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Book Details
Abstract
Fully updated to meet the demands of the 21st-century surgeon, Hand and Upper Extremity, Volume 6 of Plastic Surgery, 3rd Edition, provides you with the most current knowledge and techniques hand and upper extremity plastic surgery, allowing you to offer every patient the best possible outcome. Access all the state-of-the-art know-how you need to overcome any challenge you may face and exceed your patients’ expectations.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
- Apply the very latest advances in hand and upper extremity plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
- Purchase this volume individually or own the entire set, with the ability to search across all six volumes online!
- Master the latest on all aspects of hand surgery - including pediatric and adult conditions - in one comprehensive volume.
- Access the most up-to-date information on nerve transfers, hand allotransplantation, functional prosthetics, and fracture fixation, presented by the original innovators themselves.
- Know what to look for and what results you can expect with over 1,700 photographs and illustrations.
- See how to perform key techniques with 57 surgical videos online.
- Access the complete, fully searchable contents online, download all the tables and figures, and take advantage of additional content and images at www.expertconsult.com!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc_i | ||
| Plastic Surgery | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Video Contents | xi | ||
| Foreword | xvi | ||
| Preface | xvii | ||
| List of Contributors | xviii | ||
| Acknowledgments | xl | ||
| Dedication | xli | ||
| Introduction Plastic surgery contributions to hand surgery | xliii | ||
| Origins of hand surgery | xliii | ||
| Principles of plastic surgery and their application to hand surgery | xliv | ||
| Origins of modern hand surgery | xlvi | ||
| Developments after World War II | xlvii | ||
| The era of microsurgery | xlvii | ||
| Recent developments | xlvii | ||
| Future directions | xlviii | ||
| References | xlviii | ||
| References | xlix.e1 | ||
| I Introduction and Principles | 1 | ||
| 1 Anatomy and biomechanics of the hand | 1 | ||
| Introduction | 1 | ||
| Skin, subcutaneous tissue, and fascia | 2 | ||
| Bones and joints | 5 | ||
| Hand elements | 5 | ||
| The wrist | 7 | ||
| Joint motion | 11 | ||
| The thumb | 13 | ||
| Muscles and tendons | 14 | ||
| Extrinsic extensors | 14 | ||
| Pronators and supinators | 18 | ||
| Extrinsic flexors | 22 | ||
| The retinacular system | 29 | ||
| Intrinsic muscles | 32 | ||
| Blood supply | 35 | ||
| Peripheral nerves | 40 | ||
| Conclusion | 46 | ||
| References | 46 | ||
| References | 46.e1 | ||
| 2 Examination of the upper extremity | 47 | ||
| Obtaining a patient history | 47 | ||
| Patient demographics | 47 | ||
| Current complaint | 47 | ||
| Medical history | 48 | ||
| Allergies and medications | 48 | ||
| Social history | 48 | ||
| Physical examination of the hand | 48 | ||
| Inspection | 48 | ||
| Discoloration | 48 | ||
| Deformity | 48 | ||
| Muscular atrophy | 48 | ||
| Trophic changes | 49 | ||
| Swelling | 49 | ||
| Skin creases | 49 | ||
| Palpation | 49 | ||
| Range of motion assessment | 49 | ||
| Stability assessment | 49 | ||
| Musculotendinous assessment | 50 | ||
| Posture | 50 | ||
| Motion | 50 | ||
| Power | 50 | ||
| Tests for specific muscles | 51 | ||
| Extrinsic muscles | 51 | ||
| The flexor digitorum profundus (FDP) muscle | 51 | ||
