Plastic Surgery: Volume 6: Hand and Upper Limb (Plastic Surgery, 6)

✍ Scribed by James Chang MD, Peter C. Neligan MB FRCS(I) FRCSC FACS

• Publisher: Elsevier
• Year: 2023
• Tongue: English
• Leaves: 1200
• Edition: 5
• Category: Library

✦ Synopsis

Comprehensive and fully up to date, the six-volume Plastic Surgery remains the gold standard text in this complex area of surgery. Completely revised to meet the demands of both the trainee and experienced surgeon, Hand and Upper Extremity, Volume 6 of Plastic Surgery, 5th Edition, features new, full-color clinical photos, procedural videos, lectures, and authoritative coverage of hot topics in the field. Editor-narrated video presentations offer a step-by-step audio-visual walkthrough of techniques and procedures.

• New chapters cover nerve transfers, aesthetics, and pain management; coverage throughout includes new, pioneering translational work shaping the future of hand and upper extremity surgery. 

• New digital video preface by Dr. Peter C. Neligan addresses the changes across all six volumes. 

• New treatment and decision-making algorithms added to chapters where applicable. 

• New video lectures and editor-narrated slide presentations offer a step-by-step audiovisual walkthrough of techniques and procedures.  

• Evidence-based advice from an expanded roster of international experts allows you to apply the very latest advances in hand and upper extremity plastic surgery and ensure optimal outcomes. 

• Purchase this volume individually or own the entire set, with the ability to search across all six volumes online! 

• An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. 

✦ Table of Contents

Any screen. Any time. Anywhere.
Plastic
Surgery
Copyright
Contents
Video Contents
Lecture Video Contents
Preface to the Fifth Edition
List of Editors
List of Contributors
Acknowledgments
Dedication
1
1 Anatomy and biomechanics of the hand
Introduction
Skin, subcutaneous tissue, and fascia
Bones and joints
Hand elements
The wrist
Joint motion
The thumb
Muscles and tendons
Extrinsic extensors (Video 1.1 )
Pronators and supinators
Extrinsic flexors (Video 1.3 )
The retinacular system
Intrinsic muscles (see Video 1.2 )
Blood supply
Peripheral nerves
Conclusion
References
2
2 Examination of the upper extremity
Obtaining a patient history
Patient demographics
Current complaint
Medical history
Allergies and medications
Social history
Physical examination specific to the hand
Inspection
Discoloration
Deformity
Muscular atrophy
Trophic changes
Swelling
Skin creases
Palpation
Assessment of musculotendinous function
Posture
Motion
Power
Examination of the muscles of the hand
Examination of the extrinsic muscles
Flexor digitorum profundus muscle
Flexor profundus test (Video 2.1 )
Flexor digitorum superficialis muscle
Flexor sublimis test (Video 2.2 )
Flexor pollicis longus muscle
Milking test of the finger and thumb flexor tendons (Video 2.3 )
Extensor pollicis brevis and abductor pollicis longus muscles
Finkelstein test
Eichoff test (Video 2.5 )
Extensor carpi radialis longus and brevis muscles
Extensor pollicis longus muscle (Video 2.6 )
Extensor digitorum communis muscles (Video 2.7 )
Extrinsic tightness test
Extensor indicis proprius muscle
Extensor digiti minimi muscle
Extensor carpi ulnaris muscle
Examination of the intrinsic muscles
Thenar muscles (Video 2.8 )
Adductor pollicis muscle
Interosseous and lumbrical muscles (Video 2.9 )
Intrinsic tightness test (Bunnell)
Lumbrical-plus test
Hypothenar muscles
Assessment of stability
Scaphoid shift test (Watson) (Video 2.10 )
Finger extension test
Triquetrolunate ballottement test and the lunotriquetral shuck test
Distal radioulnar joint instability test
Ulnocarpal abutment test
The ulnar fovea sign (Video 2.11 )
Pisiform gliding test
Midcarpal instability test
Extensor carpi ulnaris synergy test
Assessment of peripheral nerves
Signs and tests for peripheral nerves
Tinel's sign
Phalen's test
Froment's test
Jeanne's sign
Wartenberg's sign
Other signs associated with ulnar nerve palsy
Tests for evaluating sensory nerve function
Two-point discrimination (2PD) test (Videos 2.12 and 2.13 )
Semmes–Weinstein monofilament test (Video 2.14 )
Moberg's pick-up test
Assessment of the vascular system
Allen's test (Video 2.15 )
Digital Allen's test (Video 2.16 )
Physical examination specific to the forearm
The interosseous membrane of the forearm (IOM)
Distal membranous portion
Middle ligamentous portion
Proximal membranous portion
Measurement of forearm rotation
Measurement of the muscle strength of the forearm
Supination
Pronation
Physical examinations specific to the elbow
Bony landmarks of the elbow
Ligaments of the elbow
Lateral ligament complex
Lateral ulnar collateral ligament
Radial collateral ligament
Annular ligament
Accessory collateral ligament
Medial collateral ligament complex
Instability of the elbow joint
Posterolateral rotatory instability
The pivot shift test
Measurement of malrotation of the distal humerus
Physical examination of thoracic outlet syndrome
Classification
Anatomy
Provocative maneuver
Adson test (Video 2.17 )
The neck tilting
The costoclavicular compression test
Wright test
Roos extended arm stress test (Video 2.18 )
Morley's test
Physical examination of the upper extremity in children
References
3
3 Diagnostic imaging of the hand and wrist
Introduction
Historical perspective
Radiography
Evaluation of the hand
Special views in the hand
Pediatric hand radiographs
Wrist evaluation
Wrist evaluation in distal radius fractures
Ultrasonography
Introduction
Masses
Injuries and degenerative conditions
Compressive neuropathies
Disadvantages
Ultrasound at the bedside
Computed tomography
Fractures and dislocations
Other applications of CT
Magnetic resonance imaging
MRI basics
Clinical applications of MRI
MRI for soft-tissue masses
Ganglion cysts
Giant cell tumors of the tendon sheath (GCTTS)
Lipomas
Hemangiomas
Enchondromas
MRI for wrist and hand trauma
Occult scaphoid and carpal fractures
Ligamentous injuries of the hand and wrist
Thumb ulnar collateral ligament injuries
Scapholunate interosseous ligament injury
MRI for evaluating ulnar-sided wrist pain
TFCC tears
Ulnocarpal abutment
DRUJ instability and tendinopathies
MRI for evaluation of fracture nonunion
MRI for avascular necrosis (AVN) in scaphoid fracture non-union
Kienbock's disease
Osteomyelitis
Vascular imaging techniques for the upper extremity
Radionuclide imaging
Safety in fluoroscopy
Future directions – Artificial Intelligence in radiology and point of care imaging
References
4
4 Anesthesia for upper extremity surgery
Introduction
Anatomy
Perineurial environment
Microneuroanatomy
Sonoanatomy
Pharmacology of local anesthetics
Pharmacokinetics
Toxicity
Vasoconstrictors
LA selection
Regional anesthesia techniques
Digital block
Wrist block
Intravenous regional anesthesia (Bier block)
Interscalene block
Supraclavicular block
Infraclavicular block
Axillary block
Wide-awake local anesthesia no tourniquet (WALANT)
Technique
Complications
Peripheral nerve injury
Local anesthetic toxicity
Vascular injury
