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1.
Syst Rev ; 12(1): 218, 2023 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-37974291

RESUMO

Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.

3.
Hand Surg Rehabil ; 41(3): 311-316, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35065270

RESUMO

Wide awake local anesthetic no tourniquet (WALANT) is gaining popularity amongst hand surgeons. Digital adrenaline use has been shown to be safe in multiple studies and the misconception forbidding it is receding. Phentolamine has been shown to safely reverse the effects of adrenaline should the feared complication of digital ischemia occur. A survey was circulated to 40 specialist practitioners who regularly perform hand procedures at a major tertiary plastic and hand surgery unit. Knowledge and understanding of WALANT, onset and duration of adrenaline effects and reversal was assessed. Whilst the majority of respondents (80%) recognized digital adrenaline use as safe, only 65% were aware of the delay until adrenaline takes full effect. Similarly, only 25% of respondents were aware of the duration of effect of adrenaline. Half of respondents were aware that phentolamine is the established reversal agent for adrenaline with only 20% knowing the correct dose. Given the lack of clinician knowledge surrounding adrenaline and its reversal, we feel that to safely undertake WALANT surgery at our Unit a WALANT protocol must be implemented. Drawing on the successes in the airline industry, a variety of safety frameworks have been established to deliver targeted education for prevention and eventual management of predictable risks. We plan to develop a checklist style protocol targeting the knowledge gaps raised in the survey. This will educate and equip all practitioners working with adrenaline with the knowledge to safely manage complications should they occur. LEVEL OF EVIDENCE: Level 5 (UK Oxford Centre for Evidence based Medicine (CEBM) Levels of Evidence).


Assuntos
Anestesia Local , Anestésicos Locais , Anestesia Local/métodos , Contraindicações , Epinefrina/uso terapêutico , Mãos/cirurgia , Humanos , Fentolamina/uso terapêutico
4.
Hand Surg Rehabil ; 41(1): 125-130, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34700023

RESUMO

Operative repair of flexor tendons after traumatic injury may be performed under general anesthesia (GA), regional blocks, or a wide-awake local anesthesia no tourniquet (WALANT) technique. To our knowledge there are currently no large-scale reports evaluating outcomes of flexor tendon repair in patients where wide-awake anesthesia was utilized in comparison to regional anesthesia (RA) and general anesthesia. We performed a retrospective analysis of patients who underwent treatment for flexor tendon injuries at a tertiary referral center for hand surgery over a two-year period. A total of 151 patients were included (53 WALANT, 57 RA, and 41 GA) and a total of 251 tendons were repaired (63 WALANT, 104 RA and 84 GA). No statistically significant difference was observed in rates of tendon rupture, adhesions, infection, or hand function. Flexor tendon repair under WALANT is found to be safe and presents comparable operative and functional outcomes to more traditional anesthetic techniques. Additional advantages, including the ability to test the repair intraoperatively, patient education, and the potential for boosting theatre efficiency. Further studies, preferably utilizing a randomized trial methodology, may further elucidate the benefits and risks of WALANT versus regional and general anesthesia.


Assuntos
Anestesia Local , Anestésicos Locais , Anestesia Geral , Anestesia Local/métodos , Humanos , Estudos Retrospectivos , Tendões/cirurgia
5.
JPRAS Open ; 29: 71-81, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34189232

RESUMO

Fibro-adipose vascular anomaly (FAVA) is a discrete type of vascular anomaly. We describe our experience managing FAVA at a tertiary level paediatric hospital and offer a treatment algorithm. METHODS: A retrospective review of 27 patients with proven FAVA was undertaken. All patients had undergone MRI and USS evaluation. Patient demographics, presenting concerns, treatment methods, and outcomes were recorded and evaluation with the paediatric outcomes data collection instrument (PODCI) completed a minimum of 12 months after definitive treatment. RESULTS: Mean age at presentation was 8.9 years (range: 9 m-17.4 y) and mean post-treatment follow-up was 7.4 y (range: 2 y-11.6 y). Twenty of 27 lesions affected the lower limb. Severe neurogenic-type pain was present in 23 cases and contractures across joints in 11 cases. Sclerotherapy with sodium tetradecyl sulphate was used in 11 cases, with no improvement in symptoms. Cryoablation provided pain relief in 3/4 cases, but contracture subsequently increased in one patient and pain recurred in another.Fourteen cases underwent surgery (four surgical excisions alone, 10 in combination with other procedures). Three patients required four further surgical procedures that include one amputation for intractable pain and poor function.PODCI evaluations suggest overall good function, with surgical management and interventional radiology that provide comparable results. Surgery did correct deformity. CONCLUSION: If conservative measures or cryoablation fail to achieve symptomatic control, surgical excision should be considered, combined with adjunctive procedures, to correct contractures and balance muscle forces.Relief of pain may compensate for the loss of muscle mass and overall improves function. Multidisciplinary team working is essential.

6.
Hand Surg Rehabil ; 39(6): 580-581, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32795518

RESUMO

Traumatic thumb amputations can seriously jeopardise hand function. Several alternatives for reconstructing an opposable thumb have been described, including distraction osteogenesis, index finger pollicisation and free toe transfer. We present in this article the case of a young male patient that sustained a circular saw injury to his non-dominant thumb which resulted in loss of his distal phalanx. Preserving the sensate pulp allowed later reconstruction with an on-top free second toe transfer achieving a satisfactory outcome.


