Perceptions of Hand Surgery Patients About Occupational Therapy.

Purpose: Occupational therapists provide holistic health care and social care and seek to promote health through occupation. This study measured how hand surgery patients who received referrals for occupational therapy perceive occupational therapy and occupational therapists. Methods: A cross-sectional online survey was designed to determine the meaning of an occupation, the role of occupational therapists, the services and benefits provided by occupational therapists, the populations served, and the work settings of occupational therapists. Results: This study included 634 patients who responded to the survey (three-fourths were women). Most participants were uncertain about the professional environment of occupational therapists. Approximately one-third of the respondents believed that occupational therapists work at general hospitals. Most participants believed that occupational therapists manage orthopedic conditions and hand injuries; however, the least participants believed that occupational therapists manage cases involving cardiorespiratory conditions. No significant correlation was noted between the participants' overall awareness of occupational therapy and their sex or age. However, a notable statistical relationship was found between the comprehensive knowledge of occupational therapy and the educational level of the participants. Conclusions: To receive the benefits of occupational therapy, it is necessary for the population to be aware of those benefits. Clinical relevance: Patient perspectives of occupational therapy can help in patient's education and their treatment plan.

Pyogenic granuloma of the thumb mimicking squamous cell carcinoma of the nail subunit: case report and review of the literature.

Pyogenic granuloma (PG) is a benign vascular lesion that usually occurs in the skin or mucous membranes. Multiple theories have been implicated in its aetiology. It can mimic variable malignancies in which histopathological examination plays a vital role. We report a case of PG of the left thumb nail subunit in a 40-year-old gentleman, who presented with left thumb mass after a trauma by a wooden splinter. Incisional biopsy of the lesion could not rule out squamous cell carcinoma. Therefore, full radiological studies were carried out as part of this highly suspicious lesion's work-up. Excisional biopsy was performed and a full thickness skin graft was harvested from the left distal forearm and applied to cover the defect. Final histopathological examination revealed the diagnosis of PG. The wound subsequently healed well with good functional and aesthetic outcome.

Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm.

Self-inflicted hand injuries have been described in the literature with varying nomenclature (factitious, malingering, and self-induced hand injuries). Identifying and treating these patients is complex and requires a multidisciplinary team approach at a high cost. There is a lack of literature that describes the different patterns and characteristics of hand injuries among military personnel, especially in Saudi Arabia. We conducted a chart review study involving military personnel who attended the emergency department with hand injuries in Saudi Arabia to fill this gap. Methods: This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. Results: A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Conclusions: Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.

Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand.

Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness. METHODS: This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up. RESULTS: There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%-100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up. CONCLUSION: The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.

Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients.

BACKGROUND: Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries. METHODS: This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients' clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study. RESULT: Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases. CONCLUSIONS: In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.