Journal of Hand Surgery-Asian-Pacific Volume最新文献

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic).

Polysyndactyly of the foot is a common congenital malformation of the lower extremity. We introduce our surgical technique for reconstruction of polysyndactyly of the fifth toe fused with the fourth toe. The technique includes the removal of the medial hypoplastic ray, web-space reconstruction using a dorsal cross-shaped advancement flap and closure of the lateral incisions of the separated toes with a tongue-shaped flap and zigzag triangular flaps. This technique is advantageous to prevent postoperative web creep, reduce the tension of the dorsal incision closure and it is relatively easy to grasp for the inexperienced surgeon. Level of Evidence: Level V (Therapeutic).

Camptodactyly is a congenital difference with flexion contracture of the proximal interphalangeal (PIP) joint. Camptodactyly limited to one finger is believed to be due to an anomaly of the lumbrical muscle that inserts into the flexor digitorum superficialis (FDS) tendon instead of the extensor expansion, whereas multiple finger camptodactyly is believed to be a result of shortage of soft tissues on the flexor surface of the fingers. It is important to differentiate camptodactyly from other causes of extension lag at the PIP joint. It is difficult to obtain good results after the release of flexion contractures in camptodactyly. The main goal of surgery is to prevent progressive contracture with appropriate postoperative therapy using night splinting and stretching. We should strive for a considered approach based on a thorough understanding of the pathophysiology of camptodactyly. Level of Evidence: Level V (Therapeutic).

Surgical management of constriction ring syndrome (CRS) is individualised due to the heterogenic presentation of the condition. CRS includes constriction rings, acrosyndactyly, nubbins and short digits. Involvement of more than one limb is common and children often need multiple surgeries. Each limb may need staged surgeries. If the child has vascular or lymphatic compromise secondary to a constriction ring, the ring needs to be excised and released in the first few days of life. The rings are released using multiple big Z-plasties in one or two stages. Nerve palsy associated with the rings need early intervention. Tendon transfers may be advised when nerve procedures like neurolysis and nerve reconstruction fail. Acrosyndactyly can be corrected with separation of the fused fingertips. At times, the web is more distal than usual and requires web deepening using partial syndactyly separation techniques and may need full thickness skin grafting. Complex type of acrosyndactyly is difficult to treat as it needs proper planning and staged surgical correction to achieve a five-digit hand. Separation of the syndactyly with web deepening gives more functional length and independence to the digits. The short fingers, especially the thumb, need reconstruction. Non-vascularised toe phalangeal transfer or a microvascular toe transfer can reconstruct a missing digit. Level of Evidence: Level V (Therapeutic).

The global burden of surgical conditions is becoming increasingly prevalent in the developing world. Hand surgery, in particular congenital hand surgery, presents with its own challenges, particularly the unique skill sets needed, multidisciplinary nature and heterogeneity of cases. The aim of this review article is to present our experience of practising congenital hand surgery in Cambodia, and to explore the feasibility of teaching this specialty in developing countries within a meaningful and sustainable framework. Since 2013, a group of hand surgeons and therapists have visited the Children Surgical Centre in Cambodia. A community-oriented curriculum was developed following the initial visits, with analysis of data and local surgeon's skill sets. These were further refined using the Pareto analysis and selected competency procedures to develop entrustable professional activities (EPAs). Common paediatric hand cases were identified and taught to the local surgeons. Essential elements of this model include the need for measurable outcomes, clear curriculum goals, long-term partnerships and information technology support.

Domestic and global access to surgical care for paediatric hand and upper limb conditions is challenged by limited resources, increasing direct and indirect costs of care and a growing number of patients who require specialty care. There are numerous barriers for patients from developing countries to receiving medical care in Japan due to the substantial costs, which include travel, uninsured medical expenses and fees imposed by intermediaries. To address this issue, I realised that I needed to take a more direct approach - by travelling to these countries, not only to provide treatment, but also to teach and train local doctors. By emphasising on the education of local clinicians through the sharing of knowledge and skills, it is possible to expand the timely access to paediatric hand surgery and improve outcomes for children in need. Our mission is rooted in the belief that every nation holds its own unique treasures - its culture, food, beauty and joy - that are worth celebrating and preserving. By fostering sustainable relationships built on mutual respect and understanding, we can make a greater impact; engagement with local surgeons will ultimately elevate the level of care that they can provide in their own communities, through improving core competencies of medical knowledge, technical/surgical skills and resource allocation for simple and complex conditions. This work not only reflects my personal commitment, but also my focus on expanding our team of fellows and strengthening organisational support. We aim to actively pursue these efforts throughout Asia, fostering cross-cultural collaboration and, ultimately, helping to heal the hands and futures of children worldwide. The aim of this review article is to share with readers how we started our mission trips to Vietnam and highlight 10 steps that I feel are critical to a successful mission trip.