Infection
Outcomes
Clinical outcomes and patient satisfaction
Operating room cost and efficiency
Special considerations
Cardiac patients
Pediatric patients
Perioperative pain management
Peripheral catheters
Preemptive analgesia
Chronic postoperative pain
References
5
5 Principles of internal fixation
Introduction
Patient selection
Fracture considerations
Patient-­specific considerations
Preoperative imaging
Treatment/­surgical technique
Preoperative planning
Fracture reduction
Intraoperative imaging
Arthroscopy
Fixation principles
Absolute stability and interfragmentary compression
Relative stability
Methods of fixation
Kirschner wires
Tension band constructs
External fixation
Interfragmentary lag screws
Compression plating
Bridge plating
Locked plating
Postoperative care
Summary
References
6
6 Nail and fingertip reconstruction
Introduction
Anatomy
Surface anatomy
Vascularity
Nerve supply
Physiology
Function
Acute injury
Epidemiology
Subungual hematoma
Treatment
Lacerations
Treatment
Postoperative care
Distal phalanx fractures
Initial evaluation
Treatment
Secondary procedures
Reconstruction
Nail ridge
Split nail
Treatment
Pterygium
Treatment
Nonadherence (onycholysis)
Treatment
Nail absence (anonychia)
Treatment
Cornified nail bed
Treatment
Nail spikes and cysts
Treatment
Hooked nail
Treatment
Eponychial deformities
Treatment
Hyponychial defects
Treatment
Pigmented lesions
Patient presentation
Subungual melanoma
Treatment
Pincer nail
Treatment
Reconstruction of fingertip injuries
Reconstructive principles
Flap selection
Skin grafting
Patient selection
Treatment: Local flaps
Volar V–­Y advancement (Atasoy, Kleinert)
Lateral V–­Y advancement flaps (Kutler)
Visor flap
Homodigital flaps
Reverse homodigital flap
Moberg flap
Heterodigital flaps
The cross-­finger flap
Thenar crease flap
Littler neurovascular island flap
Dorsal metacarpal artery flaps
Additional considerations
Completion amputation
Healing by secondary intention
Antibiotics
Summary
References
7
7 Hand fractures and joint injuries
Introduction
Anatomy
Classification of fractures and dislocations
Fracture stabilization/­fixation and return to function
Pediatric fractures
Open fractures
Bone gaps
Diagnosis
Treatment: fingers
Phalangeal fractures and dislocations
DIP joint fractures and dislocations
Middle phalanx shaft fractures
PIP joint injuries
Middle phalanx base articular fractures
External fixation
Technique of external fixation
Internal fixation
Technique of HHRA (Video 7.2 )
Proximal phalanx head fractures
Technique of open reduction and internal fixation (ORIF) of unicondylar fractures
Proximal phalanx shaft and base fractures
MCP joint fractures and dislocations
Metacarpal fractures
Indications for operative treatment of metacarpal fractures
Metacarpal head fractures
Metacarpal neck fractures
Metacarpal shaft fractures
Multiple metacarpal fractures
Technique of ORIF of multiple metacarpal fractures
CMC dislocations/­fracture dislocations
Treatment: thumb
MCP joint injuries
Stener lesion
Surgical repair of an acute UCL tear
Reconstruction of chronic UCL tear with tendon graft
Thumb metacarpal fractures
Thumb CMC joint injuries
Pediatric fractures
Proximal phalanx neck fractures
Complications
Secondary procedures
Malunion correction
Non-­union correction
Hardware removal, tenolysis, capsulotomy
Future directions
References
8
8 Fractures and dislocations of the wrist and distal radius
Introduction
Historical perspective
Basic science/­disease process
Anatomy
Biomechanics
Mechanisms of injury
Diagnosis/­patient presentation
History
Physical examination
Diagnostic tests
Patient selection
Treatment and surgical techniques
Scaphoid fractures
Scaphoid non-­union
Scapholunate ligament injury
Lunotriquetral ligament injury
Perilunate dislocation
Distal radius fractures
Ulnar styloid fractures
Future directions
References
9
9 Flexor tendon injuries and reconstruction
Introduction
Historical perspective
Basic science
Anatomy
Flexor tendon healing
Biomechanics of tendon repairs and gliding
Diagnosis
Treatment/­surgical techniques
Primary and delayed primary repairs
Indications and contraindications
Anesthesia
Surgical techniques
Zone 1 injuries
Zone 2 injuries (Videos 9.1–­9.6)
Zone 3, 4, and 5 injuries
FPL injuries
Injuries in children
Partial tendon lacerations
Closed rupture of the flexor tendons and pulleys
Postoperative care
Duran–­Houser method
Early active motion
Author's preferred combined passive–­active method (Nantong regimen)
Delayed motion exercises
Outcomes, prognosis, and complications
Secondary procedures
Free tendon grafting
Indications and contraindications
Donor tendons
Operative techniques
Staged tendon reconstruction
Indications
Techniques
The first stage
The second stage
Tenolysis
Indications
Anesthesia
Operative techniques
Postoperative treatment
Future directions
References
10
10 Extensor tendon injuries
Introduction
Historical perspective
Basic science/disease process
Anatomy of the extensor tendons
Extrinsic muscles
Intrinsic muscles
Functional anatomy
Linked chains
Functions of the intrinsic muscles
Extrinsic muscle function
Mechanisms of joint extension
Diagnosis/patient presentation
Elson test
Patient selection
Treatment/surgical technique
Suturing techniques
Zone I
The mallet finger
Open injuries
Chronic injuries
Zone II
Zone III (Video 10.1 )
Closed injuries
Open lacerations
Zone IV
Zone V
Human bite injuries
Sagittal band injuries
Zone VI
Zone VII
Zones VIII/IX
Postoperative care
Short arc motion
Dynamic splinting with passive extension
Relative motion splinting
Outcomes, prognosis, and complications
Outcomes
Complications
Secondary procedures
The mallet finger
The swan-neck deformity
The boutonnière deformity
Preoperative considerations
Tenotomy
Secondary reconstruction of the extensor tendon
Delayed sagittal band reconstruction (Video 10.2 )
The missing tendon: tendon transfers versus tendon grafting (Video 10.3 )
Soft-tissue management and staged reconstruction in combined injuries
Conclusion
Future directions
References
11
11 Replantation
Introduction
Basic science/­disease process
Pathophysiology of ischemia and reperfusion
Historical perspective
Diagnosis/­patient presentation
Transportation
Replant centers
Patient selection
Indications and contraindications
Treatment/­surgical technique
Operative sequence
Bone fixation
Tendon repair
Artery repair
Vein repair
Nerve repair
Skin closure
Special circumstances
Thumb replantation
Multiple digits
Proximal amputations
Distal amputations
Ring avulsion injuries/­degloving injuries/­avulsion amputation
Ectopic transplantation
Pediatric replantation
Postoperative care
Anticoagulation
Postoperative monitoring
Postoperative therapy
Psychosocial aspects of replantation
Future directions
References
12
12 Reconstructive surgery of the mutilated hand
Introduction
Goal of management of mutilated hand injury
Assessment of the mutilated hand
To salvage or not to salvage? Value of scoring and classification systems
Debridement
Envisioning the plan of reconstruction
Vascular reconstruction in the mutilated upper extremity
Stabilization of the skeleton
