Forthcoming Issues
Malunions and Nonunions in the Forearm, Wrist, and Hand (Source: Hand Clinics)
Source: Hand Clinics - October 11, 2023 Category: Orthopaedics Source Type: research
Forearm Nonunions —From Masquelet to Free Vascularized Bone Grafting
Forearm fractures present a unique challenge due to the anatomic relationship of the radius relative to the ulna. Associated with the complexity of the treatment for these fractures is the management of nonunion and malunion of the radius and ulna. Evaluation and management of forearm nonunions require a critical evaluation of contributing factors prior to surgical intervention. Timely and precise treatment of nonunion and malunion is necessary to restore function of the forearm. (Source: Hand Clinics)
Source: Hand Clinics - September 21, 2023 Category: Orthopaedics Authors: Marc J. Richard, Catphuong L. Vu Source Type: research
Functional Free Muscle Transfer for Reconstruction of Traumatic Adult Brachial Plexus Injuries
Traumatic brachial plexus injury is the most common indication for functional free muscle transfer, and elbow flexion recovery is the functional target, followed by shoulder stability and hand reanimation. In this article, we provide a literature review of functional free muscle transfer (FFMT) for adult traumatic brachial plexus injuries and the surgical technical recommendations to achieve the best functional results with FFMT for adult traumatic brachial plexus injuries. (Source: Hand Clinics)
Source: Hand Clinics - September 19, 2023 Category: Orthopaedics Authors: Raquel Bernardelli Iamaguchi, Marcelo Rosa de Rezende Source Type: research
Traditional Bone Grafting in Scaphoid Nonunion
Management of scaphoid nonunion remains challenging despite modern fixation techniques. Nonvascularized bone graft may be used to achieve union in waist and proximal pole fractures with good success rates. Technical aspects, such as adequate debridement and restoration of scaphoid length, and stable fixation are critical in achieving union and functional wrist usage. Rigid fixation can be achieved with compression screws, K-wires, and plate constructs. The surgeon has a choice of various bone graft options including corticocancellous, cancellous, and strut grafts to promote healing and correct the humpback deformity. (Source: Hand Clinics)
Source: Hand Clinics - September 15, 2023 Category: Orthopaedics Authors: Erin A. Miller, Jerry I. Huang Source Type: research
Scaphoid Nonunions
If untreated, scaphoid nonunions may progress to scaphoid nonunion advanced collapse in a substantial portion of cases and may require salvage procedures. Multiple different techniques have been described to address scaphoid nonunion. Vascularized bone flaps (VBFs) are associated with faster time to union compared with nonvascularized grafts. Because these are local pedicled flaps, they do not require microsurgical anastomoses and should be within the armamentarium of all hand surgeons. Appropriately chosen local VBFs, can achieve union rates up to 90% to 100% in appropriately selected patients. (Source: Hand Clinics)
Source: Hand Clinics - September 14, 2023 Category: Orthopaedics Authors: Justin C. McCarty, Ryoko Hamaguchi, Kyle R. Eberlin Source Type: research
The Foot as a Donor Site for Reconstruction in the Hand
The foot contains a unique collection of tissue types that can be used in the reconstruction of the hand. Numerous reconstructive options have been presented, some of which have been adopted, such as modifications to procedures that have been described in the past or even newly developed options for hand reconstruction. It is possible to reconstruct missing fingers and other hand structures using tissues taken from the foot rather than removing healthy tissue from a hand that has already been injured. This makes it possible to avoid having healthy tissue removed from an injured hand. (Source: Hand Clinics)
Source: Hand Clinics - September 14, 2023 Category: Orthopaedics Authors: Jorge G. Boretto, Fernando Holc, Pedro Bronenberg Victorica Source Type: research
Metacarpal and Phalangeal Malunions-Is It all About the Rotation?
Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger alignment including malrotation and severe angulation as well as intra-articular deformities can lead to functional deficits which may benefit from operative intervention. There are numerous surgical options to correct malunions and the correct choice varies based on the injury pattern, concurrent injuries/complications, and surgeon ’s preference. While these surgeries can be technically demanding, successful treatment can lead to good results with satisfactory ...
Source: Hand Clinics - September 13, 2023 Category: Orthopaedics Authors: Jeremy E. Raducha, Warren C. Hammert Source Type: research
Recent Advances in Upper Extremity Microsurgery
The upper extremity has unique functional and aesthetic requirements. Reconstruction of upper extremity soft tissue defects should ideally provide coverage for vital structures, facilitate early mobilization, be thin and pliable to match its slim contour, and reestablish sensation. Perforator flaps can be raised on the superficial fascia, which creates a thin and pliable yet durable and supple flap option to match the contour and functional needs of the upper extremity. Comparisons to traditional reconstructive methods should be performed to assess whether these innovations in microsurgical reconstruction of upper extremit...