Assuntos
Amputação Traumática/cirurgia , Procedimentos Ortopédicos/métodos , Polegar/cirurgia , Dedos do Pé/transplante , Humanos , Masculino , Polegar/lesões , Adulto Jovem
9.
J Hand Surg Eur Vol ; 41(3): 281-94, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26179866

RESUMO

UNLABELLED: Toe-to-hand transfer is an acceptable treatment option for children born with absent digits. Toe transfer can provide functionally useful digits and may enhance patient wellbeing. A total of 19 children had 31 free second-toe-to-hand microsurgical transfers between 1998 and 2012. The mean age of these children at the time of the first operation was 45 months. All transferred toes survived. The donor site was satisfactory in all 19 patients. Twelve children (19 toes) attended a special review clinic; all children could grasp large objects (Duplo bricks) after toe transfer. The total passive range of motion was greater than total active range of motion by an average of 54 degrees. Static 2-point discrimination was generally excellent (mean = 5 mm). Eleven out of 12 children strongly agreed that their toe transfer had improved hand function. Microsurgical toe-to-hand transfer is a safe and reliable technique that can provide useful function for children with congenital differences. Our series compares favourably with the published literature. LEVEL OF EVIDENCE: IV.


Assuntos
Dedos/anormalidades , Deformidades Congênitas da Mão/cirurgia , Microcirurgia , Procedimentos de Cirurgia Plástica , Dedos do Pé/transplante , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Força da Mão , Humanos , Lactente , Masculino , Amplitude de Movimento Articular , Resultado do Tratamento
11.
J Hand Surg Eur Vol ; 40(9): 973-85, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25770899

RESUMO

Tissue engineering is believed to have great potential for the reconstruction of the hand after trauma, congenital absence and tumours. Due to the presence of multiple distinct tissue types, which together function in a precisely orchestrated fashion, the hand counts among the most complex structures to regenerate. As yet the achievements have been limited. More recently, the focus has shifted towards scaffolds, which provide a three-dimensional framework to mimic the natural extracellular environment for specific cell types. In particular their surface structures (or topographies) have become a key research focus to enhance tissue-specific cell attachment and growth into fully functioning units. This article reviews the current understanding in hand tissue engineering before focusing on the potential for scaffold topographical features on micro- and nanometre scales to achieve better functional regeneration of individual and composite tissues.


Assuntos
Mãos/cirurgia , Regeneração , Engenharia Tecidual/métodos , Alicerces Teciduais , Reatores Biológicos , Vasos Sanguíneos/citologia , Osso e Ossos/citologia , Cartilagem/citologia , Humanos , Nanoestruturas , Nervos Periféricos/citologia , Pele/citologia , Propriedades de Superfície , Tendões/citologia
13.
J Hand Surg Eur Vol ; 40(9): 900-12, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25320122

RESUMO

UNLABELLED: Minimal important changes and differences describe the smallest changes and differences between individuals that are relevant to patients following treatment. Minimal important differences may vary between conditions, treatments and lengths of follow-up, and can be calculated in different ways. Minimal important differences for elective hand surgery were reviewed. A total of 99 minimal important differences were identified in 29 articles. The conditions, treatments, outcome measures used and follow-up periods are discussed. The Disabilities of the Arm, Shoulder and Hand had the most estimates of minimal important differences, but these varied. The methods used in the included studies were reviewed and appraised. Most minimal important differences were calculated using retrospective anchors. Future research directions in this area are suggested. LEVEL OF EVIDENCE: II.


Assuntos
Procedimentos Cirúrgicos Eletivos , Mãos/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Humanos , Terminologia como Assunto
14.
J Plast Reconstr Aesthet Surg ; 67(11): 1591-4, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25135398

RESUMO

We describe the use of a free medial sural artery perforator flap to reconstruct a complex composite defect to the dorsum of the right index finger following a low voltage electrical injury. The resulting defect was a 3.5 × 5 cm full thickness wound, with segmental tendon loss and loss of underlying periosteum. Due to both size and local vascular injury related to the mechanism, free tissue transfer was felt to be the most reliable option to resurface the composite defect in a single stage. The medial sural artery perforator flap, for reasons outlined below, was felt to be the best option: 1. Thin profile. 2. Vascularised fascia can be taken as a tongue, adjacent to the skin paddle: a gliding surface to prevent the tendon graft sticking to exposed bone. 3. Long pedicle: micro-anastomosis away from zone of injury. 4. Little donor site morbidity: can be closed directly (if <6 cm wide) and does not require sacrifice of any major blood vessel. 5. Can be harvested with nerve and tendon from the same wound. 6. Can include as little or as much tissue required and compared to other fasciocutaneous flaps matches the texture and thickness of the hand most closely. We describe the reconstruction of the composite defect on day 42 post-injury, following one prior debridement. This case highlights the versatility and suitability of the medial sural artery flap in the reconstruction of complex hand burns with resulting composite defects.


Assuntos
Artérias/cirurgia , Queimaduras por Corrente Elétrica/cirurgia , Traumatismos dos Dedos/cirurgia , Retalho Perfurante/irrigação sanguínea , Procedimentos de Cirurgia Plástica/métodos , Adulto , Humanos , Masculino
18.
Ann R Coll Surg Engl ; 94(4): e141-3, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22613280

RESUMO

Extraskeletal Ewing sarcoma (EES) is a rare soft tissue neoplasm of primitive mesenchymal cells. There is a scarcity of data on EES involving the head and neck, with studies being over years or even decades. We are the first to report a case of EES involving the carotid artery and its subsequent surgical excision and reconstruction.


Assuntos
Doenças das Artérias Carótidas/patologia , Artéria Carótida Primitiva/cirurgia , Sarcoma de Ewing/patologia , Neoplasias Vasculares/patologia , Adulto , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/cirurgia , Neoplasias Vasculares/tratamento farmacológico , Neoplasias Vasculares/cirurgia
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