Journal of Hand and Microsurgery最新文献

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.

Introduction: Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes.

Methods: A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable.

Results: Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months.

Conclusion: The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.

Background: Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review summarizes Taiwan's pioneering experience with robotic-assisted techniques in this specialty, with an emphasis on clinical applications, educational models, and future directions.

Methods: A narrative literature review was conducted focusing on robotic-assisted plastic and reconstructive surgery with relevance to Taiwanese clinical practice. Articles published between January 2000 and April 2024 were considered. Searches were performed in PubMed, Google Scholar, and Cochrane Library using the keywords: "robotic surgery," "plastic surgery," "reconstructive surgery," "Taiwan," and "microsurgery." Inclusion criteria were: (1) studies involving robotic-assisted surgical techniques, (2) relevance to plastic and reconstructive surgery, (3) Taiwanese institutional or clinical context, and (4) availability of clinical or technical outcome data. Articles not published in English, lacking original data, or unrelated to the Taiwan context were excluded.

Results: Robotic-assisted techniques were successfully applied in various reconstructive domains, notably in microsurgical anastomosis for free flap procedures, nerve transfers, and minimally invasive mastectomies. These approaches demonstrated favorable outcomes in terms of operative precision, reduced complications, and patient satisfaction. Taiwan's major medical centers, including Chang Gung Memorial Hospital and Taichung Veterans General Hospital, have been instrumental in driving these innovations. Furthermore, robotic training models facilitated the learning curve for microsurgeons and supported the integration of robotic platforms into surgical education.

Conclusions: Taiwan's experience underscores the feasibility and clinical value of robotic-assisted techniques in plastic and reconstructive surgery. Robotic platforms not only improve surgical outcomes but also expand the scope of reconstructive options. Ongoing research and educational efforts are crucial to optimizing technique standardization and surgeon training in this rapidly evolving field.