| Flexor profundus test | 51 | ||
| The flexor digitorum superficialis (FDS) muscle | 51 | ||
| Flexor sublimis test | 51 | ||
| The flexor pollicis longus (FPL) muscle | 51 | ||
| The extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) muscles | 51 | ||
| The extensor carpi radialis longus (ECRL) and brevis (ECRB) muscles | 51 | ||
| The extensor pollicis longus (EPL) muscle | 51 | ||
| The extensor digitorum communis (EDC) muscles | 51 | ||
| The extensor indicis proprius (EIP) muscle | 51 | ||
| The extensor digiti minimi (EDM) muscle | 51 | ||
| The extensor carpi ulnaris (ECU) muscle | 52 | ||
| Intrinsic muscles | 52 | ||
| The thenar muscles | 52 | ||
| The adductor pollicis muscle (ADP) | 52 | ||
| The interosseous and lumbrical muscles | 52 | ||
| The hypothenar muscles | 52 | ||
| Nerve assessment | 52 | ||
| Vascular assessment | 52 | ||
| Special provocative tests for the hand | 53 | ||
| Range of motion assessment | 53 | ||
| Flexor profundus test | 53 | ||
| Flexor sublimis test | 53 | ||
| Intrinsic tightness test (Bunnell) | 53 | ||
| Extrinsic tightness test | 54 | ||
| Lumbrical muscle tightness test | 54 | ||
| Stability assessment | 54 | ||
| Scaphoid shift test (Watson) | 54 | ||
| Finger extension test | 54 | ||
| Triquetrolunate ballottement test and the lunotriquetral shuck test | 54 | ||
| Distal radioulnar joint instability test | 54 | ||
| Ulnocarpal abutment test | 55 | ||
| Pisiformis gliding test | 55 | ||
| Extensor carpi ulnaris (ECU) synergy test | 55 | ||
| Midcarpal instability test | 55 | ||
| Musculotendinous assessment | 55 | ||
| Dynamic tenodesis effect | 55 | ||
| Milking test of the finger and thumb flexor tendons | 56 | ||
| Finkelstein test | 56 | ||
| Eichoff test | 56 | ||
| Nerve assessment | 56 | ||
| Tinel’s sign | 56 | ||
| Phalen’s test | 58 | ||
| Froment’s test | 58 | ||
| Jeanne’s sign | 58 | ||
| Wartenberg’s sign | 58 | ||
| Other signs associated with ulnar nerve palsy | 58 | ||
| Semmes–Weinstein monofilament test | 59 | ||
| Two-point discrimination (2PD) test | 59 | ||
| Moberg pick-up test | 59 | ||
| Vascular assessment | 60 | ||
| Allen’s test | 60 | ||
| Digital Allen’s test | 60 | ||
| Physical examination specific to the forearm | 60 | ||
| The interosseous membrane of the forearm (IOM) | 60 | ||
| Distal membranous portion | 60 | ||
| Middle ligamentous portion | 60 | ||
| Proximal membranous portion | 60 | ||
| Measurement of forearm rotation | 61 | ||
| Measurement of the muscle strength of the forearm | 61 | ||
| Supination | 61 | ||
| Pronation | 61 | ||
| Physical examinations specific to the elbow | 61 | ||
| Bony landmarks of the elbow | 61 | ||
| Lateral ligament complex | 61 | ||
| Lateral ulnar collateral ligament | 61 | ||
| Radial collateral ligament | 61 | ||
| Annular ligament | 61 | ||
| Accessory collateral ligament | 61 | ||
| Medial collateral ligament complex | 61 | ||
| Instability of the elbow joint | 61 | ||
| Posterolateral rotatory instability (PLRI) | 63 | ||
| The pivot shift test maneuver | 63 | ||
| Measurement of malrotation of the distal humerus | 63 | ||
| Physical examination of thoracic outlet syndrome | 63 | ||
| Classification | 64 | ||
| Anatomy | 64 | ||
| Provocative maneuver | 65 | ||
| Adson test | 65 | ||
| The neck tilting | 65 | ||
| The costoclavicular compression test | 65 | ||
| Wright test | 65 | ||
| Roos extended arm stress test | 66 | ||
| Morley’s test | 66 | ||
| Physical examination of the upper extremity in children | 67 | ||
| References | 67 | ||
