• Archives of Plastic Surgery
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• 제48권4호
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• pp.389-391
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• 2021

Solo hand surgery is becoming increasingly common, mostly due to a lack of assistants and dedicated operating theatres. The solo hand surgeon faces challenges of proper hand positioning, elevation, and skin flap/tissue retraction. Most commercially available hand retractors or stands do not address all the relevant problems and are not economically feasible for trainee surgeons. The Jain's hand retractor system and stand, described herein, provides solutions to all these problems, and its simple design helps surgeons to reproduce it easily.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.119-120
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• 2023

• Archives of Plastic Surgery
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• 제42권3호
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• pp.365-367
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• 2015

• Archives of Plastic Surgery
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• 제44권5호
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• pp.428-433
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• 2017

Background Candidate characteristics for hand surgery fellowship training remains unknown, as very little data is available in the literature. This study aims to provide information on the criteria that are employed to select candidates for the hand surgery fellowship match. Methods A 38-question survey was sent in April 2015 to all Accreditation Council for Graduate Medical Education recognized hand surgery fellowship program directors (n=81) involved in the U.S. match. The survey investigated factors used for the selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from "not at all important" (1) to "essential in making my decision" (5); or for five controversial factors from "very negative impact" (1) to "very positive impact in making my decision" (5). Results A total of 52% (42 out of 81) of responses were received from hand surgery fellowship program directors. The most important influential factors were interactions with faculty during interview and visit ($4.6{\pm}0.6$), interpersonal skills ($4.6{\pm}0.5$), overall interview performance in the selection process ($4.6{\pm}0.6$), professionalism and ethics ($4.6{\pm}0.7$), and letters of recommendation from hand surgeons ($4.5{\pm}0.7$). Factors that have a negative impact on the selection process include visa requirement ($2.1{\pm}1.2$), graduate of non-plastic surgery residency program ($2.4{\pm}1.3$), and graduate of a foreign medical school ($2.4{\pm}1.1$). Conclusions This study provides data on hand surgery fellowship directors' perception on the criteria important for fellowship applicant selection, and showed that interview-related criteria and letters of recommendation are the important factors.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.278-281
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• 2021

Facial palsy (FP) is a functional disorder of the facial nerve involving paralysis of the mimic muscles. According to the principle "time is muscle," early surgical treatment is tremendously important for preserving the mimic musculature if there are no signs of nerve function recovery. In a 49-year-old female patient, even 19 months after onset of FP, successful neurotization was still possible by a V-to-VII nerve transfer and cross-face nerve grafting. Our patient suffered from complete FP after vestibular schwannoma surgery. With continuous application of electrostimulation (ES) therapy, the patient was able to bridge the period between the first onset of FP and neurotization surgery. The significance of ES for mimic musculature preservation in FP patients has not yet been fully clarified. More attention should be paid to this form of therapy in order to preserve the facial musculature, and its benefits should be evaluated in further prospective clinical studies.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.312-316
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• 2014

This is a review article of the wide-awake approach to hand surgery. More than 95% of all hand surgery can now be performed without a tourniquet. Epinephrine is injected with lidocaine for hemostasis and anesthesia instead of a tourniquet and sedation. This is sedation-free surgery, much like a visit to a dental office. The myth of danger of using epinephrine in the finger is reviewed. The wide awake technique is greatly improving results in tendon repair, tenolysis, and tendon transfer. Here, we will explain its advantages.

• 대한족부족관절학회지
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• 제8권2호
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• pp.195-198
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• 2004

Purpose: To compare clinical characteristics of ganglions in hand & Foot. Materials and Methods: Seventeen cases of ganglions located in foot and fifty-five cases in hand. Excised from Mar.1988 to Apr.2003, were included in the study. The clinical characteristics and recurrence ratio were evaluated Results: The mean size of 2.2 cm in hand and 2.5 cm in foot. The most common area of ganglions are dorsum of foot and wrist. The cosmetic problem of palpable mass is the primary chief complaint of ganglions on hand and the pain is that of foot. The recurrence was found in 5 cases in hand and 4 cases in foot. The recurrence was related to incomplete excision of ganglion in foot and the large size of ganglion and incomplete excision of ganglion in hand. Conclusion: recurrence ratio in the cases of foot is higher than that of hand. The ganglions in foot and hand need to treated by meticulous surgical excision to prevent the recurrence.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.614-618
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• 2015

Background Hand strength deficit following digital replantation is usually attributed to the mechanical deficiency of the replanted digit. Zone 1 replantation, however, should not be associated with any mechanical deficit, as the joint and tendon are intact. We evaluate shortterm motor functions in patients who have undergone single-digit zone 1 replantation. Methods A single-institution retrospective review was performed for all patients who underwent zone 1 replantation. Hand and pinch strengths were evaluated using standard dynamometers. Each set of measurements was pooled according to follow-up periods (within 1 month, 1 to 2 months, 2 to 3 months, and after 3 months). The uninjured hand was used as reference for measurements. Results The review identified 53 patients who had undergone zone 1 replantation and presented for follow-up visits. Compared to the uninjured hand, dynamometer measurements revealed significantly less strength for the hand with replanted digit at one month. The relative mean grip, pulp, and key pinch strength were 31%, 46%, and 48% of the uninjured hand. These three strength measurements gradually increased, with relative strength measurements of 59%, 70%, and 78% for 4-month follow up. Conclusions Despite the lack of joint or tendon injury, strength of the injured hand was significantly lower than that of the uninjured hand during the 4 months following replantation. Improved rehabilitation strategies are needed to diminish the short-term negative impact that an isolated zone 1 replantation has on the overall hand strength.

• Archives of Plastic Surgery
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• 제40권2호
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• pp.129-133
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• 2013

Background A pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent technique in hand surgery without a tourniquet. Methods Seven patients (age range, 4 months to 37 years) underwent hand or upper extremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury, contracture, constriction ring syndrome, or acrosyndactyly. A "one-per-mil" tumescent solution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline) was used to create a bloodless operating field without a tourniquet. Observation was performed to document the amount of solution injected, the operation field clarity, and the postoperative pain. Results The "one per mil" epinephrine solution showed an effective hemostatic effect. The tumescent technique resulted in an almost bloodless operation field in the tendon and in the constriction ring syndrome surgeries, minimal bleeding in the flap and contracture release surgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injected ranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeries showed mixed results. One flap was lost, while the others survived. Conclusions Epinephrine 1:1,000,000 in saline solution is a potential replacement for a tourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.60-64
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• 2016

Segmental amputation of the digits and hand has been described as a contraindication for replantation because of poor results. We report the results of replantation for a patient who experienced multi-segment amputation of the hand. A 39-year-old man presented six hours after an accident, while using a straw cutter, that caused a multi-segment amputation of the entire palm and digits. The replantation surgery took 18 hours. We observed the patient gain satisfactory function of the hand. For replantation of a multi-segment amputation, connecting as many blood vessels as possible without tension is most important.