Soft-­tissue cover
Timing of soft-­tissue cover
The role of negative pressure wound therapy (NPWT) in a mutilated hand
Type of cover
Making the final choice
Pedicled groin flaps
Anatomy
Technique
Lower abdominal flaps
Anatomy
Technique
Pedicled radial forearm flap
Anatomy
Technique
Posterior interosseous reverse forearm flap
Anatomy
Technique
Lateral arm free flap
Anatomy
Technique
Anterolateral thigh free flap
Anatomy
Technique
Gracilis free flap (for cover and for function)
Anatomy
Technique
Major degloving injuries of the upper limb
Basic principles
Degloving injury of the hand
Degloving injury of the thumb
Degloving injury of the fingers
Degloving of the proximal upper limb
Muscle, tendon, and nerve repair
Total primary reconstruction vs. staged reconstruction
Secondary reconstruction
Secondary procedures on bones and joints
Coverage of large defects around the elbow
Free fibula transfer for long segment proximal bone defects
Anatomy
Technique
Secondary reconstruction of musculotendinous units
Restoration of motion at the elbow
Pedicled pectoralis major flap
Pedicled latissimus dorsi flap
Anatomy
Technique
Management of compartment loss
Free functioning muscle transfer (FFMT)
Nerve reconstruction
Secondary reconstruction of digital losses: toe transfers
Thumb reconstruction
Second toe for thumb reconstruction
Complications
References
13
13 Thumb reconstruction: Non-­microsurgical techniques
Introduction
Historical perspective
Basic science/­disease process
Diagnosis/­patient presentation
Patient selection
Treatment/­surgical technique
Distal third
Middle third
Proximal third
Prosthetics
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Future directions
References
14
14 Thumb reconstruction: Microsurgical techniques
Introduction
Historical perspective
Diagnosis/patient presentation
The initial operation
Patient selection
Patient factors
Timing: primary versus secondary reconstruction
Injury factors
Decision-making for the thumb
Decision-making for fingers
Decision-making for the metacarpal hand
Treatment/surgical technique
General principles in vascular dissection
General principles in recipient preparation
General guidelines in donor closure
General principles in flap inset
Specific operations
Trimmed great toe (Video 14.1 )
Second toe: total and partial (Video 14.2 )
Third toe
Modified wraparound flaps: great and second toes
Neurosensory lateral great-toe pulp flaps
First-web neurosensory flap
Combined second- and third-toe transplantation (Video 14.3 )
Vascularized joint transfer for metacarpophalangeal joint reconstruction of the thumb
Postoperative care
Immediate postoperative period
Motor rehabilitation
Sensory rehabilitation
Outcomes, prognosis, and complications
Outcomes and prognosis
Range of motion
Strength assessment
Appearance and sensory outcomes
Donor site outcome evaluation
Complications
Secondary procedures
Debates in thumb reconstruction with toe-to-hand surgery
Future directions
References
15
15 Infections of the hand
Introduction
Historical perspective
Basic science/­disease process
Causative organisms
Diagnosis/­patient presentation
Fingertip
Fingertip infections
Paronychia
Felon
Finger
Pyogenic flexor tenosynovitis
Hand
Deep space infections
Wrist/­forearm
Necrotizing soft-­tissue infection
Joints
Septic arthritis
Bone
Osteomyelitis
Atypical infections
Mycobacterial infections
Fungal infections
Mimics of infection
Gout
Pseudogout
Pyogenic granuloma
Pyoderma gangrenosum
Patient selection
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Future directions
References
16
16 Tumors of the hand
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient history
Physical examination
Laboratory studies
Imaging
Biopsy
Resection
Utility of multidisciplinary team approach
Treatment/surgical treatment by tissue of origin
Skin tumors
Cutaneous horn
Epidermal inclusion and sebaceous cysts
Verruca vulgaris
Nevi
Keratoacanthoma
Dermatofibroma
Seborrheic keratosis
Actinic keratosis
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Merkel cell carcinoma
Synovial lesions
Ganglion cysts
Giant cell tumor (pigmented villonodular synovitis)
Nerve tumors
Schwannoma/neurilemoma
Neurofibroma
Lipofibromatous hamartoma
Fat tumor: lipoma
Fibrous tissue lesions
Benign lesions
Sarcomas
Vascular lesions
Hemangioma
Vascular malformations
Glomus tumor
Pyogenic granuloma
Muscle lesions
Myositis ossificans
Osteoid osteoma
Leiomyoma
Rhabdomyosarcoma
Cartilage and bone tumors
Enchondroma
Osteochondroma
Solitary unicameral bone cyst
Aneurysmal bone cyst
Giant cell tumor of bone
Osteosarcoma
Chondrosarcoma
Staging and treatment of musculoskeletal sarcomas
Metastases
Postoperative care
Outcomes, prognosis, and complications
Future directions
References
17
17 Dupuytren’s disease
Basic science and disease process
Heredity
Cellular and molecular processes
Genes and epigenetic modifications
Inflammation
Myofibroblasts, fibroblasts and extracellular matrix (ECM)
Surgical anatomy of the palmar fascia in the hand and fingers and involvement in Dupuytren’s disease
Clinical disease process
Clinical assessment
Differential diagnosis
Grading
Indications for treatment
Shared decision-making
Treatments
Early stage DD
Steroids
Radiotherapy
Late stage DD
Non-surgical
Collagenase clostridium histolyticum (CCH)
Surgical
Percutaneous needle fasciotomy (PNF)/needle aponeurotomy (NA)
Open fasciotomy
Fasciectomy
Skin
Fascia
Dermofasciectomy
Joints
Others
External fixation and distraction
Amputation
Rehabilitation
Outcome, prognosis, and complications
Repeated procedures
Complications
Collagenase (CCH)
Percutaneous needle fasciotomy (PNF)/needle aponeurotomy (NA)
Fasciectomy
Dermofasciectomy (DF)
Salvage surgery
Arthrodesis of the PIP joint
Amputation
Future directions
Acknowledgments
References
18
18 Osteoarthritis in the hand and wrist
Introduction/epidemiology
Historical perspective
Basic science/disease process
Pathophysiology
Diagnosis
Management of OA of the fingers
Distal interphalangeal joint (DIP) arthritis
Diagnosis
Indications for surgery
Cheilectomy
Biomechanical effects of DIP fusion
DIP arthrodesis
Indications
Techniques
Interosseous wiring
K-wire fixation
Tension band wiring
Axial compression screw
Complications of DIP fusion
Infection
Non-union
DIP arthroplasty
Mucous cyst
Proximal interphalangeal (PIP) joint arthritis
Management
PIP arthrodesis
Techniques
Crossed K-wire technique
Tension band wire technique
Compression screw
Plating
PIP arthroplasty
Silicone interposition arthroplasty
Technique
Surface replacement arthroplasty with nonconstrained implants
Patient selection
Technique for nonconstrained or semiconstrained PIP arthroplasty
Postoperative therapy for PIP arthroplasty
Outcomes and complications of PIP arthroplasty
Metacarpophalangeal (MCP) joint arthritis
Anatomy and biomechanics
Resection and resurfacing arthroplasty
Implant arthroplasty
Hinged prostheses
Silicone constrained prostheses
Surface replacement prostheses
PyroCarbon arthroplasty
Technique for MCP joint arthroplasty with PyroCarbon implant
MCP arthrodesis
Vascularized joint transfer/costochondral replacement
Management of OA of the thumb
Thumb metacarpophalangeal (MCP) joint arthritis
Trapeziometacarpal arthritis
Etiology and epidemiology
Anatomy and biomechanics
Diagnosis and classification
Nonoperative treatment
Surgical procedures for stage I disease
Thumb TMC arthroscopy
Dorsal wedge extension osteotomy
Volar ligament reconstruction
Technique for Eaton–Littler procedure
Procedures for stage II–IV disease
Trapeziectomy alone
Surgical technique for simple trapeziectomy
Trapeziectomy with ligament reconstruction and/or tendon interposition
Prosthetic arthroplasty
Trapeziometacarpal arthrodesis
Technique for arthrodesis
OA of the wrist
Etiology
Patient evaluation
Surgical treatment
Technique for dorsal approach to the wrist
Radial styloidectomy
Neurectomy
Proximal row carpectomy
Four-corner fusion
Radioscapholunate fusion
Total wrist arthrodesis and total wrist arthroplasty
Future directions
References
19
19 Rheumatologic conditions of the hand and wrist
Introduction
Basic science/disease process
Etiology
Pathogenesis
Medical management
Diagnosis/presentation
Wrist involvement
Finger and thumb involvement
Patient selection
Perioperative considerations
Goals of surgery
Sequence of surgery
Treatment/surgical technique
Operations at the wrist level
Wrist synovectomy/dorsal tenosynovectomy
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Distal ulna resection (Darrach procedure)
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Partial wrist arthrodesis (radioscapholunate arthrodesis)
Postoperative care
Complete wrist arthrodesis
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Total wrist arthroplasty
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Operations for the hand and fingers
MCP synovectomy and soft-tissue reconstruction
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
MCP arthroplasty (silicone)
Postoperative care
PIP arthroplasty
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
MCP and IP arthrodesis
Postoperative care
Outcomes, prognosis, and complications
Correction of swan-neck deformity
Postoperative care
Correction of boutonnière deformity
Postoperative care
Outcomes, prognosis, and complications
Correction of thumb deformities
Postoperative care
Outcomes, prognosis, and complications
Tendon surgery and carpal tunnel syndrome
Carpal tunnel syndrome
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Flexor tendon ruptures
Postoperative care
Outcomes, prognosis, and complications
Trigger fingers
Postoperative care
Outcomes, prognosis, and complications
Extensor tendon ruptures
Postoperative care
Outcomes, prognosis, and complications
Other rheumatologic disorders of the hand and wrist
Seronegative spondyloarthropathies
Systemic lupus erythematosus
Scleroderma
Postoperative care
Crystalline arthropathy (gout)
Crystalline arthropathy (pseudogout)
Differentiating acute gout or pseudogout attack from septic arthritis
DECT scan
JAK inhibitors
Summary
Future directions
References
20
20 Occupational disorders of the hand
Introduction
Patient history and examination
Knowledge of the disease process and its causation
The role of force and repetition
Specific occupational disorders of the hand and wrist
Tendinopathies
Lateral epicondylitis
Trigger finger
De Quervain’s tenosynovitis
Extensor carpi ulnar tendinitis
Flexor carpi radialis tenosynovitis and flexor carpi ulnaris tenosynovitis
Nerve compression
Median neuropathy: carpal tunnel syndrome (CTS)
Vascular disorders
Hypothenar hammer syndrome
Hand–arm vibration syndrome (HAVS)
Bone and joint problems
Osteoarthritis
Distal interphalangeal joint arthritis
Proximal interphalangeal joint arthritis
Metacarpophalangeal joint arthritis
Carpometacarpal joint arthritis
Return to work
Measuring impairment
Summary and future directions
References
21
21 Nerve entrapment syndromes
Pathophysiology of chronic nerve compression
Double-crush syndrome
Clinical examination of upper extremity nerve entrapments
Manual muscle testing algorithm (Video 21.1 )
Scratch collapse test (Video 21.2 )
Electrodiagnostic studies (EDS)
Median nerve entrapments
Carpal tunnel syndrome
Anatomy
Etiology
History
Clinical examination
Other diagnostic tools
Patient selection
Non-operative treatment
Treatment/surgical technique
Wide-awake OCTR
Endoscopic carpal tunnel release (ECTR)
OCTR vs. ECTR
Ultrasound-guided carpal tunnel release (usCTR)
Outcomes and complications
Median nerve entrapments in the elbow and forearm
Background
Lacertus syndrome
Anatomy
History
Clinical examination
Non-operative treatment
Wide-awake surgical release
Superficialis syndrome – AIN syndrome
History
Clinical examination
Non-operative treatment
Surgical release
Ulnar nerve entrapments
Ulnar nerve compression in Guyon's canal
Background
Anatomy
History
Clinical examination
Surgical release
Cubital tunnel syndrome
Anatomy
History
Clinical examination
Non-surgical treatment
Surgical release
In situ decompression – the authors' preferred technique
Simple decompression
Endoscopic decompression
Submuscular–subcutaneous transposition
Medial epicondylectomy
Outcomes and complications
Radial nerve entrapments
Wartenberg's syndrome – entrapment of the SBRN
Anatomy
History and clinical examination
Non-surgical treatment
Surgical release
Radial tunnel syndrome – PIN compression in the proximal forearm
Anatomy
History
Clinical examination
Non-operative treatment
Surgical release
Outcomes following surgery
Lateral intermuscular syndrome – radial compression in the distal upper arm
Anatomy
History and clinical examination
Non-surgical treatment
Surgical release
Triangular interval syndrome – radial compression in the proximal upper arm
Anatomy
History and clinical examination
Non-surgical treatment
Surgical release
Other nerve compressions of the upper extremity
Quadrilateral space syndrome – axillary nerve entrapment
Anatomy and etiology
History
Clinical examination
Other diagnostic tools
Non-surgical treatment
Surgical release
Musculocutaneous nerve compression
Anatomy and etiology
History and clinical examination
Non-surgical treatment
Surgical release
Suprascapular nerve compression
Anatomy and etiology
History and clinical examination
Other diagnostic tools
Non-surgical treatment
Surgical release
Dorsal scapular nerve compression
Anatomy and etiology
History and clinical examination
Non-surgical treatment
Surgical release
Future directions
R­ef­er­en­ces
22
22 Peripheral nerve repair and reconstruction
Introduction
Basic science and natural history
Anatomy
Gross anatomy: the upper extremity
The neuron and supporting cells
The nerve trunk
Blood supply
Physiology
Degeneration and regeneration
The distal nerve segment
Diagnosis and presentation
Formal classification of injury
Neuropraxia
First-degree injury
Axonotmesis
Second-degree injury
Third-degree injury
Neurotmesis
Fourth-degree injury
Fifth-degree injury
Sixth-degree injury
Clinical examination
Functional evaluation
Electromyography/neurography
Wound inspection
Patient selection
Type of nerve injury
Condition of the wound
Treatment and surgical techniques
