Solo hand surgery

Unassisted hand surgery is being undertaken by necessity for both elective and emergency cases, due to hospital resource restrictions. The authors outline the principles of local anesthesia, surgeon-controlled tourniquet techniques, and a number of new instruments which allow a surgeon to work in comfort and safety, unassisted. The traditional surgical instruments designed for the days when trained surgical assistants were available to hold them are no longer suitable. We are entering a new era of surgical design with safer instruments that can complement our skills rather than challenge them. There are significant cost savings and efficiency when hand procedures are undertaken in the emergency and outpatient clinic settings.     

Hand Surgery in Different Countries: Hand Surgery in New Zealand

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.     

Hand Surgery in Different Countries: Hand Surgery in Japan

Japan has faced the most challenging times in the past. Through precise diligence by stalwarts and doyens of initial hand surgeons, it led an incredible path for the most significant moments of hand surgery. This article describes the early phase of development of Japanese Society for Surgery of the hand, substantial and innovative contributions from surgeons. A noteworthy and significant achievement in the hand surgery is microsurgery and its utilities for all hand-related diseases. The first replantation of the thumb, toe transfers and wrap-around flaps are the effective surgical techniques developed and imparted to the fellow hand surgeons worldwide. We had a particular interest in congenital hand surgery and developed a modification of congenital hand classifications and introduced many surgical techniques. Besides, we grew ourselves refining more in hand and microsurgery, innovating flexor tendon repair, peripheral nerve surgeries, wrist arthroscopy, joint replacements, external fixators, and implant arthroplasty for rheumatoid hand. We share our health care information, insurance working model and hand surgery training schedule in Japan.     

Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review

Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors’ aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a “Weak” global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.     

Reconstruction of the hand with wide awake surgery

Wide awake hand surgery means no sedation, no tourniquet, and no general anesthesia for hand surgery. The only medications given to the patient are lidocaine with epinephrine. Lidocaine is for anesthesia, and epinephrine provides hemostasis, which deletes the need for a tourniquet. The advantages are: (1) the ability of the comfortable unsedated tourniquet-free patient to perform active movement of the reconstructed structures during surgery so the surgeon can make alterations to the reconstruction before the skin is closed to improve the outcome of many surgeries; and (2) the deletion of all risks, costs, and inconveniences of sedation and general anesthesia.     

ECHINOIDEA TENOSYNOVITIS

Suppurative tenosynovitis involving the digital fibrous flexor sheaths in the hand can be a devastating problem. A case is reported of tenosynovitis resulting from Echinoidea sp. (sea urchin) spines. The need for awareness of flexor sheath penetration is stressed. Early aggressive operative intervention by a hand surgeon will minimize the subsequent morbidity.     

Duplicate publication in the Journal of Hand Surgery

This study evaluates the extent of duplicate publication in the Hand Surgery literature. A retrospective review of original articles published in the American and the British & European editions of Journal of Hand Surgery during the years 1999 and 2000 was performed using MEDLINE (PUBMED) search engine. Index articles suspected of dual publication were identified by using key words in the title and the names of the first, second and last authors. The full initial text was carefully studied and suspected duplicate articles were classified as dual, potentially dual or fragmented. Six hundred articles were evaluated, of which 25 (4%) index articles were identified with 33 "suspects". Eleven "index" and 15 "suspected" articles were cleared on closer scrutiny. Thus 14 "index" articles (2%) were found to be associated with 18 duplicated articles. Of these, four were classified as dual, five as potentially dual and nine as fragmented. We conclude that although duplicate publication of articles in the Journals of Hand Surgery (American and British/European Volumes) does occur, the incidence in the sample studied is lower than some other surgical journals.     

Hand Surgery in Different Countries: Hand Surgery in Saudi Arabia

Hand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.     

