The Development and Future of Reconstructive and Microvascular Surgery of the Hand

Malahias, Marco; Jordan, Daniel J; Hindocha, Sandip; Khan, WS; Juma, Ali

doi:10.2174/1874325001408010415

Cited by 3 publications

(2 citation statements)

References 62 publications

(60 reference statements)

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“…In case of vascular flap compromise, the flap salvage rate after reexploration was 54%, which is in line with our previous study on risk factors for free flap failure in 1,530 free flaps. 26 Following microsurgical reconstruction of severe upper extremity injuries, the affected limb often keeps suffering from functional impairment, 8,10,27 which has been previously found by other studies using PROMs. [28][29][30][31][32] Although the reported DASH scores (8-71) and MHQ scores (47-77) ranged considerably, all authors emphasized limb preservation as the treatment of choice.…”

Section: Discussionmentioning

confidence: 76%

Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

Bekkum

Jong

Zuidam

et al. 2019

J reconstr Microsurg

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Background Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL. Methods In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ). Results A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 “physical component score” and “role limitations due to physical health” scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36. Conclusion Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.

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Section: Discussionmentioning

confidence: 76%

Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

Bekkum

Jong

Zuidam

et al. 2019

J reconstr Microsurg

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“…7 Microvascular surgeries require the use of the surgical microscope. 8,9 However, the best way to make an effective and accurate skin incision has not been investigated, for example, should the field be magnified and what scalpel blade should be used?…”

mentioning

confidence: 99%

#15 Versus #15c Scalpel Blades for Skin Incisions: Accuracy With and Without Magnification

et al. 2021

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BACKGROUND Use of a #15 blade is the most popular way for making skin incisions in dermatology. For finer and more accurate incisions, a #15c blade can be used. However, there is no evidence that demonstrates the superiority of the #15c blade over the #15 blade. OBJECTIVE This study aimed to compare the skin incisions made with a #15 blade and #15c blade using varied magnifications. METHODS AND MATERIALS Twenty fresh chicken thighs with intact skin were used in this study. Incisions were made on the skin using #15 and #15c blades with ×1.0, ×2.5, and ×5.0 magnification. The accuracy of the incision (length and depth) made by the different scalpel blades and magnifications was analyzed using the 2 × 3 chi-squared test. Logistic regression analysis was applied to determine factors of the incision depth and length. RESULTS No statistically significant differences were found in the evaluations of length or depth using the 2 × 3 chi-squared test. However, the multiple logistic regression analyses showed that the incision length and depth were associated with use of the #15c scalpel blade. CONCLUSION Use of a #15c scalpel blade with ×5.0 magnification is recommended for making incisions when less than 1- to 2-mm accuracy is required.

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Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures

Desai,

Luo,

Borowsky

et al. 2024

J Reconstr Microsurg

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Background: Upper extremity (UE) replantation and revascularization are challenging surgical procedures, with survival rates being 50% to 90%. Preoperative risk stratification is challenging yet crucial as patients with comorbid conditions face increased complications. This study assesses the predictive value of the modified 5-item frailty index (5-mFI) for postoperative complications in these procedures. Methods: A retrospective study was done using the ACS NSQIP database (2011-2021) for UE replantation/revascularization. The 5-mFI score assigned points for comorbidities including pulmonary disease, heart failure, diabetes, hypertension, and functional status (0-5 scale; 1 point to each). 5-mFI scores stratified patients into <2 (low-risk) or ≥2 (high-risk) categories. Results: Of 2,305 patients, the mean age and BMI were 53.13 years and 28.53 kg/m2 respectively. The 5-mFI≥2 cohort experienced higher rates of all-cause complications, systemic complications, unplanned readmissions, and return to the operating room on univariate analysis. There was no significant difference in wound complication rates. Multivariable logistic regression showed that a higher 5-mFI was significantly associated with increased risks of all-cause mild and severe systemic complications. Wound complications, length of stay over 30 days, unplanned readmission, and return to the operating room were higher in high-risk patients, however not statistically significant. Conclusion: 5-mFI is an effective tool for evaluating risk in UE replantation and revascularization, correlating high scores with significantly increased postoperative complications. High-risk patients with 5-mFI≥2 also had more reoperations and readmissions. The use of 5-mFI in preoperative assessments can help personalize management, enhancing patient selection and care quality in these complex reconstructions.

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The Development and Future of Reconstructive and Microvascular Surgery of the Hand

Cited by 3 publications

References 62 publications

Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

#15 Versus #15c Scalpel Blades for Skin Incisions: Accuracy With and Without Magnification

Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures

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