Immediate compared with delayed nerve repair
General principles
Timing
Surgical approach
Principles of nerve repair
General principles (Videos 22.1 & 22.2 )
Epineurial compared with fascicular repair
End-to-side nerve repair
Wound closure and immobilization
Nerve reconstruction
Autografts
Approach and preparation
Nerve ends
The gap
Length of graft
Harvest of the graft
Coaptation and maintenance
Donor nerves
Sural nerve
Medial and lateral antebrachial cutaneous nerves
The terminal branch of the posterior interosseous nerve
Superficial sensory branch of the radial nerve
Other
Tubular repair and artificial conduits
Biological conduits
Processed nerve allografts (Video 22.3 )
Non-degradable conduits
Biodegradable conduits
Fillers
Other techniques
Nerve transfers
Postoperative care
General aspects
Postoperative movement training
Sensory re-education
Cortical reorganization
Sensory re-education in phase 1
Improving effects of sensory re-education – phase 2
Outcome
Assessment of outcome
General aspects
BMRC
The Rosen score
Factors that affect outcome
General aspects
Age
Digital nerves
Nerve trunks
Level of injury
Type of repair
Type of injury
Postoperative dysfunction
General aspects
Complex regional pain syndrome
Other factors
Future perspectives
Acknowledgments
References
23
23 Brachial plexus injuries: adult and pediatric
Introduction
History of brachial plexus reconstruction
Adult brachial plexus injury
General principles in BPI management
Anatomy
Gross anatomy
Microanatomy
Level of brachial plexus injury
Patterns of brachial plexus injury
Pathophysiology and degree of nerve injury
Timing of brachial plexus exploration
Clinical evaluation
Etiology of adult brachial plexus injury
Patient history
Preoperative evaluation and diagnosis
Motor examination
Sensory examination
Plain X-ray and imaging studies
Electrodiagnostic studies
Vascular injury
Surgical treatment and techniques
Different incision lines for different approaches
Landmarks and key points for supraclavicular dissection
Landmarks and key points for infraclavicular dissection
Surgical techniques
Level I injury
Nerve transfer
Extraplexus nerve transfer
Intraplexus nerve transfer
Closed-target nerve transfer (or distal nerve transfer)
End-to-side neurorrhaphy nerve transfer
Reconstructive strategies
Shoulder
Elbow
Finger
Pedicled muscle transfer
Functioning free muscle transplantation (FFMT)
Level II injury
Level III injury
Level IV injury
Postoperative management and rehabilitation
Palliative reconstruction for sequelae deformities
Outcome evaluation
Conclusion
Future directions
Pediatric brachial plexus injury (obstetric brachial plexus palsy)
Introduction
Infant obstetric brachial plexus palsy
Clinical presentation
Clinical examination
Timing of surgery
Preoperative preparation
Surgical technique
Reconstructive strategies
Pure rupture injury
Rupture injury associated with root avulsion
Postoperative management
Outcome assessment
Results
Sequelae obstetric brachial plexus palsy
Shoulder deformity reconstruction
Elbow deformity reconstruction
Forearm and hand deformity reconstruction
Conclusion
Future directions
R­ef­er­en­ces
24
24 Tetraplegia
Introduction
Basic science/disease process
Classification of the tetraplegic upper extremity
Patient presentation and patient selection
Forming a team
Timing
Patient evaluation/selection
Treatment/surgical technique (Table 24.2)
General guidelines for reconstruction
Tendon transfers
Nerve transfers
Surgical reconstruction
IC group 0 (high cervical spinal cord injuries)
Elbow extension
Biceps-to-triceps tendon transfer
Surgical technique
Postoperative rehabilitation
Deltoid-to-triceps transfer36
Surgical technique (Fig. 24.7)
Postoperative rehabilitation
Nerve transfer for elbow extension
IC groups 1 and 2
Improving wrist extension
Postoperative rehabilitation
Side-to-side sutures
Restoring key pinch
Split FPL-to-EPL interphalangeal stabilization
ELK-tenodesis
Flexor pollicis longus tenodesis (passive key pinch)
Postoperative rehabilitation
Nerve transfers
IC group 2 and some IC group 3
Restoring active key pinch by BR-to-FPL transfer
Surgical planning
Operative procedure
Postoperative rehabilitation
IC groups 3, 4, and 5
Restoring active key pinch, grasp, and release in one operative stage
The single-stage grip and release procedure55 (Video 24.1 )
Surgical order of procedures
Intrinsic stabilization
Zancolli “lasso” procedure
House intrinsic tenodesis
ECU tenodesis
Postoperative rehabilitation
Other considerations
Nerve transfers for hand function
Supinator to posterior interosseus nerve transfer
Patient selection
Surgical technique
Postoperative care
Nerve transfer for pinch and grasp
IC groups 6, 7, 8, and 9
Spasticity
Future directions
Functional neuromuscular stimulation
Outcomes and complications
Conclusions
References
25
25 Tendon transfers
Introduction
General principles of tendon transfers
Bone and soft-­tissue healing
Selection of donor muscle–­tendon
Expendability
Strength
Amplitude
Direction of transfer and integrity
Timing of tendon transfers
Surgical techniques
Radial nerve palsy
Indications
Timing
Operations
Standard FCU transfer (Figs. 25.3–­25.6)
FCR transfer (Fig. 25.8)
Boyes flexor digitorum superficialis transfer (Fig. 25.9)
Outcomes
Low median nerve palsy
Anatomical considerations
Timing
Operations
Burkhalter extensor indicis proprius transfer (Fig. 25.10)
Bunnell ring finger flexor digitorum superficialis transfer (Fig. 25.12)
Camitz palmaris longus transfer (Fig. 25.15)
Other opposition tendon transfers (Table 25.3)
High median nerve palsy
Indications
Operations
Outcomes
Low ulnar nerve palsy
Indications
Timing
Static procedures to correct clawing of the fingers
Tendon transfers to correct clawing
Modified Stiles–­Bunnell transfer (see Fig. 25.27)
Brand EE4T transfer (Fig. 25.28)
Brand EF4T transfer (Fig. 25.29)
Fritschi PF4T transfer
Tendon transfer to correct ulnar deviation of the small finger
Tendon transfers to provide adduction of the thumb
Ring finger flexor digitorum superficialis adductor transfer
Smith extensor carpi radialis brevis adductor transfer (Fig. 25.31)
Tendon transfers to provide index finger abduction
Neviaser accessory abductor pollicis longus and free tendon graft (Fig. 25.32)
High ulnar nerve palsy
Outcomes
Tendon transfers for combined nerve injuries
Tendon transfers for low median–­low ulnar nerve palsy
Tendon transfers for high median–­high ulnar nerve palsy
Tendon transfers for reconstruction after trauma
Tendon transfers to restore thumb extension
Tendon transfers to restore finger extension
Tendon transfers to restore thumb flexion
Tendon transfers to restore finger flexion
Summary
Future directions
References
26
26 Nerve transfers
Introduction
Basic science
Diagnosis and patient presentation
Patient history
Physical examination
Imaging
Electrodiagnostic testing
Patient selection
Examples of nerve transfer procedures for specific injury patterns
Upper plexus injury
Specific patient exam findings
Reconstruction techniques
Use of spinal accessory nerve (cranial nerve XI) to suprascapular nerve transfer (motor)