Background: Thumb carpometacarpal (CMC) arthritis is a painful and debilitating condition, which in severe cases may be treated by surgery. Previous studies have emphasised the importance of rehabilitation following surgery to achieve optimal results. This study aimed to investigate whether intensive hand therapy is effective in improving hand functions after arthroscopic partial trapeziectomy with suture-button (SB) suspensionplasty in patients with thumb CMC arthritis. Methods: This was a retrospective observational study that used non-randomised historical controls. Patients who underwent arthroscopic partial trapeziectomy with SB suspensionplasty were divided into two groups according to whether they had postoperative hand therapy or not (hand therapy group, n = 12; no hand therapy group, n = 11). CMC joint pain, range of motion (ROM), grip and pinch strength in the operative side and Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score were compared before surgery and at the final follow-up for each group. Results: CMC joint pain, ROM and QuickDASH scores significantly improved following surgery, in both groups. Conversely, postoperative grip and pinch strength only increased significantly in the hand therapy group (grip strength: effect size = 0.36, pinch strength: effect size = 0.44). Conclusions: This study demonstrates that early-stage intensive hand therapy is an effective intervention after arthroscopic partial trapeziectomy with SB suspensionplasty, specifically for improving grip and pinch strength. Level of Evidence: Level III (Therapeutic).

Background: With ageing of the population, there is an increasing likelihood that elderly people will seek employment, with a resultant increase in the incidence of hand injuries, including digital amputations. However, the surgical indication for replantation of an amputated digit in elderly patients is controversial. The purpose of this study was to compare functional outcomes after single-digit replantation of the thumb to long finger in older (≥65 years old) and younger (<65 years old) patients to assess the feasibility of digit replantation in the elderly population. Methods: A retrospective cohort study was performed in 25 patients (12 elderly and 13 younger) with successful replantation of the thumb, index or long finger at our hospital. All patients were followed up for more than 1 year. Key pinch strength, Semmes-Weinstein (S-W) test, % total active motion (TAM), Purdue Pegboard Test score (hand dexterity) and Disabilities of the Arm, Shoulder and Hand (DASH) score were investigated. Results: Elderly patients showed significantly worse results for the S-W test and Purdue Pegboard Test score. The % TAM, key-pinch strength and DASH scores were similar in the two groups. Conclusions: Replantation surgery in elderly patients results in similar postoperative hand function (finger mobility and pinch strength) and activities of daily living to those in younger patients. Level of Evidence: Level III (Therapeutic).

Background: Triphasic bone scintigraphy (TPBS) is often used to diagnose complex regional pain syndrome (CRPS). The primary aim of this study is to determine if the diagnosis of CRPS in patients with a positive TPBS (TPBS +ve) is accurate. A secondary aim is to determine if there was delay in treatment of patients who underwent TPBS compared to those who did not have a TPBS. Methods: Of 225 consecutive patients presenting to the first author's practice with a diagnosis of CRPS, 65 had TPBS performed before referral with 62 having TPBS +ve. The remaining 160 were clinically diagnosed and a TPBS was not done (TPBS-ND). Patients were classified into five categories - wrong diagnosis, dystonic-psychogenic hand, causalgia, flare reaction and irritative carpal tunnel syndrome (ICTS). Patients with flare reaction and ICTS were considered as having true CRPS and the rest were considered as misdiagnosis. The patients' demographics, duration of symptoms, pre- and postoperative pain, functional score and patient satisfaction were compared. Results: Of the 62 TPBS +ve, there were 38 (61%) misdiagnosis. The proportion of misdiagnoses was fewer in the TPBS-ND group (45%; p = 0.036). Thirty-two of the 62 TPBS group (52%) and 92/160 (56%) of the TPBS-ND group had surgical treatment. At a mean follow-up of 19 months, pain dropped 6.5 ± 2.5 points in the TPBS +ve group. Disabilities of the arm, shoulder and hand (DASH) score fell by 56 ± 27. The mean single assessment numeric evaluation (SANE) score was 8.6 ± 2.3. These results did not differ substantially from those of the TPBS-ND group. Conclusions: A significant number of patients in this study who had TPBS +ve were misdiagnosed in this study. Outcomes after treatment of CRPS were consistently good despite the results of the TPBS. Patients with TPBS +ve had a significant delay to diagnosis. We conclude that TPBS is not useful in the management of CRPS. Level of Evidence: Level III (Therapeutic).