Source: Hand Clinics - September 13, 2023 Category: Orthopaedics Authors: Widya Adidharma, Kevin C. Chung Source Type: research
Evolution and Diversity of Medial Sural Artery Perforator Flap for Hand Reconstruction
The free medial sural artery perforator (MSAP) flap is a recently popularized flap. It has evolved from a composite myocutaneous flap to a pedicled perforator flap for lower limb reconstruction. It is also a versatile free perforator flap for extremity and head and neck reconstruction. The diversity of the flap designs with options for harvest of non-vascularized grafts enhances the versatility for hand and upper limb reconstruction. The adjunctive use of endoscopy and indocyanine green fluorescence imaging studies can assist and demystify the flap anatomy. The authors present their experience using free MSAP flaps for com...
Source: Hand Clinics - September 13, 2023 Category: Orthopaedics Authors: Yun-Huan Hsieh, Hao-I Wei, Chung-Chen Hsu, Cheng-Hung Lin Source Type: research
Functioning Free Muscle Transplantation to Restore Finger Movement for Sequalae of Volkmann Ischemic Contracture
Volkmann ischemic contracture (VIC) is a devastating condition that results from neglected compartment syndrome, which leads to prolonged ischemia, irreversible tissue necrosis, and various degrees of muscle and nerve damage, causing serious motor and sensory functional implications for the limb and a spectrum of diseases associated with worsening deformities. A thorough understanding of the anatomy and VIC pathophysiology is needed to plan an appropriate strategy. Functioning free muscle transplantation (FFMT) can restore finger movement in a paralyzed limb but requires a three-staged approach to maximize the benefits of ...
Source: Hand Clinics - September 13, 2023 Category: Orthopaedics Authors: Kota Hayashi, David Chwei-Chin Chuang, Tommy Nai-Jen Chang, Johnny Chuieng-Yi Lu Source Type: research
Evolution and Application of Ultrasound for Flap Planning in Upper Extremity Reconstruction
Accurate preoperative localization of dominant perforators provides crucial information about their location and diameter, leading to reduced surgical time, improved flap viability, and decreased complications. Ultrasound has increased in popularity in recent years, with the advantages of providing reproducible, accurate, cost-effective, and real-time information while reducing radiation exposure. Precise preoperative mapping of perforators allows for rapid and safe elevation of suprafascial, thin, and superthin flaps. This review focuses on the role of ultrasound as a tool for preoperative flap planning in the upper extre...
Source: Hand Clinics - September 11, 2023 Category: Orthopaedics Authors: Ramin Shekouhi, Harvey Chim Source Type: research
Simultaneous or Delayed Free Tissue Transfer in Combination with Replantation Surgery
In hand and upper extremity replantation surgery, simultaneous free flap reconstruction restores the physiologic circulation to the amputated part, ensuring its survival, and promotes wound healing through anatomic restoration. Especially in digit replantation, an arterialized venous flap serves to reconstruct both vessel and soft tissue defects simultaneously. Delayed free flap reconstruction aims to enhance both functional improvement and cosmetic acceptance in a successfully replanted part using flaps that include functioning muscle, bone, joint, nerve, and soft tissue. (Source: Hand Clinics)
Source: Hand Clinics - September 11, 2023 Category: Orthopaedics Authors: Soo Jin Woo, Kwang Hyun Park, Sang Hyun Woo Source Type: research
Pediatric Forearm Malunions
The aim of this article is to review the evaluation and management of pediatric forearm malunions. Acceptable parameters for nonoperative management of pediatric forearm fractures are reviewed, followed by clinical and imaging workups of malunions and decision-making points for treatment. The landscape of available technology for planning and execution of corrective osteotomy is discussed. Several cases of pediatric forearm malunion are presented, along with surgical and functional outcomes. Recommendations are given regarding the authors ’ preferred approach for management of pediatric forearm malunions. (Source: Hand Clinics)
Source: Hand Clinics - September 11, 2023 Category: Orthopaedics Authors: Shea Ray, M. Claire Manske Source Type: research
Alternative Flap Options for Upper Extremity Reconstruction
For major upper limb defects, a wide range of established pedicled and free flap options can be used. These include the latissimus dorsi/thoracodorsal artery perforator, lateral arm, posterior interosseous artery, rectus abdominis, gracilis, and anterolateral thigh flaps. Technical proficiency is essential, and favorable success rates in terms of functional and esthetic outcomes can be achieved. Herein, alternative flap options (both pedicled and free) are introduced and discussed through a few illustrative case examples. (Source: Hand Clinics)
Source: Hand Clinics - September 6, 2023 Category: Orthopaedics Authors: Yanis Berkane, Riccardo Giorgino, Zhi Yang Ng, Ruben Dukan, Alexandre G. Lellouch Source Type: research
Distal Radius Nonunions
Although distal radius fractures are common injuries, nonunion is extremely rare. Nonunion has been associated with increased metaphyseal comminution, concomitant distal ulna fracture, inadequate immobilization, and patient factors. Nonunion should be suspected in patients with persistent pain, limited range of motion, and worsening wrist deformity after wrist remobilization. Treatment selection depends on presence of infection, status of the radiocarpal and distal radioulnar joints, and type of prior surgical interventions. Multiple surgical techniques exist for managing distal radius nonunions including open reduction an...
Source: Hand Clinics - September 4, 2023 Category: Orthopaedics Authors: Sofia Bougioukli, Kevin C. Chung Source Type: research
