Conversion Rate of Abstracts Presented at Plastic Surgery The Meeting From 2010 to 2019: A 10-Year Analysis of Factors for Success.

BACKGROUND: Presentations are an important means of knowledge generation. Publication of these studies is important for dissemination of findings beyond meeting attendees. We analyzed a 10-year sample of presented abstracts at Plastic Surgery The Meeting and describe factors that improve rate and speed of conversion to peer-reviewed publication. METHODS: Abstracts presented between 2010 and 2019 at Plastic Surgery The Meeting were sourced from the American Society of Plastic Surgery Abstract Archive. A random sample of 100 abstracts from each year was evaluated. Abstract information and demographics were recorded. The title or author and keywords of each abstract were searched using a standardized workflow to find a corresponding published paper on PubMed, Google Scholar, and Google. Data were analyzed for trends and factors affecting conversion rate. RESULTS: A total of 983 presented abstracts were included. The conversion rate was 54.1%. Residents and fellows constituted the largest proportion of presenters (38.4%). There was a significant increase in medical student and research fellow presenters during the study period (P < 0.001). Conversion rate was not affected by the research rank of a presenter's affiliated institution (ß = 1.001, P = 0.89), geographic location (P = 0.60), or subspecialty tract (P = 0.73). US academics had a higher conversion rate (61.8%) than US nonacademics (32.7%) or international presenters (47.1%) (P < 0.001). Medical students had the highest conversion rate (65.6%); attendings had the lowest (45.0%). Research fellows had the lowest average time to publication (11.6 months, P = 0.007). CONCLUSIONS: Lower levels of training, factors associated with increased institution-level support, and research quality affect rate and time to publication. These findings highlight the success of current models featuring medical student and research fellow-led projects with strong resident and faculty mentorship.

Is the h-Index Enough? A Comprehensive Bibliometric Analysis of 871 Academic Plastic Surgeons and Their Departments/Divisions.

BACKGROUND: In plastic surgery academia, research output is heavily used as a metric of accreditation, from assessing residency applicants to evaluating faculty for promotion. The h index, defined as an author's h papers with at least h citations, is commonly used as a measure of academic success. However, the index itself disfavors junior researchers, favors publication quantity, and discounts highly cited works. Given the importance of bibliometrics within plastic surgery, there is a paramount need to adopt additional metrics to measure research productivity. The authors sought to validate the use of time-independent bibliometrics to complement the h index in measuring citation impact. METHODS: The genders and academic titles of plastic surgeons affiliated with US plastic surgery programs were recorded. Author publications were retrieved from Scopus. Bibliometrics software was used to calculate the following metrics per surgeon: h index, e index, and g index. Time-adjusted versions of these indices were used to correct for the number of years since first publication. Medians and interquartile ranges (IQRs) are reported. Departmental ranks were determined using the cumulative sum of time-corrected indices and compared with Doximity departmental research rankings. P < 0.05 was deemed significant. RESULTS: Indices were calculated for 871 academic plastic surgeons in 85 departments/divisions. Men had statistically greater h index (median, 13.0 [IQR, 7.0-21.0] vs 6.0 [IQR, 3.0-13]; P < 0.001), e index (18.3 [IQR, 10.0-28.7] vs 11.1 [IQR, 5.5-18.4]; P < 0.001), and g index (23.0 [IQR, 11.0-39.0] vs 11.0 [IQR, 5.0-22.0]; P < 0.001) than women. Professors had the highest median time-uncorrected indices. After adjusting for the number of years since an author's first publication, there were no significant differences in m quotient (men: 0.66 [IQR, 0.40-0.98] vs women: 0.57 [IQR, 0.33-0.90]; P = 0.05) and ec index (men: 0.93 [IQR, 0.62-1.3] vs women: 0.87 [IQR, 0.50-1.3]; P = 0.08) between genders. Departmental chairs had significantly higher indices than other faculty after correcting for time. The calculated program rankings were low to moderately correlated with that of Doximity (correlation coefficient τ = 0.49 [95% confidence interval, 0.37-0.59; P < 0.001]). CONCLUSIONS: Men and women have statistically similar citation patterns after correcting for the time. Citation differences between academic levels are less pronounced when controlling for time, suggesting comparable research quality between academic roles.

Ongoing Challenges With Price Transparency in Hospital Charges for Hand Procedures.

