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In the surgical hand clinic, psychopathological hand disorders can be sorted into one of the following four categories: (1) factitious wound creation and manipulation; (2) factitious edema; (3) psychopathological dystonias, and (4) psychopathological sensory abnormalities and psychopathological Complex Regional Pain Syndrome. This article introduces these four categories. Pertinent literature that...
Adequate soft tissue coverage is imperative after any interventions performed to maximize or preserve hand function. Although this can most simply be achieved by primary closure or a skin graft if possible, often a vascularized flap will be preferable, especially if a later secondary procedure is planned. Even moderately sized skin deficits of the upper extremity, and especially if involving the hand...
Since 1976, experimental and clinical studies have suggested the superiority of vascularized nerve grafts. In this study, a 27-year experience of the senior author is presented regarding vascularized nerve grafts and fascia for complex upper extremity nerve reconstruction. The factors influencing outcomes as well as a comparison with conventional nerve grafts is presented. Since 1981, 21 vascularized...
Background Upper extremity electrical burns are a cause of major morbidity and disability in affected individuals. Anecdotally, we have noted changes in the presentation of cases to our institution. We sought to compare current data on upper extremity electrical burns in children with our previously published historical data. Methods Using the Shriners Hospital Boston and American Burn Association...
Digital replantation has become a well-established technique among reconstructive hand surgeons. Numerous replantation centers around the world have published series with impressive survival rates. The ultimate goal of replantation is the restoration of normal hand or digital function; thus, replantation success is not solely related to the outcome of the microvascular anastomosis, but also to the...
Background The epidemiology of upper extremity injuries presenting to emergency departments in the USA is not well studied. The purpose of this investigation was to estimate the incidence rates of upper extremity injuries presenting to emergency departments. Methods The National Electronic Injury Surveillance System (NEISS)—a database of emergency department visits based on a sample of hospitals...
Purpose This study evaluated the validity of the Patient Specific Functional Scale (PSFS) in patients with upper extremity nerve injury. Methods Following Research Ethics Boards (REB) approval, we included English-speaking adults, with greater than 6 months after an upper extremity nerve injury. Patient reported questionnaires included: PSFS, 36-item short-form health survey (SF-36), Disabilities...
Background Tumors are common in the upper extremity and are mostly benign and inconsequential. The purpose of this study was to determine factors associated with operative treatment for suspected benign tumors of the upper extremity. Methods Treated by three different hand surgeons between July 2001 and July 2011, 1,593 tumors were identified using billing records. The measured variables were: sex,...
Background The purpose of this study is to investigate functional outcomes and cost impacts of immediate functional reconstruction performed in conjunction with limb-sparing resection of upper extremity soft tissue sarcomas. Methods Patients undergoing simultaneous limb-sparing upper extremity soft tissue sarcoma resection and functional reconstruction between December 1998 and March 2004 were retrospectively...
Background Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types...
Background Disorders involving the peripheral nervous system can have devastating impacts on patients’ daily functions and routines. There is a lack of consideration of the impact of injury on social/emotional well-being and function. Methods We performed a retrospective database and chart review of adult patients presenting between 2010 and 2012 with peripheral nerve compression, brachial plexus...
Background Upper extremity fractures are increasing in frequency and have profound socioeconomic implications. The purpose of this study was to assess trends in ambulatory upper extremity fracture fixation in the USA from 1996 to 2006 using data from the National Survey of Ambulatory Surgery (NSAS). Methods The NSAS was used to identify cases of closed forearm, carpal, metacarpal, and phalanx fractures...
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