Journal of Hand and Microsurgery最新文献

Purpose: Prosthetic replacement of the fragmented, collapsed and unreconstructable lunate is a treatment option in Kienbock's disease. The objective of this study is to assess the effectiveness, safety and outcomes of prosthetic lunate arthroplasty for the treatment of Kienbock's disease.

Methods: We conducted a PRISMA-P compliant systematic review PROSPERO (CRD 42021283996) searching Cochrane, Medline, PubMed and Embase databases for the outcomes of prosthetic lunate arthroplasty. Primary outcomes were patient reported outcome measures, complications and re-operations. Secondary outcomes were pain, grip strength and range of motion.

Results: 1093 citations were identified of which 42 studies met the inclusion criteria. Five types of prosthetic lunate arthroplasty were identified including silicone, pyrocarbon, acrylic, metal and 3D printed lunates. Swanson silicone lunates (n = 70) had a 78.5 % complication and 21.4 % re-operation rate at long-term (275.5 months) follow-up with high silicone synovitis incidence. High performance silicone lunates (n = 47) had a 63.8 % complication and 14.8 % re-operation rate at medium term (52.2 months) follow-up. Acrylic lunates (n = 14) had a complication rate of 14.2 % and re-operation rate of 7.1 % at long-term (169.4 months) follow-up. Metal lunates (n = 41) had a 7.3 % complication and re-operation rate at medium-term (120 months) follow-up. Anatomic design Pyrocarbon lunates (n = 13) with medium-term (30.3 months) follow-up had a 23 % complication rate and a 15.3 % re-operation rate with high implant dislocation incidence. 3D-Printed lunates (n = 7) with short-term (14.4 months) follow-up had no complications.

Conclusions: The role of lunate prosthetic arthroplasty in the treatment of Kienbock's disease remains uncertain. Early silicone implants had unacceptably high complication and revision rates and their use has been discontinued as a result. Modern materials such as pyrocarbon and bespoke 3D printed designs remain unproven in the long-term and the challenges of maintaining implant stability remain.

Distal radius fracture nonunion can result in significant deformity, loss of function, and chronic pain. Presented here is a case of distal radius nonunion that was surgically reconstructed with a pedicled distal ulna bone graft based on the periosteal branches of the posterior interosseus artery (PIA). This technique has limited prior utilization for adult distal radius nonunion treatment but offers an effective option for surgical reconstruction of distal radius nonunion with preservation of the radiocarpal joint, utilizing a less invasive surgery that also reduces hospitalization stay. The objective of this report is to provide the first illustrative step-by-step surgical technique for the vascularized distal ulnar bone graft technique and demonstrate its promising utility in clinical practice.

Introduction: Soft-tissue sarcomas arising in the thigh may require total or subtotal compartmentectomy, with subsequent need for functional reconstruction with free functional muscle transfer (FFMT). We present our series, describing a new approach with chimeric propeller antero-lateral thigh-vastus lateralis (ALT-VL) free flap, which allows for independent muscle inset and soft tissue defect resurfacing.

Patient and methods: A retrospective review of a prospectively maintained database was performed, analyzing all patients referred to Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy, between 2018 and 2023 for soft-tissue sarcomas of the thigh requiring wide excision and reconstruction with functional ALT-VL. Cases involving a functional chimeric ALT-VL flap with propeller skin island were reported.

Results: Eight patients underwent quadriceps reconstruction with functional ALT-VL. All of them underwent neoadjuvant radiation therapy. Patients' age ranged from 59 to 82 years old (mean 68 years old). Skin defect size ranged from 54.95 cm² to 324.99 cm² (mean 204.26 cm²). The mean operation time was 611.5 min. Two of these patients required the chimeric flap harvesting with independent propeller mobilization of the skin island. The recipient vessels used were the descending branch of lateral circumflex femoral artery and venae comitantes. The recipient nerve was the motor branch to vastus lateralis.Minor complications occurred in three patients (one seroma and two cases of marginal skin necrosis with delayed wound healing), with no requirement for additional surgery. One patient developed an infected seroma with wound breakdown, necessitating hospital readmission and revision surgery. One patient experienced local relapse one year after surgery.

Conclusion: The free functional chimeric ALT-VL flap with propeller skin island is a valid reconstructive option for complex defects of the anterior compartment of the thigh, especially indicated when functional impairment is associated with wide or transversely-oriented skin defects.

Background: Vascularized bone grafts (VBGs) are currently the main surgical option for the restoration of humeral bone defects particularly when defects are larger than 6 cm. Because it offers a strong, rapid blood supply, VBGs easily integrate into the recipient sites and undergo active resorption and remodeling into healthy bone through primary bone healing. Additionally, they support the recipient site's immune system in preventing and reducing infection.The Aim was to assess the outcomes of utilizing vascularized bone grafts to reconstruct large humeral bony defects (greater than 6 cm).

Patients and methods: This study comprised twenty patients with major humeral bony defects treated by vascularized bone grafts. Under general anesthesia, the procedure was carried out with the patient in the supine position for free fibula harvesting or in the lateral or prone position for pedicled scapular graft harvesting.

Results: The union rate was 90 % and the mean healing time was 7.78 ± 3.04 months. Complications were present in 40 % of cases, with non-union being the most common, followed by infection and wound dehiscence.

