Floor plan - 2013 Annual Meeting - American Association for Hand ...

More documents

Recommendations

Info

ASRM SCIENTIFIC PAPER PRESENTATIONS: UPPER EXTREMITY Total and Subtotal Amputations with Destruction of the Proximal Interphalangeal and Metacarpal Phalangeal Joint: a Paradigm Shit Towards Salvage Institution where the work was prepared: California Pacific Medical Center, San Francisco, CA, USA Darrell Brooks, MD; Rudolf F. Buntic; Buncke Clinic INTRODUCTION: Beneficial function can be obtained utilizing a staged approach for salvage of digital amputations through the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints. Completion amputation is currently recommended for these injuries. 1,2 METHODS: Between 2002 and 2006 we treated 14 patients for total and subtotal amputations characterized by destruction of their PIP (12) and MCP (4) joints in a staged approach. In the initial stage, patients underwent restoration of joint height, reconstruction of joint supporting joint structures, as well as repair of tendons, vessels and nerves. Tissue was transferred or transplanted as needed for soft tissue coverage. In a subsequent stage, pyrolytic carbon two-piece arthroplasty (Ascension Austin, Texas) was performed through a dorsal approach. Outcome evaluation involved range of motion (ROM), grip strength, pain, and analysis of the joint characteristics such as lateral stability, stem loosening, and subsidence. RESULTS: All patients completed 18 months follow-up evaluation. Mechanisms of injury included crush, ring avulsion, and saw. An average of 2.8 (PIP group) and 2.0 digits (MCP group) were injured per hand. Range was 1-4 and 2-3 digits per hand respectively. All digits undergoing staged reconstruction survived. Outcome analysis is illustrated in table 1. Video documentation of function will be provided at presentation. CONCLUSION: In selected patients rewarding function can be obtained in cases previously thought to be a contraindication for salvage. Table 1. Patients Joint ROM (degrees) 11 3 PIP (12) MCP (4) 60-95 65-90 ROM (% of nl) 60-95 70-100 157 Avg. % Reference 1: Soucacous PN. Indications and selection for digital amputation and replantation. J Hand Surg [Br]. 2001 Dec;26(6):572-81. Reference 2: Allen DM, Levin LS. Tech Hand Up Exterm Surg. 2002 79 86.2 Grip (% of nl) 39-70 12-66 Avg. injured digits/hand 2.8 2.0
Single-Stage Reconstruction of the Mutilated Hand Using Bilobed and Trilobed Free Flaps Based on the Anterior Tibial Artery Institution where the work was prepared: Duke University, Durham, NC, USA Keith E. Follmar; Yi Xin Zhang; Danru Wang; Detlev Erdmann; L. Scott Levin; Duke University BACKGROUND: Reconstruction of the mutilated hand remains a challenging clinical problem. Due to the complex shape of the hand, multiple flaps or staged procedures are often necessary to resurface the hand with an acceptable outcome. Furthermore, involvement of the thumb or other fingers often complicates reconstruction. The authors describe our experience with bilobed and trilobed free flaps based on the anterior tibial artery system for single-stage reconstruction of the mutilated hand. METHODS: Five patients with mutilated hands (two traumatic injuries, three burn injuries) underwent soft tissue coverage with a bilobed (N=2) or trilobed (N=3) free flap based on the anterior tibial vessel system, including the anterior tibial, dorsalis pedis, and, in the trilobed cases, the first dorsal metatarsal vessels. The flaps consisted of a lateral leg lobe, a dorsalis pedis lobe, and the great toe as the third lobe. The sensatory nerve was also anastomosed in all cases. All donor sites were resurfaced by thick-split skin grafts. RESULTS: All flaps survived. Functional and aesthetic outcome was acceptable at 3 to 12 months of follow up. Some recovery of protective thermal sensation was observed in all patients. In the three cases where a great toe was included in the flap, this allowed the reconstructed thumb to act as an opposable post and provide some pinching action. All donor sites were free from major disability. CONCLUSION: Bilobed and trilobed free flaps based on the anterior tibial artery are a robust reconstructive option for resurfacing of the mutilated hand, especially in cases where the thumb or another digit has been lost. It allows for excellent results in a single stage. Figure Legend: A 36year-old female presented with severe burn contractures three years after a burn to her right hand. (A) Preoperative view showing severe contractures involving the wrist, dorsum, and thenar regions. Also note partial loss of the thumb. (B) Preoperative flap design showing the three lobes of the flap. (C) Intraoperative view after raising the three lobes of the flap, prior to pedicle division. (D) Postoperative view, showing the three lobes of the flap used to reconstruct the first web and palm area, the thenar area, and the thumb respectively. Complications Associated With Specific Types of Intrinsic Pedicle Flaps Used to Reconstruct Digital Trauma Defects Institution where the work was prepared: Hand & Wrist Center of Houston, Houston, TX, USA Mark Henry, MD; University of Texas One hundred and seventy-five consecutive pedicle flaps of the hand and wrist performed over a 4 year period were reviewed, eliminating 5 cases for inadequate patient follow-up and 61 cases for recipient sites proximal to the metacarpophalangeal joints. The remaining 108 intrinsic hand vessel based pedicle flaps were performed in 98 males and 10 females averaging 36 years of age for digit level trauma in 19 thumbs, 27 index fingers, 50 long fingers, 8 ring fingers, and 4 small fingers. Specific flaps employed were 79 antegrade flow homodigital proper digital artery, 10 reverse flow homodigital proper digital artery, 3 reverse flow second dorsal metacarpal artery, 5 antegrade flow first dorsal metacarpal artery, 6 reverse flow dorsal ulnar artery of thumb, and 2 dorsal middle phalangeal flaps based on a dorsal branch of the proper digital artery. The final average total active motion in the fingers was 235 degrees. Complications occurred in 42 cases in which 39% of the patients were actively smoking post-operatively. Complications included 10 partial flap losses, 13 cases of superficial epidermolysis, 4 cases of venous congestion, 4 superficial infections, 3 deep infections, and 8 cases of delayed healing at the wound margin. Second surgeries were required to manage these complications in 15 cases: 3 debridements of deep wound infections, 3 revisions of the distal fingertip amputation profile for partial flap loss, 5 full-thickness skin grafts for partial flap loss, and 4 full-thickness skin grafts for wound breakdown at the flap margin. Specific associations of complications with flap type were that the antegrade homodigital proper digital artery flaps used to preserve length in digital amputations experienced partial flap loss, epidermolysis, delayed wound healing, and infections involving the portion of the flap bordering the amputation margin in a secondary zone of crush but no cases of venous congestion. Reverse flow proper digital artery flaps of the finger and reverse flow dorsal ulnar artery flaps of the thumb experienced venous congestion and epidermolysis but no partial flap losses or infection. Whether the skin taken as part of the flap has experienced direct trauma itself and the direction of flow in the pedicle may play a role in determining what type of complications can be expected when using pedicle flaps intrinsic to the hand in the reconstruction of digital trauma defects. 158
Page 2 and 3:
HYATT REGENCY CENTURY PLAZA FLOOR P
Page 4 and 5:
2007-2008 AAHS BOARD OF DIRECTORS P
Page 6 and 7:
AAHS HISTORICAL INFORMATION AAHS PA
Page 8 and 9:
ASPN COMMITTEES Please join us in t
Page 10 and 11:
2007-2008 ASRM EXECUTIVE COUNCIL ME
Page 12 and 13:
ASRM HISTORICAL INFORMATION 1983 FO
Page 14 and 15:
GENERAL ANNOUNCEMENTS Meeting Servi
Page 16 and 17:
2008 EXHIBITOR LISTING AMERICAN SOC
Page 18 and 19:
LIPPINCOTT, WILLIAMS & WILKINS Boot
Page 20 and 21:
SYNTHES CMF Booth: 21 Angela Obzud
Page 22 and 23:
ASPN CONTINUING MEDICAL EDUCATION A
Page 24 and 25:
Association for Hand Surgery Americ
Page 26 and 27:
AAHS DAY-AT-A-GLANCE Wednesday, Jan
Page 28 and 29:
AAHS DAY-AT-A-GLANCE Thursday, Janu
Page 30 and 31:
12:09pm -12:15pm *The Volar Approac
Page 32 and 33:
AAHS DAY-AT-A-GLANCE Friday, Januar
Page 34 and 35:
11:35am - 11:41am Thumb Metacarpal
Page 36 and 37:
AAHS/ASPN/ASRM DAY-AT-A-GLANCE Satu
Page 38 and 39:
ASPN DAY-AT-A-GLANCE Friday, Januar
Page 40 and 41:
Dr. Schwartz moved from the Barrow
Page 42 and 43:
ASPN Saturday, January 12, 2008 11:
Page 44 and 45:
ASPN Sunday, January 13, 2008 6:30a
Page 46 and 47:
ASRM DAY-AT-A-GLANCE Saturday, Janu
Page 48 and 49:
ASRM DAY-AT-A-GLANCE Sunday, Januar
Page 50 and 51:
11:45am - 12:15pm Presidents Addres
Page 52 and 53:
ASRM DAY-AT-A-GLANCE Monday, Januar
