AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

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<strong>ASRM</strong> Concurrent Scientific Paper Presentations A-2 Replantation in Developing Countries Institution where the work was prepared: SOS Mano Santo Domingo, Hand group, Santo Domingo, Dominican Republic Hector Herrand, MD; Marcos Nuñez, MD; Otoniel Diaz, MD; SOS Mano Santo Domingo From January 1995 to January 2006 we have done 42 hands replantation including one bilateral case, in Santo Domingo, Dominican Republic, by our group SOS Mano Santo Domingo. Males were involved in 95% of the cases. Age ranges from 10 years to 59 years with and average of 26 years.The most common mechanism of action was agression 38/41 (93%), and machete was the instrument used during the agression in all cases.36 patients were right hand dominant and the majority of cases involved the non dominant hand. The most common amputation level was the Radiocarpal area with 22 cases (52%).Most of patients (19/41) 46% arrived between 4 and 6 hours after the trauma. 16 hands were correctly preserved and 26 hands were incorrectly transported under cold or warm ischemia. Our local temperature range from 29 to 32 centigrades. Operative time range from 6 hours to 13 hours, average 9.36 hours. All cases were done under loupes magnification (3.5X and 4.5X). Only one case was fixed with plates and screws the others were done with pins and wires. Residents participate very actively in most of the cases. We have 2 important complications associated to postop bleeding, one case developed a transitory acute renal failure that require dialysis. 12 cases developed vascular insufficiency, one of them could be solved and the hand survived. 31 hands (74%) do succesfully and we lost 11 hands (26%). 23 patients showed good or excellent results, 8 patients did regularly or poorly (4 and 4) when we compared return to daily activities, ROM, and 2PD static. The maximum follow up is 10 years and the minimal 4 months. Only 20 patients have been followed by personal contact during at least one year. We performed this 41 patients in 7 different institutions: 3 public, 1 semiprivate and 4 private. We calculate an average of 2,600 dollars in hospitalization and OR expenses per patient, and we only have charged private fees in only 5 patients with an income average of 1,394 dollars per patient. In the public hospital we have only the payment of the monthly salary equivalent to 606 dollars. Reconstruction of Congenital Differences of the Hand Using Microsurgical Toe Transfers Institution where the work was prepared: University of California, Los Angeles, Los Angeles, CA, USA Neil F. Jones, MD; University Of California Los Angeles Introduction: A large series of children with congenital differences of the hand was analyzed retrospectively to develop a more simplified classification system for congenital absence of the digits and to develop an algorithm which directly predicts which microsurgical toe-to-hand transfers will provide the best hand function. Materials and Methods: 78 toe transfers have been performed in 65 children for congenital anomalies of the hand, classified by the Swanson system as transverse deficiencies or symbrachydactyly (32); radial longitudinal deficiencies (5); cleft hand (9) and congenital constriction ring syndrome (17). Preoperative X-rays and photographs were analyzed to determine which rays were missing and their level of absence. A new classification system was developed to describe nine phenotypes of congenital absence of the digits. Results: Optimal reconstruction of the severe radial deficiency phenotypes involving the thumb, index and middle fingers is a toe-to-thumb transfer using either the second toe (21) or great toe (14). For severe transverse deficiencies involving all four fingers, there are two options - either a single second toe transfer into the ring or small finger position (25); or bilateral second toes transferred either simultaneously or in sequential procedures into the middle finger and small finger positions to provide three point pinch (5). The aplastic hand with absence of all five digits is best reconstructed with bilateral second toe transfers into the thumb and small finger positions (6). Six toe transfers required re-exploration of the microsurgical anastomoses for a re-exploration rate of 7.7%. Two toe transfer failed for a success rate of 97.5%. All the children have regained sensation in the transferred toes and improvement in hand function. Discussion: Retrospective analysis of a large series of children with congenital anomalies of the hand has resulted in the development of a simplified classification system and a treatment algorithm, which directly predicts which of four possible microsurgical toe-to-hand transfers will provide the most optimal reconstruction of severe transverse and longitudinal deficiencies of the hand. Simultaneous Double Second Toe Transplantation for Reconstruction of Multiple Digit Loss in Traumatic Hand Injuries Institution where the work was prepared: The Buncke clinic and Division of