingertip and nail bed injuries represent complex reconstructive challenges in hand surgery, requiring restoration of both function and aesthetics. The nail unit's intricate anatomy-comprising the matrix, bed, and surrounding tissues-necessitates precise surgical techniques to prevent long-term deformities and sensory deficits. This study presents and evaluates the "clover flap," a novel homodigital advancement technique designed for dorsal fingertip injuries involving partial or complete nail bed loss.

Methods: In this retrospective cohort study, 63 patients with dorsal fingertip defects were treated between 2005 and 2023 using the clover flap at a primary referral center. The flap involves volar V-Y advancements redirected dorsally in a trifoliate configuration, allowing one-stage coverage without grafts. Outcomes were assessed using standardized clinical, functional, and aesthetic metrics including Quick-DASH, 2PD, POSAS, FIOS, and OFNAS scores.

Results: No complete flap necrosis occurred. Nail deformities were limited to 17.5 % of cases, with minimal donor site morbidity. Patients achieved a mean Quick-DASH score of 14.6, 2PD of 7.3 mm, and an active ROM of 224°. Grip and pinch strength recovered to 79 % and 81 % of the contralateral side, respectively. Aesthetic outcomes were favorable, with an OFNAS of 4.5 and FIOS of 11.3. Multivariate analysis confirmed functional and cosmetic stability over time, regardless of complication presence.

Conclusion: The clover flap offers a reliable, one-stage reconstructive option for dorsal fingertip injuries, combining high functional recovery with excellent nail bed and scar aesthetics. Its design preserves nail matrix integrity, avoids microsurgery, and is particularly suitable in acute care settings.

Introduction: the reconstruction of intercalary femoral defects after tumour resection is challenging. We have evaluated the clinical, functional, and oncological results of using free vascularized fibular graft combined with preserved pasteurized tumour segment.

Materials: this study was retrospective in nature and included 12 patients [eight males and four females]. The mean age was 21.3 years ± 11.3. The diagnoses of the patients were osteosarcoma (Five cases) and Ewing's sarcoma (seven cases). The resection was wide local excision, and the defect was reconstructed using combined free vascularized fibular graft and pasteurized tumour segment.

Results: the mean time to union was 7.1 ± 1.9 months while the mean time to full weight bearing was 12 ± 1.8 months. The mean size of skeletal defect was 17.7 cm ± 1.92. The mean duration of surgery was 12.1 h ± 1.88. Nonunion occurred in four cases, stress fractures occurred in two cases and metal failure occurred in one case.

Conclusion: the combined technique of using free vascularized fibular graft and pasteurized tumour segment for intercalary femoral defects following tumour resection is a valuable technique with accepted complications and good results.

Peripherally-induced movement disorder (PIMD) is a group of conditions manifested by involuntary movements or other motor abnormalities that are induced by or emerge in the context of injury to the peripheral nervous system. Peripheral nerve entrapment (PNE) in the upper extremities is common and their clinical signs are very well known by hand surgeons. Only 3 cases of tremor with PNE have already been reported (one in 1986 and two very recently). The aim of this multicentric retrospective study is to report clinical cases of tremors caused by PNE and to analyze their clinical findings and treatment. 17 patients was referred to 5 hand centers for tremors of their hand after being examined by a neurologist clinically and electrophysiologically. The clinical examination showed simple, double or multiple crush nerve entrapment at the upper limb (elbow was involved for all of them except one). The treatment was conservative (myofascial manipulation and taping) for 8 patients and surgical (wide awake nerve release) for 9 others after failure of conservative treatments. The tremors disappeared for all of them. Our study showed upper limb peripheral nerve entrapment can be a cause of tremor of the hand in rare but misdiagnosed situations. We suggest that tremor induced by peripheral nerve entrapment can be a new type of tremor classified in the PIMD group. Hand physiotherapist and surgeons must be questioned by medical doctors who take care of tremors (family doctors, neurologists …) and so, be awared of that etiology.

Purpose: Trapeziectomy has a particularly significant role in relieving pain in patients with trapeziometacarpal arthritis. With the advantage of arthroscopy combined with hematoma distraction, arthroscopic distal trapeziectomy can achieve good pain relief with minimum wound complications.

Aim: Evaluation of the clinical and functional results of arthroscopic distal trapeziectomy and hematoma distraction.

Patients and methods: The study included thirty patients with stage II and III trapeziometacarpal arthritis. The articular surface & subchondral bone were resected. Then the joint was distracted using percutaneous Kirschner wires. The mean follow-up period was about 20 months.

Results: There was a statistically significant difference in pre- and post-operative pain scores with slight improvement of tip & key pinch strength.

Conclusion: According to our study findings, arthroscopic distal trapeziectomy and hematoma distraction can be performed with significant improvements and satisfactory clinical and functional results in patients with stage II and III trapeziometacarpal arthritis.

Complex hand defects that involve multiple components present significant challenges for reconstructive surgery. The Anterolateral Thigh (ALT) flap is one of the most versatile options in reconstructive microsurgery, offering numerous advantages. Variations in ALT anatomy enable the creation of different types of multi-pedicle flaps, which aid in addressing complex injuries. This study involved 116 patients treated with the ALT flap for hand lesions, with a focus on 20 patients who received multipedicle flaps for complex hand defects. Among these, ten patients were treated with adipocutaneous multi-pedicled flaps for the coverage of defects, while the remaining ten patients received a combination of adipocutaneous and FL multi-pedicled flaps, which enabled both the covering of the skin and the reconstruction of the extensor tendon. Prior to thinning, the average thickness of the flaps was measured at 21 mm, which was subsequently reduced to an average of 6.5 mm following the thinning procedure. The overall survival rate of the flaps was 97.5 %, and two patients required defatting after one year. Patient satisfaction regarding both functional and aesthetic outcomes was reported to be high. Multi-pedicle flaps that incorporate two skin islands or combinations of skin islands and FL flaps have proven to be highly effective for complex, multi-unit hand reconstruction. The success of this technique is influenced by various factors, including the types and number of perforators, the composition of the flap, the methods used for thinning, and the specific arrangement of flaps tailored to each defect.

Scapholunate (SL) instability remains a challenging condition with significant possibility of implications for wrist function and long-term outcomes. This review explores the limitations and complications of current trans-osseous scapholunate ligament (SLL) reconstruction techniques, focusing on isometric reconstruction challenges and complications, for example osteonecrosis, tunnel fractures, graft failure, and iatrogenic extrinsic ligament injuries. Through biomechanical analysis and clinical case reviews, we demonstrate that the conventional three-ligament tenodesis (3LT) scaphoid tunnel has high risk of resulting in a non-isometric volar scapho-trapezial (vST) ligament reconstruction, potentially exacerbating carpal instability. Additionally, trans-osseous techniques have risk of osteonecrosis and fracture, which can accelerate degenerative changes and necessitating salvage procedures. This paper will additionally highlight concerns regarding tendon graft viability, anchor failure, and the critical role of extrinsic ligaments in SL stability. It will also be shown that modular arthroscopic approaches, which focus on selective ligament repair, may provide better outcomes with fewer complications and lower morbidity compared to traditional reconstructions. Future advancements probably should prioritise preserving bone vascularity and minimising iatrogenic injury, guiding surgeons toward safer and more effective treatment strategies.