Page 54 and 55:
11:04am - 11:08am Aesthetic Perfora
Page 56 and 57:
ASRM DAY-AT-A-GLANCE Tuesday, Janua
Page 58 and 59:
9:04am - 9:08am *Timing of Microsur
Page 60 and 61:
ABSTRACT TABLE OF CONTENTS AAHS/ASP
Page 62 and 63:
59 ABSTRACT AUTHOR INDEX Luciano, J
Page 64 and 65:
Expression of TGF beta and IL-10 in
Page 66 and 67:
A Novel Approach for Treating Fract
Page 68 and 69:
Wrist Arthrodesis as a Salvage Oper
Page 70 and 71:
Post-Operative Complications Of Art
Page 72 and 73:
Surgical Management of Post-traumat
Page 74 and 75:
Clinical Outcome in Dupuytren's Dis
Page 76 and 77:
The Spiral Flap for Fingertip Resur
Page 78 and 79:
Deep Inferior Epigastric Artery Gra
Page 80 and 81:
Flexor Tendon Repair with Barbed Su
Page 82 and 83:
Modified Allen's Test Using Near In
Page 84 and 85:
Long-term Outcomes of Dorsal Interc
Page 86 and 87:
Thumb Metacarpal Phalangeal Joint C
Page 88 and 89:
Preliminary Experience with Fat Gra
Page 90 and 91:
Mesh Implant Arthroplasty for Treat
Page 92 and 93:
AAHS Concurrent Scientific Paper Se
Page 94 and 95:
Innervations of the Medial Head of
Page 96 and 97:
An Upper Limb Reach and Grasp Cycle
Page 98 and 99:
Local Immunotherapy Inhibits Skin R
Page 100 and 101:
The Effect of Donor Presensitizatio
Page 102 and 103:
Efficacy of Endoscopic Cubital Tunn
Page 104 and 105:
Wrist Arthroscopy: Correlation of C
Page 106 and 107:
AAHS/ASPN/ASRM OUTSTANDING NERVE PA
Page 108 and 109:
ASPN SCIENTIFIC PAPER SESSION A Mai
Page 110 and 111: Nerve Regeneration through Nerve Au
Page 112 and 113: Insulin-Like-Growth Factor 1 Improv
Page 114 and 115: Comparative Analysis of Holding Str
Page 116 and 117: The Mechanisms of Axonal Sprouting
Page 118 and 119: Caspase 3 Knockout Mice Show Partia
Page 120 and 121: Soleus Arch as Compression Site for
Page 122 and 123: A Study of Modality Specific Nerve
Page 124 and 125: Increase of Neuronal Camp by Electr
Page 126 and 127: ASPN SCIENTIFIC PAPER SESSION D Bra
Page 128 and 129: Spontaneous gait recovery in denerv
Page 130 and 131: Repairing Peripheral Nerve Injuries
Page 132 and 133: Pressure Changes in the Medial and
Page 134 and 135: The Feasibility of Using Side-to-Si
Page 136 and 137: Subperiosteal Approach: A New, Safe
Page 138 and 139: The Use of Ultrasound to Identify t
Page 140 and 141: Regenerative Acellular Collagen Tub
Page 142 and 143: Postoperative Changes in Blood Velo
Page 144 and 145: The Use of Thrombolytics in Microva
Page 146 and 147: ASRM SCIENTIFIC PAPER PRESENTATIONS
Page 148 and 149: Comparison Of Superior Gluteal Arte
Page 150 and 151: Outcome of Microvascular Complicati
Page 152 and 153: Utilization of the Internal Mammary
Page 154 and 155: Tissue Oximetry, A Reliable Techniq
Page 156 and 157: Partial Muscle Transplantation: Str
Page 158 and 159: Outcomes of Immediate VRAM Flap Rec
Page 162 and 163: Refinement of Arterialized Venous F
Page 164 and 165: The Aesthetic Mini Wrap - Around Te
Page 166 and 167: The Extended Lower Trapezius Flap f
Page 168 and 169: The Use of Corticoperiosteal Flaps
Page 170 and 171: The Distal Superficial Femoral Arte
Page 172 and 173: Pedicled Perforator Flaps of the Lo
Page 174 and 175: ASRM SCIENTIFIC PAPER PRESENTATIONS
Page 176 and 177: In Vivo and In Vitro Evidence that
Page 178 and 179: Quantitative Evaluation of the Dila
Page 180 and 181: Targeted Motor Reinnervation of the
Page 182 and 183: The Role of Thymus in Chimerism Ind
Page 184 and 185: Three-and Four-Dimensional Arterial
Page 186 and 187: Microsurgical Correction of Craniof
Page 188 and 189: Maxilla Transplantation Institution
Page 190 and 191: Harnessing the Potential of the Fre
Page 192 and 193: Chronic deep venous thrombosis in t
Page 194 and 195: Buried flap monitoring using a nove
Page 196 and 197: Further Esthetic Refinement for Gre
Page 198 and 199: Achieving Aesthetic Results in Faci
Page 200 and 201: Modified Tibial Turn-up Fillet flap
Page 202 and 203: End-to-Side Anastomosis to the Inte
Page 204 and 205: Limiting Complications and Complexi
Page 206 and 207: The SIEA, DIEP and Free TRAM flaps:
Page 208 and 209: A Ten-Year Experience of Free Flaps
Page 210 and 211:
ASRM POSTERS PRESENTATIONS Concentr
Page 212 and 213:
Microsurgical Treatment of Chronic
Page 214 and 215:
Aesthetic Outcomes in the Free TRAM
Page 216 and 217:
The Incorporation of Biologics and
show all

Floor plan - 2013 Annual Meeting - American Association for Hand ...

Create successful ePaper yourself

Delete template?

Save as template?