Journal of Hand and Microsurgery最新文献

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.

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.

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.

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.

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.

Purpose: This study aims to evaluate the effectiveness and safety of lateral closing wedge osteotomy with tension-band wire fixation for correcting cubitus varus deformity in pediatric patients. The primary objective was to assess the bone union rate, functional outcomes, and potential complications associated with this surgical approach.

Methods: We conducted a retrospective review of 104 pediatric cases (ages 7-15) with post-traumatic cubitus varus deformity treated between January 2018 and December 2019 at the Pediatric Orthopedic Department. The surgical technique involved a lateral closing wedge osteotomy with fixation achieved using an 8-figure tension-band wire on the lateral column of the distal humerus. Follow-up assessments were conducted for bone union, correction stability, range of motion, and any post-surgical complications.

Results: Out of 104 cases, 63 involved left elbows and 41 right elbows, with an average patient age of 8.12 years. The deformity was severe (>30° varus) in 33.65 % of cases. Successful correction and bone union were achieved in 100 % of cases, with an average follow-up duration of 8 months (range: 3-20 months). Complications included minor recurrence in two cases due to early post-operative trauma, limited range of motion in three cases, K-wire protrusion in three cases, and infection in two cases. Functional outcomes rated as excellent in 94.2 % of cases and good in 5.8 %.

Conclusion: Lateral closing wedge osteotomy with tension-band wire fixation is a reliable technique for correcting pediatric cubitus varus deformity, offering stable fixation, high success rates in bone healing, and favorable functional outcomes with minimal complications.

Introduction: Hand microsurgery is an important advancement of the speciality that has improved outcomes in hand trauma and hand surgical conditions. This bibliometric analysis aims to identify the 75 most cited hand microsurgery articles and explore their relevance to contemporary practice.

Methods: The Web of Science core collection database was used to screen and identify the top 75 most-cited articles relevant to hand microsurgery. VOSviewer 1.6.18 and CiteSpace 6.2.R4 software were used to analyse and visualise occurrences, authorship, countries, institutions, journals, keywords, and Evidence Level (Oxford Centre for Evidence-Based Medicine).

Results: The initial search identified 3024 articles. The top 75 most-cited articles were published between 1980 and 2018, with contributions from 291 authors. Professor Fu Chang Wei from Chang Gung Memorial Hospital, Taiwan, was the most prolific author. Articles originated from 14 countries, with the United States leading (29.3 %), followed by Taiwan (14.6 %), Italy (8.0 %), and Germany (8.0 %). The 75 most-cited articles were published in 22 journals, led by Plastic and Reconstructive Surgery, followed by the Journal of Hand Surgery (American Volume) and Microsurgery. A total of 345 keywords were analysed, with "Hand," "Defects," "Reconstruction," and "Regeneration" being the most frequent. Level of Evidence 4 was most common (40 %), followed by Levels 3 (25 %) and 5 (24 %).

Conclusions: The top 75 most-cited hand microsurgery articles influence current surgical practice and teaching material. Understanding specific surgical techniques in hand microsurgery and examining their outcomes will benefit patients, surgeons, researchers and policymakers alike.

Background: The Oxford Shoulder Score (OSS) is a well-established and extensively utilized shoulder score translated into Western and Asian languages for use in respective countries. Our study aimed to translate, cross-culturally adapt, and psychometrically validate the OSS in the Tamil language community.

Methods: The translation and cross-cultural adaptation were conducted according to previously established standards. We recruited 61 patients with degenerative or inflammatory shoulder pain presenting to a tertiary care hospital between January-August 2021. Patients were evaluated using the Tamil-OSS (OSS-T) and Constant-Murley scores (CMS). We assessed the understanding, acceptability, reproducibility, and reliability of the OSS-T. In addition, we evaluated the intra-observer and inter-observer reproducibility. We also evaluated the correlation of the OSS-T with another validated score namely the CMS.

Results: The mean age of the patient included in the study was 43 (±12) years. Patients took an average of 8 (±2) minutes to complete the OSS form. Internal Consistency of the OSS-T was strong (Cronbach's alpha = 0.98). The intraclass coefficient was 0.963 (95 % CI 0.93-0.98, p < 0.001). We noted significant interobserver reliability (r = 0.963, p < 0.001). The Tamil OSS showed a strong significant correlation with the CMS (r = 0.82, p < 0.001) and original OSS (r = 0.98, p < 0.001). The OSS-T has a high level of convergent validity with CMS (p < 0.001). The 12 included translated questions in the OSS-T scored more than 0.95 from the subject experts for inclusion based on the three-point Likert scale.

Conclusion: This study indicated that the Tamil version of the OSS is a reliable and valid, self-reported questionnaire, which can be applied to patients with shoulder disorders. Furthermore, the very good psychometric properties of the OSS-T score would allow for its use in clinical practice in national and international research projects concerning Tamil-speaking patients.

Level of evidence: 4.

Purpose: We aim to evaluate outcomes after off-roading injuries to determine their impact on patients' pain and function. Further, we aim to evaluate the burden on the healthcare system that result from these injuries.

Methods: Patients treated surgically for an off-roading injury at a single tertiary academic center completed surveys about their current level of upper extremity pain and function using QuickDASH and VAS-Pain scores. Qualitative questions were used to assess work status. Patients were classified as having acceptable versus unacceptable pain and upper extremity function in reference to previously published PASS (Patient Acceptable Symptom State) thresholds. Descriptive statistics were calculated to describe the burden these injuries place on the healthcare system.

Results: Of 23 included patients, mean age was 38 ± 12 and 70 % (16/23) were male. At a mean follow-up of 2.0 ± 1.2 years post-injury, 40 % (9/23) patients reported that they were unable to work, or this ability was severely impaired. The mean VAS pain and QuickDASH scores were 2.8 ± 2.9 and 19.8 ± 21.7 respectively. Nearly half of patients were classified as having unacceptable levels of pain and upper extremity function [48 % (11/23) and 43 % (10/23) respectively]. Patients required an average of 2.7 ± 2.6 surgeries and 100 % were admitted with a mean length of stay of 10.2 ± 12.1 days.

Conclusions: Off-roading related upper extremity injuries have lasting impacts on patients and their abilities to work. Treatment of these injuries is resource-intensive based on the number of required surgeries and length of admission.