In 2020, the Centers for Medicare & Medicaid Services issued a historic rule on price transparency that aimed to better inform Americans about their health care costs by requiring hospitals to publicly provide pricing information on their items and services. In this review article, we describe the current gaps in transparency that persist after the implementation of the rule, from incomplete pricing files to noncompliance despite the issuance of monetary penalties by Centers for Medicare & Medicaid Services. Price transparency is vital for hand and upper extremity procedures, given their cost variation and patient desire for more financial discussions with their physicians regarding these procedures. Further improvements and interventions by various stakeholders are necessary to improve the current state of hospital price transparency and cost information for these patients and for anyone who seeks to make informed health care decisions. Policymakers should enforce stronger financial interventions and penalties and promote the use of bundled payments to facilitate better compliance by hospitals through a more expanded and accessible display of health care service costs. To help increase health care financial literacy among consumers, hand surgeons and hospital staff should engage in more dialog regarding health care prices and financial considerations with their patients.

The Impact of Venous Reconstruction on Finger Replantation Success Rates Based on Level of Injury.

PURPOSE: The requirement for anatomic venous reconstruction in digit replantation is an ongoing area of research. In this study, we evaluated our institutional experience to study whether replantation success is affected by the presence or absence of vein repair, stratified by the level of injury. METHODS: A retrospective review was performed at an urban, level-1 trauma center of all single-digit replantations performed in adults from 2012 to 2021. Patient demographics, injury mechanism, level of injury, whether a vein was repaired, and replant survival were recorded. RESULTS: Sixty-seven single replanted digits were included. Patients were, on average, 38 years old, and 94% were men. The most common mechanism of injury was a sharp laceration (81%). The overall survival rates for all replantations were 68.7% (46/67) and 60% (12/20) for distal finger replantation. Patients with digital replantations at Tamai zone III or more proximal exhibited a 1.8 times increase in survival rates when one vein was repaired versus zero veins (84.4% vs 46.7%). Patients with digital replantations at Tamai zones I and II exhibited similar survival rates. CONCLUSIONS: Replantations at or proximal to the middle phalanx should be repaired with at least one artery and vein to maximize the chance for success. However, for distal finger replantations, artery-only replantation is a viable option when vein anastomosis is not achievable. TYPO OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Rethinking the Need for Nail Plate Removal: A Comparison of the Risks Between Standard Nail Bed Repair and Nonoperative Management.

PURPOSE: Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or nonoperative management. METHODS: A retrospective cohort study was performed of adult patients with nail bed lacerations from 2012 to 2019. Nail bed lacerations were diagnosed in patients with fingertip injuries resulting in subungual hematoma greater than 50% or in any subungual hematoma in the setting of a distal phalanx fracture. All patients included had an intact nail plate. Patients were treated with nail bed laceration repair or nonoperatively without nail plate removal. The primary outcome was the development of a nail deformity. Secondary outcomes included infection, fracture nonunion, and patient-reported functional outcomes using the quick Disabilities of the Arm, Shoulder and Hand score. RESULTS: Thirty-eight patients with nail bed lacerations were treated nonoperatively, and 40 patients were treated with nail bed repair. The average follow-up time was 4.5 weeks in the office. In addition, 1-year evaluation of patients was performed through telephone interview. The patients in the nonoperative group exhibited no statistically significant difference in the calculated risk for nail deformities compared with the nail bed repair group (13% vs 23%, relative risk = 0.58, P = 0.40, 95% confidence interval = 0.42-1.25). There were no significant differences in secondary outcomes or quick Disabilities of the Arm, Shoulder and Hand scores between groups. CONCLUSIONS: The authors observed no meaningful difference in the rate of nail deformities in adult patients who underwent nail bed repair compared with those managed nonoperatively.

Persistent Trigger Finger Due to Tendon Subluxation.

We report the case of an adult patient with persistence of triggering after A1 pulley division in the ring finger, which was caused by flexor digitorum superficialis tendon subluxation. This resolved after longitudinal flexor digitorum superficialis tendon separation.

Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients.

BACKGROUND: Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown. OBJECTIVES: The authors sought to evaluate social media preferences of patients seeking aesthetic surgery. METHODS: We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk). RESULTS: A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred. CONCLUSIONS: The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.

Use of a Purse-String Suture to Reduce Skin Graft Requirements.