Use of triceps to axillary nerve transfer (motor component)
Use of the double fascicular nerve transfer (motor)
Other potential donors to restore elbow flexion
Lower plexus injury
Specific patient exam findings
Reconstruction techniques
Complete/­near-­complete plexus injury
Specific patient exam findings
Reconstruction techniques
Use of spinal accessory and intercostal nerves as donors (motor)
Discussion of cross C7 transfer, phrenic nerve transfers (motor)
Median nerve injury
Specific patient exam findings
Reconstruction techniques
Use of radial to median branch nerve transfers (motor)
Use of brachialis branch to AIN branch nerve transfer
Use of adjunct tendon transfers to augment nerve transfers
Ulnar nerve injury
Specific patient exam findings
Reconstruction techniques
Use of median to ulnar branch nerve transfers (motor)
Use of adjunct tendon transfers to augment nerve transfers
Radial nerve injury
Specific patient exam findings
Reconstruction techniques
Use of median to radial branch nerve transfers
Use of adjunct tendon transfers to augment nerve transfers
Sensory nerve injury
Restoration of key sensory functions
Use of ulnar to median branch nerve transfers (sensory)
Use of median to ulnar branch nerve transfers (sensory)
Use of median and ulnar nerve transfers to restore first webspace sensation in C5–­C6 root level brachial plexus injury (se ...
Use of median to radial nerve transfers (sensory)
Use of radial to axillary nerve transfers (sensory)
Postoperative care
Postoperative wound care
Complications
Rehabilitation
Postoperative patient evaluation
Outcomes and prognosis
Secondary procedures
Future directions
References
27
27 Free-functioning muscle transfer
Introduction
Historical perspective
Patient selection
Preoperative planning
Selecting the donor muscle
Selecting the axon source
Surgical technique of the free-functioning gracilis transfer
Preparing the recipient site
Harvesting the gracilis muscle
Muscle transfer to restore finger flexion
Muscle transfer to restore finger extension
Muscle transfer to restore thumb opposition
Muscle transfer to restore elbow flexion
Complications
Future directions
References
28
28 The ischemic hand
Introduction
Historical perspective
Raynaud’s phenomenon
Basic science
Anatomy
Embryology
Arterial system in the forearm, hand, and digits
Superficial palmar arch
Deep palmar arch
Surgical landmarks of superficial and deep palmar arch
Digital arteries
Micro-arterial system
Physiology of blood flow
Hemodynamics
Cellular control mechanisms
Pathophysiology
Emboli
Trauma
Systemic disease
Diagnosis/patient presentation
Evaluation
History and physical examination
Diagnostic investigations
Capillaroscopy
Ultrasound
Duplex ultrasonography
Isolated cold stress testing
Infrared thermography
Laser speckle contrast imaging
Conventional angiography
MR and CT angiography
Patient selection
Acute ischemia
Acute arterial injury
Arterial emboli
Iatrogenic injuries
Cannulation injury
Arterial injection injuries
Acquired arteriovenous fistula
Chronic ischemia
Arterial thrombosis
Aneurysm
Buerger’s disease
Connective tissue disorders
Vasospastic disease
Treatment
Non-surgical treatment
Environmental modification
Medical management
Pharmacological agents
Thrombolytic therapy
Botulinum toxin A therapy
Biofeedback
Surgical treatment
Embolectomy
Sympathectomy
Leriche sympathectomy (arteriectomy)
Periarterial sympathectomy
Classic sympathectomy
Extended or radical digital sympathectomy
Arterial reconstruction
Wrist inflow artery reconstruction (ulnar artery, radial artery, and superficial palmar arch)
Digital artery reconstruction
Other surgical options
Balloon angioplasty with stenotic lesion
Venous arterialization
Fat grafting
Treatment algorithm
Postoperative care
Outcomes, prognosis, and complications
Future directions
References
29
29 The spastic hand
Introduction
Cerebral palsy
Cerebrovascular accident (CVA)
Traumatic brain injury (TBI)
Spinal cord injury
Patient presentation
Clinical examination
Resting posture of the upper limb
Evaluation of spasticity
Muscle contracture
Joint deformity
Motor assessment
Sensory examination
Functional assessment
General preoperative assessment
Other neurological impairments
Imaging and electromyography
The role of botulinum toxin
Technique
Patient selection and timing of surgery
Treatment
Rebalancing the forces
Reducing spasticity
Partial neurectomy
Neurosurgical procedures
Muscle contracture
Tenotomy
Muscle release
Joint contracture
Tendon transfers
Most frequent procedures
At the elbow level
At the forearm level
At the wrist level
At the finger level
Swan-neck deformity
Intrinsic contracture
At the thumb level
Future directions
Conclusions
References
30
30 The stiff hand
Introduction
Etiology, basic science, anatomy, and clinical examination
Treatment
Nonoperative intervention
PIP joint flexion contracture
PIP joint extension contracture
MCP joint extension contracture
Tendon gliding
PIP joint extension lag
Motor retraining
Operative intervention
Anesthesia
MCP joint extension contracture
PIP joint flexion contracture
PIP joint extension contracture
Outcomes
Future directions
References
31
31 The painful hand
Introduction
Assessment
Mechanism of injury
Penetrating injury
Blunt or “closed” injuries
Subjective descriptors
Patient-­reported measures
Clinical examination
Diagnosis/­pathologies
Neuritis
Neurostenalgia
Symptomatic post-­traumatic neuroma
Spinal nerve root avulsion (deafferentation)
Causalgia
Complex regional pain syndrome
Atraumatic neuropathy
Non-­surgical management
Physical therapies
Psychological therapies
Co-­occurring psychiatric and psychological disorders
Features of psychological assessment
Patient-­reported measures
Pain Catastrophizing Scale (PCS)
Pain Self-­Efficacy Questionnaire (PSEQ)
Psychological therapeutic interventions
Cognitive Behavioral Therapy
Acceptance and Commitment Therapy
Pharmacological therapies
Specific medications
Gabapentinoids
Tricylic antidepressants (TCAs)
Nonsteroidal anti-­inflammatory drugs and opioids
Infusions and topical treatments
Abuse and withdrawal
Side-­effects and interactions
Surgical treatment
Operative procedures
Treatment for neurostenalgia: neurolysis
Treatment of symptomatic post-­traumatic neuroma
Graft reconstruction
Neuroma relocation
Targeted muscle re-­innervation
Spinal nerve root re-­implantation after brachial plexus avulsion injury
Dorsal root entry zone procedure
Summary
References
32
32 Congenital hand I: Embryology, classification, and principles
Introduction
Limb development
Classification
Assessment and principles of treatment
Limb development (embryology)
Overview of upper limb morphogenesis
The molecular control of limb outgrowth and patterning
Limb vasculature
Skeletogenesis
Myogenesis
Innervation
The development/differentiation of specific tissues
Anomalies of limb development and their classification
Background
Problems of the Swanson classification
The OMT classification
Assessment of the child and family
The clinic
History
Examination
Investigations
Diagnosis
Principles of surgical management
Indications
Function
Appearance
Timing
