Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial.

The aim of this double anonymized, randomized controlled trial was to determine whether total joint arthroplasty has superior outcomes than trapeziectomy 1 year after surgery for trapeziometacarpal osteoarthritis. A total of 62 women aged 40 years and older, scheduled for surgery for stage II or III osteoarthritis of the trapeziometacarpal joint, were included and randomized to trapeziectomy or total joint arthroplasty. The primary outcome was the total score of the Michigan Hand Outcomes Questionnaire. Secondary outcomes were the Michigan Hand Outcomes Questionnaire subscale scores, Disability of the Arm, Shoulder and Hand Questionnaire, active range of motion, strength, return to work, patient satisfaction and complications. Data were collected at baseline and at 3 and 12 months. At 1 year, we found no superiority of total joint arthroplasty over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire. The total joint arthroplasty did show a significant advantage in strength and range of motion.Level of evidence: I.

[Local anaesthetics containing epinephrine for use in the hand and fingers]. / Lokale anesthesie met adrenaline in hand en vingers.

In the Netherlands there is no consensus regarding the addition of epinephrine (adrenaline) to local anaesthetics for use in the fingers. This is based on the persistent belief that the addition of epinephrine to local anaesthetics for use in the fingers is contraindicated due to the risk of ischaemic complications. Ischaemic complications arising from the use of modern anaesthetics containing epinephrine have, however, never been described. The addition of epinephrine results in a reduced arterial blood-flow and has several benefits, such as reduced blood loss and extended duration of anaesthesia. Local anaesthesia containing epinephrine enables relatively extensive surgical procedures to be carried out on the extremities without the customary use of a tourniquet. Preoperative threat of reduced circulation in the fingers is a contraindication for the use of local anaesthetics with added epinephrine.

The unilateral deep inferior epigastric perforator flap: comparing university to community hospital.

The deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. This study evaluates the outcome of unilateral DIEP flap reconstructions, comparing university with a community hospital setting. A total of 77 unilateral DIEP flaps were performed at one university hospital and two community hospitals by the same two surgeons. Outcome parameters were: hospital stay, operating time, wound infection, wound dehiscence, fat necrosis, haematoma, (partial) flap necrosis and the need for surgical intervention. Forty-nine unilateral DIEP flaps were performed in the university hospital and 28 in the community hospitals. Baseline characteristics were equal. No significant difference was found in total complication rate, flap loss or need for surgical intervention. Although wound dehiscence occurred more often in the community hospitals, unilateral DIEP flap breast reconstructions can be performed with a comparable degree of safety and complication risk in both university and community hospital settings.

Substantial chest-wall deformity following tissue expansion after radiotherapy.

We present the case of a 54-year-old woman who underwent a two-stage breast reconstruction with a tissue expander after sustaining a lumpectomy and local radiotherapy for breast cancer. During expansion, the woman developed an abnormal concave deformity of the chest wall. Although respiratory or aesthetic consequences were expected, our patient reported only pain and was satisfied with the end result. Osteoporosis or local recurrence was excluded as predisposing factors, and radiotherapy was considered to be the causal factor in our patient. On the basis of this finding, we advise surgeons to take the risk of chest-wall deformity into consideration when planning a reconstruction with tissue expanders, especially in patients with a history of radiotherapy, and we recommend an alternative reconstructive method in this group of patients.