| References | 67.e1 | ||
| 3 Diagnostic imaging of the hand and wrist | 68 | ||
| Introduction | 68 | ||
| Historical perspective | 68.e1 | ||
| Radiography | 68 | ||
| Evaluation of the hand | 69 | ||
| Special views in the hand | 70 | ||
| Pediatric hand radiographs | 71 | ||
| Wrist evaluation | 72 | ||
| Ultrasonography | 76 | ||
| Computed tomography | 78 | ||
| Fractures and dislocations | 78 | ||
| Other applications of CT | 81 | ||
| Magnetic resonance imaging | 82 | ||
| Basics | 82 | ||
| Clinical applications of MRI | 82 | ||
| MRI for soft-tissue masses | 82 | ||
| Ganglion cysts | 83 | ||
| Giant cell tumors of the tendon sheath (GCTTS) | 83 | ||
| Lipomas | 83 | ||
| Hemangiomas | 83 | ||
| Enchondromas | 85 | ||
| MRI for wrist and hand trauma | 85 | ||
| Occult scaphoid and carpal fractures | 85 | ||
| Ligamentous injuries of the hand and wrist | 85 | ||
| Thumb ulnar collateral ligament injuries | 85 | ||
| Scapholunate interosseous ligament injury | 85 | ||
| MRI for evaluating ulnar-sided wrist pain | 86 | ||
| TFCC tears | 86 | ||
| Ulnocarpal abutment | 86 | ||
| DRUJ instability and tendinopathies | 86 | ||
| MRI for evaluation of fracture nonunion | 88 | ||
| MRI for AVN in scaphoid fracture nonunion | 88 | ||
| Kienbock’s disease | 88 | ||
| Osteomyelitis | 88 | ||
| Vascular imaging techniques for the upper extremity | 89 | ||
| Radionuclide imaging | 90 | ||
| References | 91 | ||
| References | 91.e1 | ||
| 4 Anesthesia for upper extremity surgery | 92 | ||
| Introduction | 92 | ||
| Anatomy | 92 | ||
| Perineurial environment | 92 | ||
| Microneuroanatomy | 94 | ||
| Sonoanatomy | 94 | ||
| Pharmacology of local anesthetics | 94 | ||
| Pharmacokinetics | 94 | ||
| Toxicity | 94 | ||
| Vasoconstrictors | 95 | ||
| LA selection | 95 | ||
| Regional anesthesia techniques | 96 | ||
| Digital block | 96 | ||
| Wrist block | 97 | ||
| Intravenous regional anesthesia (Bier block) | 97 | ||
| Interscalene block | 97 | ||
| Supraclavicular block | 97 | ||
| Infraclavicular block | 99 | ||
| Axillary block | 99 | ||
| Complications | 100 | ||
| Peripheral nerve injury | 100 | ||
| Evaluation and management | 101 | ||
| Local anesthetic toxicity | 101 | ||
| Vascular injury | 102 | ||
| Infection | 102 | ||
| Outcomes | 102 | ||
| Clinical outcomes and patient satisfaction | 102 | ||
| Operating room cost and efficiency | 103 | ||
| Special considerations | 103 | ||
| Cardiac patients | 103 | ||
| Pediatric patients | 103 | ||
| Perioperative pain management | 103 | ||
| Peripheral catheters | 103 | ||
| Preemptive analgesia | 103 | ||
| Chronic postoperative pain | 104 | ||
| References | 104 | ||
| References | 105.e1 | ||
| 5 Principles of internal fixation as applied to the hand and wrist | 106 | ||
| Introduction | 106 | ||
| Patient selection | 106 | ||
| Fracture assessment | 106 | ||
| Host factors | 106 | ||
| Preoperative imaging | 107 | ||
| Treatment/surgical technique | 107 | ||
| Preoperative planning | 107 | ||
| Fracture reduction | 107 | ||
| Intraoperative imaging | 108 | ||
| Fixation options | 108 | ||
| Absolute versus relative stability | 108 | ||
| Interfragmentary compression | 108 | ||
| Kirschner wires | 108 | ||
| Tension band constructs | 109 | ||
| External fixation | 110 | ||
| Interfragmentary lag screws | 111 | ||
| Compression plating | 112 | ||
| Bridge plating | 113 | ||
| Locked plating | 115 | ||
| Postoperative care | 115 | ||
| Summary | 115 | ||
| References | 116 | ||
| References | 116.e1 | ||
| II Acquired Traumatic Disorders | 117 | ||