References
33
33 Congenital hand II: Malformations – whole limb
Poland syndrome
Introduction
Basic sciences/disease processes
Diagnosis/patient management
Patient selection, treatment, and surgical plan
Emergent complications
Psychosocial concerns
Functional and aesthetic problems
Management of the underdeveloped or absent pectoralis major
Management of hand differences
Postoperative care
Outcome, prognosis, and complications
Secondary and additional procedures
Future directions
Ulnar dimelia and mirror hand
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment and surgical technique
Outcome, prognosis, and complications
Secondary procedures
Radioulnar synostosis
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Osteotomy through synostosis
Osteotomies through the diaphyseal portion of radius and ulna
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Future directions
Madelung deformity
Introduction
Basic science/disease process
Genetic associations
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Physiolysis and ligament release
Radial osteotomy
Ulnar epiphysiodesis
Ulnar osteotomy
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Future directions
References
34
34 Congenital hand III: Malformations – abnormal axis differentiation – hand plate: proximodistal and radioulnar
Proximodistal
Brachydactyly
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Postoperative care
Outcome, prognosis, and complications
Symbrachydactyly
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Non-vascularized toe phalanx transfers
Free vascularized toe-to-hand transfers
Distraction lengthening
Postoperative care
Outcome, prognosis, and complications
Transverse deficiency
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Outcome, prognosis
Cleft hand
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Transverse bones
Border digit syndactyly
First webspace reconstruction
Cleft closure
Thumb reconstruction
Postoperative care
Outcome, prognosis, and complications
Radioulnar
Radial longitudinal deficiency, hypoplastic thumb
Introduction
Basic science/disease process
Diagnosis/patient presentation
Type 1 thumb hypoplasia
Type 2 thumb hypoplasia
Type 3A thumb hypoplasia
Type 3B thumb hypoplasia
Type 4 thumb hypoplasia
Type 5 thumb hypoplasia
Patient selection
Treatment/surgical technique (see Algorithms 34.1 & 34.2)
Type 1 hypoplastic thumbs
Type 2 and 3A hypoplastic thumbs
First webspace deepening
Opposition transfer
ADM (Huber) opposition transfer
FDS opposition transfer with UCL reconstruction
Type 3B, 4, and 5 hypoplastic thumbs
Pollicization
Type 0 and 1 RLD forearms
Joint release and tendon transfer
Type 2 RLD forearms
Radius lengthening
Type 3, 4, and 5 RLD forearms
Soft-tissue release and bilobed flap
Precentralization soft-tissue distraction
Centralization
Ulna osteotomy
Postoperative care
Opposition transfer, collateral ligament reconstruction
Pollicization
Joint release and tendon transfer (type 0 and 1 RLD forearm)
Soft-tissue release and bilobed flap
Precentralization soft-tissue distraction, centralization
Outcome, prognosis, and complications
Secondary procedures
Ulnar longitudinal deficiency
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Polydactyly
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Radial polydactyly
Type I and II
Type III and IV
Type V and VI
Ulnar polydactyly
Type A
Type B
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Triphalangeal thumb
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Abnormally shaped phalanx (delta, trapezoid, rectangle, angular epiphysis)
Delta middle phalanx
Trapezoid or rectangle middle phalanx
Angular epiphysis
Five-fingered hand
Narrow first webspace
Thumb opposition
Associated polydactyly, primarily radial polydactyly
Outcome, prognosis, and complications
Future directions
References
35
35 Congenital hand IV: Malformations – abnormal axis differentiation – hand plate: unspecified axis
Syndactyly
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Creation of a web
Treating the lateral soft tissue defects
Separation of the fingertips
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Clinodactyly
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Kirner deformity
Introduction
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Apert hand
Introduction
History
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Separation of fingers
Thumb and first web
Additional procedures
Feet
Postoperative care
Outcomes, prognosis, and complications
Complications
Secondary procedures
References
36
36 Congenital hand V: Deformations and dysplasias – variant growth
OMT classification of deformation
Pediatric trigger thumb
Basic science/disease process
Diagnosis/patient presentation
Patient selection (Algorithm 36.1)
Treatment/surgical technique (Fig. 36.1)
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Congenital trigger fingers
Basic science/disease process
Diagnosis/patient presentation (Algorithm 36.2)
Patient selection
Treatment/surgical technique (see Video 36.2 Algorithm 36.3)
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Constriction ring sequence
Basic science/disease process
Diagnosis/patient presentation
Patient selection
In utero diagnosis (Algorithm 36.4)
Postnatal presentation (Algorithm 36.5)
Later presentations (Algorithm 36.6)
Treatment/surgical technique
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
OMT classification of dysplasia
Macrodactyly
Basic science/disease process
Diagnosis/patient presentation (Algorithm 36.7)
Flatt type 1: Macrodactyly with fibrolipomatous hamartoma
Flatt type 2: Macrodactyly with neurofibromatosis
Flatt type 3: Osteohypertrophic macrodactyly
Flatt type 4: Macrodactyly with hemihypertrophy
Treatment/surgical technique
Strategies to slow growth
Treatment of the nerves and blood vessels
Strategies to reduce volume
Amputation
Postoperative care
Outcome, prognosis, and complications
Secondary procedures
Future directions
References
37
37 Congenital hand VI: Dysplasias – tumorous conditions
Introduction
Diagnosis/patient presentation
Treatment/surgical technique
Postoperative care
Vascular anomalies
Vascular tumors
Infantile hemangioma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Congenital hemangioma (CH)
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Vascular tumors
Pyogenic granuloma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Capillary malformation
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Lymphatic malformation
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Outcomes, prognosis, and complications
Venous malformation
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Conservative treatment
Minimally invasive treatment
Surgical treatment
Outcomes, prognosis, and complications
Arteriovenous malformation
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Fibro-adipose vascular anomaly (FAVA)
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Vascular malformations with overgrowth – CLOVES syndrome
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Peripheral nerve tumors