Conclusion: The study suggests that the reconstruction of large bony defects of humerus using vascularized bone grafts is effective, with a predictable healing time and a manageable complication rate.

Intorduction: There is little difference in the outcome of various surgical treatment for thumb carpometacarpal osteoarthritis. Suture suspension arthroplasty is a very simple technique without sacrifice of tendon or specific implants and can be performed under regional anesthesia. We hypothesize that the technique yields similar good results to an approach under general anesthesia at less medical cost.

Methods: Eighteen patients underwent suture suspension arthroplasty by trapezial excision and metacarpal suspension using #2 high-strength suture passed from the attachment of abductor pollicis longus to the most distal part of flexor carpi radialis without tendon transfer or K-wire fixation. Nine patients received wide-awake anesthesia and 9 patients received general anesthesia. Postoperatively, patients were evaluated by clinical and radiographic outcomes. We investigated the first to second metacarpal angle, the first metacarpophalangeal angle, trapezial space ratio, grip strength, pinch strength, Kapandji score, DASH score, medical cost and patient satisfaction.

Results: Five of 18 patients were male. Average age was 66.3 (range 53-76). Eleven patients had Eaton stage 3 and 7 had stage 4. The mean follow-up was 17.9 months (range, 7-48 months). Postoperatively, the first to second metacarpal angle, the first metacarpophalangeal angle, grip strength, DASH and Kapandji score showed significant improvements. However, there is no significant difference of clinical and radiographic outcome between wide-awake anesthesia and general anesthesia. Medical cost was significantly less in wide-awake anesthesia than in general anesthesia. Most patients receiving wide-awake anesthesia would hope the same anesthesia if they were to have surgery again.

Conclusion: Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis is a very simple technique and has good results. Because of the simplicity, wide-awake surgery is possible and yields similar good results to an approach under general anesthesia at less medical cost. Therefore, Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis under wide-awake anesthesia is highly recommended.

Thumb carpometacarpal (CMC) arthritis is a prevalent pathology, particularly among elderly women, with a significant impact on patients' quality of daily life. Total joint replacement can provide a shorter rehabilitation period and satisfying function, at least in the short term with encouraging findings according to recent studies concerning its complications (e.g., dislocation, loosening) and longevity. TOUCH® is a second-generation, dual mobility prosthesis with promising results. Step-by-step surgical technique and keypoints for successful implantation and satisfying thumb function are presented in this article.

Background: Since the release of ChatGPT by OpenAI in November 2022, generative artificial intelligence (AI) models have attracted significant attention in various fields, including surgery. These advancements have been particularly notable for creating highly detailed and contextually accurate images from textual prompts. A notable area of clinical application is the representation of surgeon demographics in various specialties, particularly in the context of microsurgery and plastic surgery-related subspecialties.

Methods: This cross-sectional study, conducted in June 2024, utilized the latest version of the Copilot Creative Mode powered by DALL-E 3 to generate images of surgeons across various plastic surgery subspecialties. Real-world demographic data from the US, Japan, and Zambia were compared with AI-generated images for an accurate representation analysis.

Results: Five hundred images (350 from various subspecialties and 150 from geographical sources) were analyzed. The AI model predominantly generated images of male and female surgeons with a statistical underrepresentation of female and Black microsurgeons. Geographical prompts influenced the representation, with an overrepresentation of female (64.0 %; p < 0.001) and Black (16.0 %; p < 0.001) plastic surgeons in the US and exclusively Asian surgeons in Japan. Discrepancies were also observed in the depiction of surgical equipment, with the majority of AI-generated microsurgeons inaccurately portrayed using either surgical loupes (46.0 %) or optical microscopes (32.0 %), not with surgical microscopes (4.0 %).

Conclusions: This study revealed significant disparities between AI-generated images and actual demographics in the fields of microsurgery and plastic surgery-related subspecialties, highlighting the need for more diverse and accurate training datasets for AI models.

Wide-Awake Local Anesthesia with No Tourniquet shifted how we provide hand surgery and liberated us from anesthesia-related constraints. This change led to the realization that hand surgery can be done in the office setting as long as safety requirements are fulfilled. This review focuses on what we know about office surgery from safety, society, facility, patient, and surgeon perspectives, and looks at the barriers that impede further expansion.

Caliber mismatch in microvascular anastomosis can significantly increase procedural difficulty and elevate the risk of thrombosis. A comprehensive literature search in PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify articles addressing surgical techniques for overcoming caliber mismatch in microvascular anastomosis. Various techniques described in the literature were found: modifications of end-to-end anastomosis, the use of end-to-side anastomosis, the application of vessel grafts and the use of vessel couplers. In this review, we critically analyze these techniques and introduce additional technical variations. We discuss the options and express our preferred choice of methods based on specific clinical scenarios: if an alternative vessel (either new or isolated further away) is not found, the severity of the mismatch guides the choice. When less then 1/3 our choice is for vessel dilation and oblique cut of the smaller vessel end (if necessary with the adjunct of a titanium small Ligaclip in an oblique fashion to avoid a cul-de-sac). If caliber mismatch is around or over 1/3, we would prefer an end to side anastomosis.