Microsurgery, CPMC, San Francisco, CA, USA Fernando A. Herrera Jr, MD; Alfonso Camberos, MD; Jacob J. Freiman; Charles K. Lee; Rudy Buntic; Gregory M. Buncke; California Pacific Medical Center Purpose: To review our recent 10-year experience of simultaneous double second toe transplants for reconstruction of traumatic injuries following multiple digit loss. Methods: Retrospective chart review of 11 cases of traumatic hand injuries resulting in multi-digit loss of the index, long, ring, or small fingers (excluding the thumb) that underwent simultaneous double second toe transplantation for digital reconstruction. Results: From 1995 to 2005, 11 patients underwent a simultaneous double second toe transplantation. Mean age was 36 years (range 6 to 60 years); all patients were male, all were right hand dominant. Index and long fingers were reconstructed in 3 patients, long and ring finger in 7 patients, and ring and small finger in 1 patient. All patients had undergone completion amputation after mutilating crush/avulsion injuries obviating replantation. A simultaneous 3-Team approach was used in all cases. The average operating time was 9 hrs (Range 7-15hrs). The mean time to reconstruction was 5.7 months following injury (range 2 to 15 months). Complications included microvascular venous thrombosis, loss of the transplanted toe, bleeding, and infection. All donor sites were closed primarily and there was minimal donor-site morbidity. 21/22 (95%) toe transplants survived. Secondary surgery was performed in 10/11 patients, including tenolysis, flap debulking, and skin grafting. Average moving-2 point discrimination was 5mm in each digit after 7 month follow-up. Mean grip strength approached 50% of the contralateral hand. Mean time to work return after digital reconstruction was 10 months. 8/11 of the patients returned to work after vocational rehabilitation. Conclusion: Simultaneous double second toe transplantation is a viable and efficient procedure for multi-digit reconstruction. The 3-Team approach allows for a single stage reconstruction to a multi-level problem. Functional and aesthetic improvement to the hand can be significant with minimal donor site morbidity to the feet. 147
Functional Assessment of the Reconstructed Fingertips after Free Toe Pulp Transfer Institution where the work was prepared: Cheng-Hung Lin, Taipei, Taiwan Cheng-Hung Lin, MD; Chih-Hung Lin; Yu-Te Lin; Paolo Sassu; Fu-Chan Wei; Chang Gung Memorial Hospital, Chang Gung University Background: Posttraumatic fingertip reconstruction with a free toe pulp was first described in 1979. Although there have been several studies regarding the sensibility assessment of the reconstructed digits, only two-point discrimination (2PD) test was usually employed and the case numbers were limited. The goal of this study was to comprehensively assess the functional outcome of the reconstructed fingertips after free toe pulp transfer. Methods: There were 15 flaps in 14 male patients recruited in this retrospective study. Objective sensory recovery was assessed with 2PD and Semmes-Weinstein monofilament (SWM) tests. Pinch power of the reconstructed digits as well as subjective pain and discomfort was also evaluated. Statistical analysis was used to compare and investigate the relationship of the results. Results: According to the findings of 2PD test, 6 flaps obtained good results, 6 flaps gained fair results, and 3 flaps could perceive only one point. The SWM test revealed diminished light touch in 6 flaps, diminished protective sensation in 8 flaps and loss of protective sensation in one flap. Strong correlation between s2PD and m2PD (?=0.78747, p=0.0005), but weak correlation between s2PD and SWM of the flaps (?=0.34240, p=0.2116) was found. There was significant difference in s2PD (p
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PROGRAM B O O K AAHS January 10-13,
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TABLE OF CONTENTS AAHS Board of Dir
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AAHS COMMITTEES Please join us in t
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HAND SURGERY ENDOWMENT The followin
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HONOR ROLL CON’T Norman Payea, MD
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ASPN COMMITTEES Please join us in t
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2006-2007 ASRM EXECUTIVE COUNCIL ME
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ASRM COMMITTEES CON’T CPT/RUC COM
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MESSAGES FROM THE PROGRAM CHAIRS Th
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SOCIAL EVENTS Social events are off
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HAND SURGERY ENDOWMENT Booth: TABLE
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AAHS CONTINUING MEDICAL EDUCATION A
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ASRM CONTINUING MEDICAL EDUCATION A
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FUTURE ANNUAL MEETING LOCATIONS AAH
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AAHS Wednesday, January 10, 2007 6:
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B. Operative Treatment 12, 13 1. He
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REFERENCES 1. Adolfsson, L; Lindau
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The Treatment of Unstable Distal Ra
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Metacarpal and Phalangeal Fractures
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Method of choice for middle phalanx
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Introduction AAHS SPECIALTY DAY PRO
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A second parallel 0.045-inch k-wire
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New Techniques for Flexor Tendon Re
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Core Sutures New Techniques for Fle
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RAPID RECOVERY: Pediatric Injuries
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References RAPID RECOVERY & NERVE I
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AAHS Thursday, January 11, 2007 6:3
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11:35am - 11:40am *Thumb Extension
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AAHS Friday, January 12, 2007 6:30a
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11:45am - 11:50am *Mechanical Testi
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AAHS/ASRM/ASPN DAY-AT-A-GLANCE Satu
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12:30pm - 4:00pm ASRM Master Series
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ASPN Saturday, January 13, 2007 1:0
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ASPN DAY-AT-A-GLANCE Sunday, Januar
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10:19am - 10:21am Discussion 10:21a
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3:16pm - 3:18pm Discussion 3:18pm -
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ASRM Sunday, January 14, 2007 6:00a
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9:56am - 10:00am Discussion 10:00am
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ASRM DAY-AT-A-GLANCE Monday, Januar
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9:27am - 9:35am Discussion 9:35am -
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1:00pm - 5:15pm Composite Tissue Al
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ASRM Tuesday, January 16, 2007 6:00
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ABSTRACT TABLE OF CONTENTS AAHS/ASR
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Mardinis, Samir . . . . . . . . . .
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The Distal Radio Ulna Joint Prosthe
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Biomechanical Comparison of Differe
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AAHS Concurrent Scientific Paper Se
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Management of the Central Extensor
Page 99 and 100: Giant Cell Tumor of the Tendon Shea
Page 101 and 102: A Detailed Cost and Efficiency Anal
Page 103 and 104: Comparison of Return to Work: Endos
Page 105 and 106: Traumatic Thumb Reconstruction by I
Page 107 and 108: Arthroscopic Cuetis Interpositional
Page 109 and 110: Nerve Ending Distribution in Human
Page 111 and 112: Complications in Percutaneous Screw
Page 113 and 114: Re-do Digital Sympathectomy in Refr
Page 115 and 116: Flexor Digitorum Profundus Repair t
Page 117 and 118: Unmasking the Flexor Digitorum Supe
Page 119 and 120: The Genetic Modification of the Hum
Page 121 and 122: ASPN Scientific Paper Presentations
Page 123 and 124: Metastatic Breast Cancer Recurrence
Page 125 and 126: Development of Assessment Tasks for
Page 127 and 128: ASPN Scientific Paper Presenations
Page 129 and 130: The Diagnostic Value of Ultrasound
Page 131 and 132: The Cystic Transverse Limb of the A
Page 133 and 134: A New and Novel Model of Peripheral
Page 135 and 136: ASPN Scientific Paper Presentations
Page 137 and 138: Nerve Fiber and Motor Neuron Count
Page 139 and 140: Multiple Costimulatory Pathway Inhi
Page 141 and 142: The Effect of Cold Storage on Somat
Page 143 and 144: ASRM Concurrent Scientific Paper Pr
Page 145 and 146: A Comparison of Donor Site Morbidit
Page 147 and 148: Blood Supply of Abdominal flaps for
Page 149: The Semi-Lunar Transverse Inner Thi
Page 153 and 154: Prevention of First Web Retraction
Page 157 and 158: Marriage of Hard and Soft Tissues o
Page 159 and 160: Immediate Free Flap Reconstruction
Page 161 and 162: Shift of Concepts in the Management
Page 163 and 164: A long-Term Study Of Donor Site Wit
Page 165 and 166: Coronal-Posterior Approach for Faci
Page 167 and 168: Hindlimb Osteomyocutaneous Flap can
Page 169 and 170: Four Dimensional CT-Scan Analysis o
Page 171 and 172: Microdialysis is a Reliable Tool fo
Page 173 and 174: Perfusing with Anti-alpha-beta-T Ce
Page 175 and 176: Inside-Out Tissue Engineering: Usin
Page 177 and 178: Effects of Hyperbaric Oxygen on the
Page 181 and 182: Prelamination of Radial Forearm Fas
Page 185 and 186: Anatomy and Hystology of the Latiss
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