| 6 Nail and fingertip reconstruction | 117 | ||
| Introduction | 117 | ||
| Basic science/disease process | 117 | ||
| Anatomy | 117 | ||
| Vascularity | 117 | ||
| Nerve supply | 118 | ||
| Physiology | 118 | ||
| Function | 119 | ||
| Acute injury | 119 | ||
| Epidemiology | 119 | ||
| Subungual hematoma | 119 | ||
| Treatment/surgical technique | 119 | ||
| Lacerations | 119 | ||
| III Acquired Nontraumatic Disorders | 311 | ||
| 15 Benign and malignant tumors of the hand | 311 | ||
| Introduction | 311 | ||
| Basic science/disease process | 311 | ||
| Diagnosis/patient presentation | 312 | ||
| History | 312 | ||
| Physical examination | 312 | ||
| Laboratory studies | 312 | ||
| Imaging | 312 | ||
| Patient selection | 313 | ||
| Treatment/surgical treatment by tissue of origin | 313 | ||
| Skin tumors | 313 | ||
| Cutaneous horn | 314 | ||
| Epidermal inclusion cyst | 314 | ||
| Sebaceous cyst | 314 | ||
| Verruca vulgaris | 314 | ||
| Nevi | 315 | ||
| Keratoacanthoma | 315 | ||
| Dermatofibroma | 316 | ||
| Seborrheic keratosis | 316 | ||
| Actinic keratosis | 316 | ||
| Basal cell carcinoma | 317 | ||
| Squamous cell carcinoma | 317 | ||
| Melanoma | 318 | ||
| Synovial lesions | 318 | ||
| Ganglion cysts | 318 | ||
| Giant cell tumor (pigmented villonodular synovitis) | 319 | ||
| Nerve tumors | 320 | ||
| Schwannoma/neurilemoma | 320 | ||
| Neurofibroma | 320 | ||
| Lipofibromatous hamartoma | 320 | ||
| Fat tumor: lipoma | 321 | ||
| Fibrous tissue lesions | 321 | ||
| Benign lesions | 321 | ||
| Sarcomas | 321 | ||
| Vascular lesions | 324 | ||
| Hemangioma | 324 | ||
| Vascular malformations | 324 | ||
| Glomus tumor | 324 | ||
| Pyogenic granuloma | 324 | ||
| Muscle lesions | 326 | ||
| Myositis ossificans | 326 | ||
| Leiomyoma | 326 | ||
| Rhabdomyosarcoma | 326 | ||
| Cartilage and bone tumors | 327 | ||
| Enchondroma | 327 | ||
| Osteoid osteoma | 327 | ||
| Osteochondroma | 328 | ||
| Solitary unicameral bone cyst | 328 | ||
| Aneurysmal bone cyst | 328 | ||
| Giant cell tumor of bone | 329 | ||
| Osteosarcoma | 329 | ||
| Chondrosarcoma | 329 | ||
| Staging and treatment of musculoskeletal sarcomas | 329 | ||
| Metastases | 330 | ||
| Postoperative care | 331 | ||
| Outcomes, prognosis, and complications | 331 | ||
| References | 331 | ||
| References | 332.e1 | ||
| 16 Infections of the hand | 333 | ||
| Introduction | 333 | ||
| Basic science/disease process | 333 | ||
| Historical perspective | 333.e1 | ||
| Diagnosis/patient presentation | 334 | ||
| Classification of infections | 335 | ||
| Mimicks of infection | 335 | ||
| Gout | 335 | ||
| Pseudogout | 335 | ||
| Pyogenic granuloma | 335 | ||
| Pyoderma gangrenosum | 335 | ||
| Brown recluse spider bite | 336 | ||
| Granuloma annulare | 336 | ||
| Rheumatoid arthritis | 336 | ||
| Types of infection | 336 | ||
| Cellulitis | 336 | ||
| Paronychia | 336 | ||
| Felon | 337 | ||
| Deep space infections of the hand | 338 | ||
| Pyogenic flexor tenosynovitis | 339 | ||
| Flexor tenosynovitis | 339 | ||
| Septic arthritis | 339 | ||
| Osteomyelitis | 341 | ||
| Necrotizing fasciitis | 341 | ||
| Herpetic whitlow | 342 | ||
| Mycobacterial infections | 342 | ||
| Noncholera Vibrio infections | 343 | ||
| Fungal infections | 343 | ||
| Bites | 343 | ||
| Animal bites | 343 | ||
| Human bites | 343 | ||
| Hardware infections | 344 | ||
| Patient selection | 344 | ||
| Outcomes, prognosis, and complications | 344 | ||
| References | 345 | ||
| References | 345.e1 | ||
| 17 Management of Dupuytren’s disease | 346 | ||
