Can Dermofasciectomy for Dupuytren Disease be Performed Safely and Effectively Under Local Anesthesia with Adrenaline?

Purpose: Wide-awake local anesthesia no tourniquet (WALANT) surgery is well suited to dermofasciectomy for Dupuytren contracture because it permits active assessment of the central slip after disease excision; however, it is seldom performed. This study had two main aims: first, to describe our technique for dermofasciectomy under WALANT; second, to compare outcomes with dermofasciectomy performed under WALANT and regional anesthesia (RA).

Methods: This retrospective cohort study included all patients treated with dermofasciectomy by the senior author in a single center between April 2020 and April 2024.

Health-related quality of life in patients with conditions affecting the hand: meta-analysis.

Background: Health state utility values provide the quality component of quality-adjusted life years and are essential for health economic analyses, such as the National Institute for Health and Care Excellence Technology Appraisal. The aims of this systematic review were to: catalogue utility values for health states experienced by patients with hand conditions; provide pooled utility estimates for common hand conditions; and determine how utilities have been estimated.

Methods: A PRISMA-compliant systematic review and meta-analysis was conducted (registered in PROSPERO, the international prospective register of systematic reviews (CRD42021226098)).

Modified Scoring of the QuickDASH Can Achieve Previously-unattained Interval-level Measurement in Dupuytren Disease and Carpal Tunnel Syndrome.

Background: Rasch measurement theory can be used to identify scales within questionnaires and to map responses to more precise continuous scales. The aim of this article was to use RMT to refine the scoring of the QuickDASH in patients with Dupuytren disease and carpal tunnel syndrome (CTS).

Methods: Data were collected between 2013 and 2019 from a single center in the UK.

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations.

Background: Traditionally, the use of a pneumatic arterial tourniquet was requisite for safe and effective surgery of the hand. The use of arterial tourniquets necessitates the use of regional or general anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has emerged as a novel technique to overcome the limitations of tourniquet use in conjunction with regional/general anaesthesia.

Utilization of a 3D Printed Simulation Training Model to Improve Microsurgical Training.

Unlabelled: Simulation is integral to the development and maintenance of micro- surgical skills. Several simulation models have been described ranging from bench- top to live animal models. High fidelity models are often burdened by cost and ethical issues limiting widespread implementation.

The Use of Botulinum Toxin in the Management of Hidradenitis Suppurativa: A Systematic Review.

Unlabelled: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by suppurative infection, sinus tract, and abscess formation. International management guidelines are largely consensus-based. Botulinum toxin (BTX) has been widely used in the treatment of apocrine and eccrine gland disorders, such as hyperhidrosis, although the effectiveness of BTX in the treatment of HS remains unknown.

Developing Machine Learning Algorithms to Support Patient-centered, Value-based Carpal Tunnel Decompression Surgery.

Background: Carpal tunnel syndrome (CTS) is extremely common and typically treated with carpal tunnel decompression (CTD). Although generally an effective treatment, up to 25% of patients do not experience meaningful benefit. Given the prevalence, this amounts to considerable morbidity and cost without return.

Open tibia/fibula in the elderly: A retrospective cohort study.

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ.

Factors Associated with the Development, Progression, and Outcome of Dupuytren Disease Treatment: A Systematic Review.

Background: The factors typically considered to be associated with Dupuytren disease have been described, such as those in the "Dupuytren diathesis." However, the quality of studies describing them has not been appraised. This systematic review aimed to analyze the evidence for all factors investigated for potential association with the development, progression, outcome of treatment, or recurrence of Dupuytren disease.

Perspectives: A surgeon's guide to machine learning.

The exponential increase in the volume and complexity of healthcare data presents new challenges to researchers and clinicians in analysis and interpretation. The requirement for new strategies to extract meaningful information from large, noisy datasets has led to the development of the field of big data analytics. Artificial intelligence (AI) is a general-purpose technology in which machines carry out tasks traditionally thought to be only achievable by humans.

Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review.

Introduction: Venous thromboembolism (VTE) represents a major cause of morbidity and mortality. A variety of novel physical therapies have been proposed for patients in whom standard prophylaxis, including early mobilisation, is contraindicated. This article presents a systematic literature review of alternative physical treatments for VTE prophylaxis, focusing on surgical and trauma patients.

Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal.

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes.

Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures.

Study Design: Systematic review; Level of evidence, 4.

Syndactyly.

Here we present an interesting case of simple syndactyly and provide a narrative review of its incidence, associations and management.

A patient with chronic fingertip pain.

Isolated chronic fingertip pain is an uncommon presentation with a broad differential diagnosis, including but not limited to, subungal neuroma, subungal haematoma, subungal exostosis and glomus tumour. We present an interesting case of a young lady with debilitating chronic fingertip pain diagnosed with a glomus tumour of her right index finger. Surgical excision provided complete resolution from pain, return to work and restoration of quality of life.

A systematic review assessing the quality of clinical practice guidelines in chronic venous disease.

Objective: Our aim was to assess the methodologic quality of clinical practice guidelines (CPGs), which inform the diagnosis and management of chronic venous disease (CVD), using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Methods: A systematic review was performed through the Medline and Embase databases to identify CPGs relevant to CVD. The included articles were evidence-based CPGs available in English and reported in the past 20 years.

Perioperative Thromboprophylaxis in Digital Replantation: A Systematic Review.

Unlabelled: There is no international consensus on the use of perioperative thromboprophylaxis in digital replantation. Suboptimal perioperative management may lead to replant failure, which compromises extremity function, worsens psychosocial outcomes for patients, and incurs significant cost. This systematic review evaluates and compares the efficacy and safety of perioperative antithrombotic protocols used in digital replantation.

Ten technical considerations revisited in tissue expansion.

Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion.