Background: Nerve injuries remain a challenging complication after shoulder surgery. While most resolve spontaneously, some require surgical intervention. This study describes the characteristics of patients sustaining nerve injuries following shoulder surgery, evaluates referral patterns to nerve surgeons, and characterizes nerve surgeries performed and their outcomes. Increased awareness of these injuries allows patients and providers to be better informed regarding the appropriate management when these complications occur. Methods: A retrospective review of referrals with nerve injuries following shoulder surgery between 2007 and 2015 was performed. The final analysis included 65 patients. Data reviewed included demographics, procedure and anesthesia type, and diagnosis of nerve injury. Time to referral to nerve surgeon and proportional changes in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores were determined. Outcomes were categorized as failed, partially successful, and successful based on final follow-up. Results: Patients were referred following arthroscopic shoulder surgeries (35.4%), shoulder arthroplasties (24.6%), open shoulder procedures (21.5%), and combined open and arthroscopic procedures (18.5%). The mean time to referral was 7.6 months. Nerve injuries involved brachial plexus (33) and individual and multiple peripheral nerve branches (23 and 7, respectively). Twenty-five (38%) nerve injuries demonstrated spontaneous recovery. Thirty-five patients underwent surgical intervention, of which 27 were successful, 3 were partially successful, and 3 failed. Conclusions: This is the largest series of patients with iatrogenic nerve injury following shoulder surgeries to date. Our data demonstrate a lack of timely referral to nerve surgeons, especially after arthroscopy. There continues to be a variable injury pattern even among similar surgeries. Despite this, timely surgical intervention, when indicated, can lead to favorable outcomes.

Background: Throughout history, plastic surgeons have advocated for the protection of the specialty and for better care for their patients. Whether through efforts to support and move legislation through Congress or through preventative advocacy in the form of lobbying against legislation, plastic surgeons have often used their expertise in the political sphere to shape patient care. We hope to inspire current and future plastic surgeons to be politically active and to devise ways in which their expertise can be used within the legislative system to better care for their patients. Methods: This article highlights four historical examples of plastic surgeon-led advocacy within the federal government: the U.S. Flammable Fabrics Act; the American Society of Plastic and Reconstructive Surgeons and the Federal Trade Commission, 1979; the Women's Health and Cancer Rights Act; and the Breast Cancer Patient Education Act. Results: We hope that plastic surgeons will-like Dr. Crikelair, Dr. Wider, and the members of American Society of Plastic Surgeons/American Society of Plastic and Reconstructive Surgeons-continue to play an active role in the shaping of the legislative system for our profession and, ultimately, our patients. Conclusions: To ensure the best care for their patients, plastic surgeons must continue to maintain their relationship with public health and legal professionals and legislators. Through relationships with patients and a firm understanding of their stories, plastic surgeons can have great impacts in all local, state, and national political spheres.

No abstract

Summary: Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable “learned” level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.