| Introduction | 346 | ||
| Epidemiology | 346 | ||
| Palmar and digital fascia | 346 | ||
| Palmar fascia | 347 | ||
| Digital fascia | 347 | ||
| First webspace | 347 | ||
| Historical perspective | 346.e1 | ||
| Basic science and disease process | 348 | ||
| Basic science | 348 | ||
| Disease process | 349 | ||
| Diagnosis/patient presentation | 351 | ||
| Clinical presentation | 351 | ||
| Differential diagnosis | 353 | ||
| Patient selection | 353 | ||
| Treatment | 353 | ||
| Modality therapy | 353 | ||
| Injection treatment | 353 | ||
| Surgical treatment | 354 | ||
| Percutaneous fasciotomy (needle aponeurotomy) | 354 | ||
| Open fasciotomy | 356 | ||
| Local fasciectomy | 356 | ||
| Regional (partial) fasciectomy | 356 | ||
| Radical fasciectomy | 358 | ||
| Dermatofasciectomy | 359 | ||
| Postoperative care | 359 | ||
| Outcomes, prognosis, and complications | 359 | ||
| Secondary procedures | 360 | ||
| Skeletal traction | 361 | ||
| Wedge osteotomy | 361 | ||
| Total volar tenoarthrolysis | 361 | ||
| PIP arthrodesis | 361 | ||
| Amputation | 361 | ||
| Conclusion | 361 | ||
| References | 361 | ||
| References | 362.e1 | ||
| 18 Occupational hand disorders | 363 | ||
| Introduction | 363 | ||
| Causation | 363 | ||
| Patient history | 364 | ||
| Initial events | 364 | ||
| The course of illness | 364 | ||
| Physical examination | 364 | ||
| Knowledge of the disease process and its causation | 364 | ||
| The role of force and repetition | 364 | ||
| Clinical care in illness related to the workplace | 365 | ||
| Tendinopathy | 366 | ||
| Medial and lateral epicondylitis | 366 | ||
| Lateral epicondylitis | 366 | ||
| Tendinopathy at the wrist and hand | 366 | ||
| De Quervain’s tenosynovitis | 366 | ||
| Trigger finger | 367 | ||
| Nerve compression | 367 | ||
| Vascular disorders | 368 | ||
| Hand–arm vibration syndrome (HAVS) | 368 | ||
| Patient management | 369 | ||
| Return to work | 369 | ||
| Measuring impairment | 369 | ||
| Summary | 370 | ||
| References | 370 | ||
| References | 370.e1 | ||
| 19 Rheumatologic conditions of the hand and wrist | 371 | ||
| Introduction | 371 | ||
| Basic science/disease process | 371 | ||
| Etiology | 371 | ||
| Pathogenesis | 372 | ||
| Medical management | 372 | ||
| Diagnosis/presentation | 373 | ||
| Wrist involvement | 374 | ||
| Finger and thumb involvement | 376 | ||
| Patient selection | 380 | ||
| Perioperative considerations | 380 | ||
| Goals of surgery | 380 | ||
| Sequence of surgery | 380 | ||
| Treatment/surgical technique | 381 | ||
| Operations at the wrist | 381 | ||
| Wrist synovectomy/dorsal tenosynovectomy | 381 | ||
| Postoperative care | 381 | ||
| Outcomes, prognosis, and complications | 382 | ||
| Secondary procedures | 382 | ||
| Distal ulna resection (Darrach procedure) | 382 | ||
| Postoperative care | 383 | ||
| Outcomes, prognosis, and complications | 383 | ||
| Secondary procedures | 384 | ||
| Partial wrist arthrodesis (radioscapholunate arthrodesis) | 384 | ||
| Postoperative care | 386 | ||
| Complete wrist arthrodesis | 386 | ||
| Postoperative care | 388 | ||
| Outcomes, prognosis, and complications | 388 | ||
| Secondary procedures | 388 | ||
| Total wrist arthroplasty | 388 | ||
| Postoperative care | 390 | ||
| Outcomes, prognosis, and complications | 390 | ||
| Secondary procedures | 390 | ||
| Operations for the hand and fingers | 390 | ||
| MCP synovectomy and soft tissue reconstruction | 390 | ||
| Postoperative care | 391 | ||
| Outcomes, prognosis, and complications | 391 | ||