Neurofibroma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Schwannoma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Adipose lesions of nerve
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Malignant peripheral nerve sheath tumor
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Connective tissue dysplasias
Infantile digital fibromatosis
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Juvenile aponeurotic fibroma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Infantile myofibromatosis
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Lipoblastoma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Infantile fibrosarcoma
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Skeletal dysplasias
Osteochondromatoses – multiple hereditary exostosis
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Osteochondromatoses – metachondromatosis
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Enchondromatoses – multiple enchondromatosis (Ollier disease)
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Enchondromatoses – Maffucci syndrome
Basic science/disease process
Diagnosis/patient presentation
Treatment/surgical technique
Future directions
References
38
38 Congenital hand VII: Dysplasias – congenital contractures
Arthogryposis
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical care
Humeral external rotation osteotomy
Elbow extension contracture release
Active elbow flexion transfers
Wrist contracture correction
Finger and thumb contracture correction
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Future directions
Camptodactyly
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical care
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Future directions
Thumb-in-palm deformity
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical care
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
Future directions
References
39
39 Growth considerations in the pediatric upper extremity
Introduction
Basic science/disease process
Anatomy and physiology of the epiphyseal growth plate
Vascular anatomy of the growth plate
Growth plate closure and skeletal age assessment during puberty
Diagnosis/patient presentation
Conditions affecting the growth plate
Trauma
Incidence and distribution in the upper extremity
Classification of physeal fractures
Treatment of physeal fractures
Tumor
Bone sarcoma involving the epiphysis
Congenital chondrodysplasia
Patient selection
Treatment/surgical technique
Treatment of physeal arrest
Observation
Completion of a partial physeal arrest and epiphysiodesis
Physeal distraction
Bar resection
Corrective osteotomies, lengthening or shortening
Epiphyseal transfer of the proximal fibular epiphysis
Indications
Vascular supply of the proximal fibular epiphysis
Harvest technique of the proximal fibula based on the tibialis anterior artery (Video 39.1)
Skin incision
Exposure of the anterior tibial pedicle
Dissection of the peroneal nerve at the fibular neck
Section of the interosseous membrane and distal osteotomy
Harvest of the biceps femoris tendon and capsulotomy of the proximal tibiofibular joint
Final dissection of the proximal portion of the vascular pedicle
Postoperative care
Donor site
Recipient site
Outcomes, prognosis, and complications
Secondary procedures
Donor site
Recipient site
Future directions
References
40
40 Treatment of the upper extremity amputee
Introduction
Principles of prosthetic reconstruction
Improve the soft tissues to help wear a prosthesis
Understand that the type of prosthetic is based on patient needs and amputation level
Passive/aesthetic devices
Body-powered devices
Externally powered prosthesis
Hybrid devices
Understand prosthetic attachment systems
Plan for the means of prosthetic control
Treat upper extremity pain and phantoms
Treatment of upper extremity amputees
Principles of acute upper extremity amputation surgery
Surgery for the shoulder disarticulation level amputee
Surgery for the transhumeral amputee
Surgery for the transradial level amputee
Surgery for the wrist disarticulation amputee
Surgery for the partial hand amputee
Surgery for the patient with digit amputations
Future directions
Conclusion
References
41
41 Upper extremity composite allotransplantation
Introduction
Evolution of upper extremity vascularized composite allotransplantation
Immunology of vascularized composite allotransplantation
Experimental background and scientific basis for upper extremity transplantation
Chronology of clinical upper extremity allotransplantation
Historical development and milestones
Clinical experience with upper extremity allotransplantation
Program, patient, procedural, and protocol-related considerations
Program establishment and implementation
Donor and recipient selection
Procedural aspects
Donor limb procurement
Recipient surgery
Protocol-related considerations
Maintenance immunosuppression
Rehabilitation and functional assessment after upper extremity allotransplantation
Assessment for rejection (host-versus-graft reaction)
Immunologic monitoring
World experience and surgical outcomes
Unique aspects of vascularized composite allotransplantation
Emerging insights in vascularized composite allotransplantation
Cortical plasticity and neuro-integration
Chronic rejection
Tolerance approaches and immunomodulatory strategies
Future directions of upper extremity reconstructive transplantation
References
42
42 Aesthetic hand surgery
Introduction
Relevant anatomy
Basic aesthetics of the hand
The aging process
Grading systems
Patient management
Rejuvenation of the epidermis and dermis
Non-surgical management
Topicals
Chemical peels
Microdermabrasion
Laser therapy
Q-switch lasers
Intermittent pulsed light
Photodynamic therapy
Non-ablative non-fractionated lasers
Non-ablative fractionated lasers
Ablative lasers
Radiofrequency
Dorsal vein prominence
Non-surgical management
Sclerotherapy
Endovenous ablation
Surgical management
Phlebectomy
Volume restoration
Non-surgical management
Injectables
Hyaluronic acid
Poly-L-lactic acid
Calcium hydroxyapatite
Injection technique
Surgical management
Autologous fat grafting
Author’s preferred technique
Skin excision
Arthroplasty/arthrodesis
Skin excess
Articular aging
Future directions
Adipose-derived stem cells
Platelet-rich plasma
Allograft adipose matrix
Conclusions
References
43
43 Hand therapy
Patient evaluation
Occupation-based assessments
Impairment-based assessments
Rehabilitation following tendon injury
Extensor tendon injury
Zone I/II
Zone III/IV
Zone V–VII
Thumb
Flexor tendon injury
Timing
Positioning
Motion
Tenolysis
Tendon transfer
Rehabilitation following nerve injury
Nerve decompression
Carpal tunnel release
Cubital tunnel release
Nerve repair
Sensory re-education
Desensitization
Nerve transfer
Motor re-education
Anterior interosseous nerve to ulnar motor nerve
Rehabilitation following fractures
Protective phase
Restorative phase
Strengthening and functional phase
Metacarpal fractures
Proximal/middle phalanx fractures
Distal phalanx fractures
Rehabilitation following replantation
Future directions
References
Confidence is ClinicalKey