手外科出院患者回顾性流行病学调查

目的了解手显微外科创伤住院病人的来源、伤因、医疗费用等，为预防、科研及有关部门提供参考数据。方法设计调查内容表，抽调手外科2002年1月1日～12月31日出院的所有病例，入选标准为创伤后2周以内住院病例。结果入选病例共331例，年龄3～94岁，平均35．9岁。其中开放伤234例，占70．7％；闭合伤97例，占29．3％。20～40岁男178例，占53．8％。受伤性质：压砸捻挫伤173例，占52．3％；切割伤81例，占24．5％；撕脱伤9例，占2．7％；烧炸伤3例，占0．9％；生物伤2例，占0．6％；其他（主要为居家跌倒伤）64例，占19．3％。平均住院天数为15．3天。住院病人均次费用4558元，药比率23％。结论（1）本组病人的平均年龄约36岁，20～40岁青壮年占一半以上，对劳动力损失较大。（2）夏季及晨、晚问的受伤比例较高；可能与高温、倒时差作业疲劳、光线暗淡等有关，应开展有针对性的研究。（3）加强车间、工地的安全设施及安全教育，加强就业培训、改善居家老人的生存状况，可明显减少创伤的发生。     

The first description of the absence of the palmaris longus muscle

Background: While Realdo Colombo from Cremona, Italy has, to date, been acknowledged to be the first to describe the possible absence of the palmaris longus muscle in men in 1559, the authors found this absence to be recorded in the first edition of “De Humani Corporis Fabrica Libri Septum” by Andreas Vesalius, published in 1543. Method: To commemorate Vesalius’ 500th birthday, this earlier record is quoted and discussed. Results and conclusion: It remains unknown whether the observation on the absence of the palmaris longus was first done by Vesalius or was based on joined work by Vesalius and Colombo.     

Hand Surgery in Different Countries: Hand Surgery in Cambodia

As a lower middle-income nation, Cambodia has made significant improvements in basic health but hand surgery development continues to lag behind due to scarcity of trained and quality surgical manpower. Most of the hand surgery development locally has been due to surgical volunteers from Asia, Europe, and the United States. The introduction of a structured and systematic community-oriented hand surgery training over a 5-year period was successful in producing local surgeons to meet the basic needs of hand surgery patients. Brachial plexus surgery has benefited significantly, with local surgeons able to independently manage cases with minimal support. With the expansion of local surgical manpower and guidance, motivation, and assistance of regional hand surgeons, the future of hand surgery in Cambodia looks promising.     

Can Brief Interventions by Hand Surgeons Influence Medical Students Toward a Career in Hand Surgery?

PURPOSE: In 2004, the American Society for Surgery of the Hand and the American Association for Hand Surgery formed a joint task force to deal with the difficulty of promoting hand surgery as a career choice to medical students. The purpose of this study was to use a previously validated format to expose medical students to a brief intervention early in their medical education that might influence their perceptions of hand surgery as a career choice. METHODS: First-year medical students were asked to rank 11 items on a Likert scale from 1 (not important) to 5 (very important) regarding their beliefs about hand surgery as a career before and after a brief 1-hour presentation by a hand surgeon. Additional information about career choice and prior exposure to hand surgery was obtained before the intervention, and student interest in hand surgery was measured after the intervention. RESULTS: Of 110 first-year medical students, 72 (65%) students completed both the pre-lecture survey and the post-lecture survey. Of the 72 students with matched responses, 8 (11%) ranked surgery as their first career choice, whereas 13 (18%) ranked a surgical subspecialty as their first choice. Thirty-nine (54%) students stated that the lecture raised their interest in hand surgery as a possible career, and 36 (50%) were interested in doing an elective in it while in medical school. Nonparametric tests showed improvement in knowledge after the lecture for length of training, technical aspects, intellectual challenge, and fellowship requirements. CONCLUSIONS: A positive information-providing encounter with a hand surgeon may favorably influence the perceptions of first-year medical students toward hand surgery.