| Secondary procedures | 391 | ||
| MCP arthroplasty (silicone) | 392 | ||
| Postoperative care | 393 | ||
| PIP arthroplasty | 394 | ||
| IV Congenital Disorders | 526 | ||
| 25 Congenital hand I: Embryology, classification, and principles | 526 | ||
| Introduction | 526 | ||
| Limb development | 526 | ||
| Classification | 526 | ||
| Assessment and principles of treatment | 527 | ||
| Limb development (embryology) | 527 | ||
| Overview of upper limb morphogenesis | 527 | ||
| The molecular control of limb outgrowth and patterning | 527 | ||
| The development/differentiation of specific tissues | 530 | ||
| Limb vasculature | 530 | ||
| Skeletogenesis | 531 | ||
| Myogenesis | 532 | ||
| Innervation | 534 | ||
| Anomalies of limb development and their classification | 534 | ||
| Background | 534 | ||
| Problems of the Swanson/IFSSH classification | 535 | ||
| A modified classification | 537 | ||
| Assessment of the child and family | 539 | ||
| The clinic | 541 | ||
| History | 541 | ||
| Examination | 542 | ||
| Investigations | 543 | ||
| Diagnosis | 544 | ||
| Principles of surgical management | 544 | ||
| Indications | 544 | ||
| Function | 544 | ||
| Appearance | 544 | ||
| Timing | 545 | ||
| References | 547 | ||
| References | 547.e1 | ||
| 26 Congenital hand II: | 548 | ||
| Congenital transverse arrest | 548 | ||
| Introduction | 548 | ||
| Basic science/disease process | 548 | ||
| Diagnosis/patient presentation | 549 | ||
| History | 548.e1 | ||
| Patient selection, treatment/surgical technique and postoperative care | 550 | ||
| Transhumeral level | 550 | ||
| Forearm level | 550 | ||
| Carpal level | 551 | ||
| Metacarpal level (symbrachydactyly) | 551 | ||
| Outcomes, prognosis, and complications | 553 | ||
| Prosthetics | 553 | ||
| Free nonvascularized phalangeal transfer | 553 | ||
| Distraction augmentation manoplasty | 554 | ||
| Foot donor site (free phalangeal transfer) | 554 | ||
| Outcomes of free toe transfer | 555 | ||
| Secondary procedures | 555 | ||
| Congenital longitudinal arrest | 555 | ||
| Phocomelia | 556 | ||
| Introduction | 556 | ||
| Basic science/disease process | 556 | ||
| Diagnosis/patient presentation | 556 | ||
| Patient selection | 556 | ||
| Treatment/surgical technique | 556 | ||
| Postoperative care | 557 | ||
| Outcomes, prognosis, complications | 557 | ||
| Secondary procedures | 557 | ||
| History | 556.e1 | ||
| Radial hypoplasia or aplasia | 557 | ||
| Introduction | 557 | ||
| Basic science/disease process | 557 | ||
| Diagnosis/patient presentation | 558 | ||
| Patient selection | 560 | ||
| Treatment/surgical technique | 560 | ||
| Postoperative care | 563 | ||
| Outcomes, prognosis, complications | 563 | ||
| Secondary procedures | 563 | ||
| Postoperative care | 566 | ||
| Outcomes, prognosis, and complications | 566 | ||
| Secondary procedures | 567 | ||
| History | 557.e1 | ||
| Central ray deficiency | 563 | ||
| Introduction | 563 | ||
| Basic science/disease process | 564 | ||
| Diagnosis/patient presentation | 564 | ||
| Patient selection | 565 | ||
| Treatment/surgical technique | 565 | ||
| History | 564.e1 | ||
| Ulnar hypoplasia or aplasia | 567 | ||
| Introduction | 567 | ||
| Basic science/disease process | 567 | ||
| Diagnosis/patient presentation | 567 | ||
| Patient selection | 569 | ||
| Treatment/surgical technique | 569 | ||
| Postoperative care | 570 | ||
| Outcomes, prognosis, and complications | 570 | ||
| Secondary procedures | 570 | ||
| History | 567.e1 | ||
| References | 570 | ||