BACKGROUND: When a wound cannot be closed in a linear fashion and either a local flap or skin graft is needed, a purse-string suture can be a useful adjunct to wound closure. Local tissue architecture is maintained in cases where clear surgical margins have not been achieved at the time of extirpative skin cancer surgery. We hypothesized that this technique could be applied to a range of wound sizes and locations to avoid or reduce the need for skin grafting. METHODS: We applied a non-absorbable purse-string suture to wounds in 18 patients over a 15-month period and measured the defect size before and after application of the suture intraoperatively. Residual defects were covered with full- or split-thickness skin grafts. Postoperative wound area, scar hypertrophy, partial graft loss and dehiscence following suture removal were additional outcomes. RESULTS: Ten patients achieved primary wound closure with the purse-string suture, while additional skin grafting was required in eight patients. Wounds closed primarily did not re-expand. Skin-grafted subjects had a 53.8% intraoperative wound area reduction but the skin grafts expanded during recovery, and ultimate reduction diminished to 11% on late follow-up. Wounds accounting for this late re-expansion were located on the extremities. CONCLUSIONS: Purse-string sutures are helpful for wound closure in wounds that cannot be closed primarily. They can decrease the size of a skin graft if the wound cannot be closed completely. Wound re-expansion, particularly in extremity defects, may occur following early removal of the tension-bearing purse string.

Sex Bias in Hand Surgery Research.

It has been long recognized that sex-based biases related to participant inclusion exist in research. To help address inequities in research participation, the National Institutes of Health Revitalization Act was passed into law in 1993. Although this act was primarily designed to increase inclusion of females and minorities in research funded by National Institutes of Health, it has also helped raise global awareness of the value of routinely including females and minority groups in research. Subsequent work has demonstrated a continued gap in inclusion of females in medical and surgical research and female animals and cell lines in basic science research. Hand surgeons have recognized that certain conditions have greater incidence in one sex over the other, but there has been no widespread discussion on whether, when, and how sex should be used as an outcomes variable. This review investigated the recent hand surgery literature to assess for equity in inclusion of both sexes in research as well as whether outcomes were analyzed based on sex.

The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.

PURPOSE: To assess the variability of opioid prescription patterns among hand surgeons in a single practice and to attempt to standardize postoperative prescription sizes based on the patient's surgical procedure. METHODS: We performed a preliminary chart review to assess the range of prescription sizes for 4 common hand surgery procedures. A group of hand surgeons agreed to write postoperative opioid prescriptions based on an evaluation of historical prescription patterns. An educational assist device (the pink card) was created to serve as a memory prompt and was given to physicians, midlevel practitioners, and trainees. Subsequent chart reviews of number of pills prescribed were done 3 and 15 months later. RESULTS: After implementation of the pink card, the average postoperative prescription size decreased for all 4 case types by 15% to 48%, reaching statistical significance for 2 of the procedures. Variability in prescription sizes decreased in all cases. There was a trend toward a decreasing number of prescription refills over the course of the study. There was no evidence that patients were obtaining refills from other sources within our multigroup practice. CONCLUSIONS: Although generalized opioid prescription guidelines exist, they lack specificity. Our multimodal approach using a simple educational-assist device and changes to postoperative order sets significantly affected surgeon behavior without evidence of inadequate treatment of pain. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Current uses of botulinum toxin A as an adjunct to hand therapy interventions of hand conditions.

STUDY DESIGN: Literature review. DISCUSSION: Botulinum toxin A, a neurotoxin causing temporary muscle paralysis at the neuromuscular junction, has been used to treat multiple acquired conditions of the hand and upper extremity. Initially approved for use in treating blepharospasm and strabismus in the 1980s, indications have expanded to include spasticity associated with cerebrovascular accidents, vasospastic disorders, focal dystonias, and pain conditions. This article reviews the current literature discussing the efficacy of botulinum toxin A in management of disorders of the hand and upper extremity relevant to hand therapists. LEVEL OF EVIDENCE: NA.

Common Peroneal Nerve and Tarsal Tunnel Release Surgery in an Adolescent Male with Hunter Syndrome: Illustrative Case.

BACKGROUND: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse. OBSERVATIONS: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient's family reported subjective improvement in lower extremity mobility and plantar flexion. LESSONS: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

Background: There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians. Methods: The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages. Results: Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages. Conclusions: Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

Refining Treatment Strategies in Patients With Fingertip Wounds and End-Stage Renal Disease.

BACKGROUND: Individuals with end-stage renal disease (ESRD) and fingertip wounds are at high risk of poor wound healing, ultimately requiring amputations. Optimal performance of upper extremity amputation (UEA) in patients with ESRD is important to decrease complications and minimize total operative procedures needed. This study evaluated outcomes of UEA in patients with ESRD and described risk factors predisposing patients to complications. METHODS: A retrospective analysis of patients receiving nontraumatic UEA for fingertip wounds was conducted, stratified by patients with and without ESRD. Demographics, comorbidities, complications, and hospital course were analyzed between groups for differences. Subanalysis of patients with ESRD was conducted to characterize operative course and predictors of complications. RESULTS: A total of 132 patients were included, 106 controls and 26 with ESRD. Compared with controls, patients with ESRD required more amputations (P < .001) and total operations (P < .001) to achieve wound healing. Patients with ESRD experienced higher rates of postoperative complications (P < .001). Predictors for complications in patients with ESRD were comorbid diabetes (odds ratio [OR]: 45; 95% confidence interval [CI], 1.7-1226.9), vascular disease (OR: 30; 95% CI, 2-441.8), arterial calcification (OR: 18; 95% CI, 1.56-207.5), and presence of a hemodialysis shunt in the affected arm (OR: 18; 95% CI, 1.56-207.5). Within patients with ESRD, initial amputation at, or proximal to, the metacarpophalangeal joint (MCPJ) led to fewer amputations (1.2 vs 2.19, P = .04) and fewer total operative procedures (4.1 vs 6.6, P = .03), compared with initial amputation distal to the MCPJ. CONCLUSION: In nontraumatic fingertip wounds, patients with ESRD had worse operative outcomes than patients without ESRD. More aggressive management of fingertip wounds using earlier and more proximal initial amputations may expedite wound healing in certain high-risk patients with ESRD.

The Effect of Upper Extremity Slings (UESs) on Balance in Young Adults.

INTRODUCTION: Upper extremity slings (UESs) are frequently provided for patients with a hand or forearm injury. However, their effect on balance has not been well explored. We sought to characterize the effect of a UES on balance in young adults. METHODS: Healthy young adult participants with no injuries acting as a proxy for the general young adult patient population using UESs balanced on a BioDex Balance System platform: once while wearing a UES and once without wearing it, to serve as their own control. Participant weight, height, gender, hand dominance, overall stability index, anterior/posterior stability index, and medial/lateral stability index were recorded. Comparisons were analyzed with paired t-tests and linear regression analysis.  Results: No significant difference in the three stability index scores were found between UES and no UES usage. Height and weight were found to have positive significant relationships with the overall stability index during UES usage.  Conclusions: Our study demonstrates the feasibility of assessing balance discrepancies between the sling and nonsling usage in a broader patient population and suggests that height and weight may impact balance negatively during UES use.

An analysis of community-level socioeconomic status effects on pricing transparency and variability of hand surgery procedures.

BACKGROUND: The Hospital Price Transparency final rule requires hospitals to publish pricing information about provided items and services via two methods: a comprehensive machine-readable file (MRF), and a display tool of selected shoppable services. Using MRFs on hospital websites, we examined trends in pricing transparency and variation in association with community-level socioeconomic factors for three common hand surgery procedures among AAMC-affiliated hospitals. METHODS: Available discount cash prices and payer-specific negotiated prices for CPT codes 64721, 26615, and 25111 were recorded. Multivariate analysis was used to stratify hospitals into two groups based on their area's median household income, percent uninsured, and GPCI practice expense scores. Generalized linear mixed effects modeling was used to evaluate price variability against community-level financial characteristics of the patient population. RESULTS: Of hospitals that met selection criteria, a majority did not display discount cash prices and payer-specific negotiated prices for the three procedures. Hospitals in lower-income and higher percentage uninsured areas tended to charge a higher average payer-specific negotiated price for CPT code 25111. They also tended to have greater variation in payer-specific negotiated prices than hospitals found in higher-income and lower percentage uninsured areas. CONCLUSIONS: This study demonstrates that considerable pricing variation and incomplete transparency exists for CPT codes 64721, 26615, and 25111 among AAMC-affiliated hospitals. Patients in lower-income and higher-percentage uninsured areas are more exposed to a higher variability and average of negotiated prices than those in higher-income areas, which may translate to higher out-of-pocket costs for those with higher coinsurance and less socioeconomic prowess.

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis.

BACKGROUND: Pyogenic flexor tenosynovitis (PFT) has been considered a surgical emergency. Varying operative approaches have been described, but there are limited data on the method, safety, and efficacy of nonoperative or bedside management. We present a case series where patients with early flexor tenosynovitis are managed using a limited flexor sheath incision and drainage (I&D) in the emergency department (ED) to both confirm purulence within the flexor sheath and as definitive treatment. METHODS: A retrospective study of all patients clinically diagnosed in the ED with flexor tenosynovitis at our institution from 2012 to 2019 was performed. Patients with frank purulence on examination were taken emergently to the operating room (OR). Patients with equivocal findings underwent limited flexor sheath I&D in the ED. Safety and efficacy were studied for patients with early flexor tenosynovitis managed with this treatment approach. RESULTS: Thirty-four patients met the inclusion criteria. Ten patients underwent direct OR I&D, and 24 patients underwent ED I&D. In the ED I&D group, 96% (24 of 25) of patients did not have frank purulence in the flexor sheath and were managed with bedside drainage alone. There were no procedural complications and no need for repeat operative intervention. Time to intervention (3.1 hours vs 8.4 hours) was significantly shorter for the ED I&D group compared with the OR I&D group. Within the ED I&D group, 86% of patients exhibited good/excellent functional scores. CONCLUSIONS: Limited flexor sheath I&D in the ED provides a potential safe and effective way to manage patients with early flexor tenosynovitis.

Current trends in hand surgery.

Hand surgery became an established subspecialty between World Wars I and II. Prior to this time, hand injuries were cared for by various specialists-neurosurgeons, plastic surgeons, orthopedic surgeons, and general surgeons-each of whom would focus on their particular tissue within the hand. With the nearly 90,000 hand injuries sustained during World War II, military hospitals were created to deal solely with hand injuries, and hand specialists began to treat the hand as a single functional organ. This article briefly reviews the origin of the field and discusses current trends in hand surgery.

Patient-Provider Communication on Concerns Related to Sexuality Following Upper Extremity Surgery.

BACKGROUND: Sexuality and sexual health are important components of overall quality of life that can be affected by injuries, operations, and disease processes. Much of the research into health-related sexuality has been devoted to patients with spinal cord injuries and urogenital disease processes. There is very little research on the relationship of upper extremity injuries and their impact on a patient's sex life. The purposes of this study are to assess the proportion of patients who experience sexual limitation following upper extremity surgery and to assess the frequency of discussions regarding their sexual function with their surgeons. METHODS: This was a prospective study of a cohort of patients who had hand, shoulder, or arm surgery more than 6 weeks prior to study recruitment. Patients were approached during a follow-up visit with their hand surgeon and were provided with an deidentified survey that focused on upper extremity function, impact of upper extremity injury or surgery on sexual satisfaction, and patient-physician communication surrounding the topic. RESULTS: Of the patients surveyed, 11 (39%) reported that their upper extremity injury frequently negatively affected their sexual satisfaction. In addition, 9 patients (35%) reported that they wanted their surgeon to initiate discussion about recovery from surgery and its impact on sexual activity. CONCLUSIONS: Upper extremity injuries may negatively affect sexual well-being. Many people want their physician to discuss this with them. Additional research is necessary to qualitatively assess what interventions may be useful for this population as well as how to integrate these discussions into hand surgery clinic visits.

Sinestre, deviance, or biology? An investigation of hand dominance in relation to tendon absence.

The present study aimed to examine the relationship between hand dominance and the presence or absence of the flexor digitorum superficialis (FDS) in the fifth digit to add to the current body of knowledge. We hypothesized that the absence of the FDS in the right small finger is more prevalent in left-handed individuals. This was a prospective study conducted from January 2020 to April 2021 and performed at the plastic surgery department of a university hospital. The sample consisted of volunteers with no history of upper limb trauma, surgery, or any other condition. The study included male and female individuals over 18 years old at a local Rhode Island university campus. The FDS tendons of the bilateral fifth fingers were evaluated through clinical testing by an independent examiner. A total of 236 hands from 118 volunteers were analyzed. Left-hand dominant participants composed of 5% of the population. For these participants, the prevalence of absence of the fifth finger FDS tendon in the right hand was significantly higher than that of right-hand dominant participants (71.4% vs. 28.8%). No significant difference between sex assigned at birth (male vs. female) was noted and the absence of the FDS in either hand, regardless of hand dominance. The results from the current study demonstrate that anatomy may contribute to one's preference for left-handedness. For children who have difficulty using their right hand, perhaps, an assessment of their FDS status may result in earlier acceptance of using their left hand.