| References | 571.e1 | ||
| 27 Congenital hand III: | 572 | ||
| Introduction | 572 | ||
| History | 572.e1 | ||
| Basic science/disease process | 572 | ||
| Incidence | 572 | ||
| Etiology | 573 | ||
| Associated conditions | 573 | ||
| VACTERL | 574 | ||
| Fanconi anemia and other hematologic abnormalities | 574 | ||
| Holt–Oram syndrome | 574 | ||
| Thrombocytopenia absent radius syndrome (TAR) | 574 | ||
| Diagnosis and patient presentation | 574 | ||
| Classification | 574 | ||
| Clinical presentation (types of hypoplasia) | 574 | ||
| Type I: mild hypoplasia | 574 | ||
| Type II: moderate hypoplasia | 575 | ||
| Type III: severe hypoplasia | 577 | ||
| Type IV: floating thumb | 577 | ||
| Type V: aplasia | 577 | ||
| Type VI: central deficiencies: cleft hand and symbrachydactyly thumb | 579 | ||
| Cleft hand (typical) | 579 | ||
| Symbrachydactyly thumb | 580 | ||
| Type VII: constriction ring syndrome | 581 | ||
| Type VIII: five-fingered hand | 581 | ||
| Type IX: radial polydactyly | 582 | ||
| Type X: syndromic short skeletal thumb ray | 583 | ||
| Patient selection | 583 | ||
| General considerations | 583 | ||
| Timing | 583 | ||
| Treatment | 584 | ||
| Treatment considerations for thumb hypoplasia (types I–V) | 584 | ||
| Type I: mild hypoplasia | 584 | ||
| Type II: moderate hypoplasia | 584 | ||
| Type IIIA: severe hypoplasia | 584 | ||
| Type IIIB, type IIIC: severe hypoplasia | 584 | ||
| Type IV: floating thumb | 586 | ||
| Type V: aplasia | 586 | ||
| Clinical conditions and surgical treatment (types I–V) | 586 | ||
| Deficient first web space | 586 | ||
| Technique of first web release with four flap Z-plasty | 586 | ||
| Metacarpophalangeal joint instability | 587 | ||
| Technique of tendon graft stabilization | 587 | ||
| Poor/absent palmar abduction (opposition) | 587 | ||
| Technique of ADQM transfer | 587 | ||
| Technique of FDS transfer | 588 | ||
| Lack of IP joint motion | 590 | ||
| Pollex abductus | 590 | ||
| Technique of pollicization | 590 | ||
| Principles | 590 | ||
| Incisions and plan | 590 | ||
| Dissection and exposure | 590 | ||
| Skeletal shortening | 594 | ||
| Tendon and intrinsic muscle rebalancing | 594 | ||
| Skin closure and web construction | 594 | ||
| Treatment of other types of thumb hypoplasia (types VI–X) | 594 | ||
| Type VI: central deficiencies: cleft hand and symbrachydactyly thumb | 594 | ||
| Cleft hand | 594 | ||
| Symbrachydactyly thumb | 595 | ||
| Type VII: constriction ring syndrome | 595 | ||
| Type VIII: five-fingered hand | 596 | ||
| Type IX: radial polydactyly | 596 | ||
| Type X: syndromic short skeletal thumb ray | 596 | ||
| Postoperative care | 597 | ||
| Outcomes, prognosis, and complications | 597 | ||
| Type I | 597 | ||
| Type II | 597 | ||
| Type IIIA | 597 | ||
| Types IIIB, IIIC, and IV | 597 | ||
| Types IIIB, IIIC, IV, and V: pollicization | 598 | ||
| Other types of thumb hypoplasia (types VI–X) | 598 | ||
| Type VI: central deficiencies – cleft hand and symbrachydactyly thumb | 598 | ||
| Cleft hand | 598 | ||
| Symbrachydactyly thumb | 598 | ||
| Type VII: constriction ring syndrome | 599 | ||
| Type VIII: five-fingered hand | 599 | ||
| Type IX: radial polydactyly | 599 | ||
| Type X: syndromic short skeletal ray thumb | 599 | ||
| Secondary procedures | 599 | ||
| The inadequate index finger | 599 | ||
| References | 601 | ||
| References | 602.e1 | ||
| 28 Congenital hand IV: | 603 | ||
| Syndactyly | 604 | ||
| Introduction | 604 | ||
| Basic science/disease process | 604 | ||
| Diagnosis/patient presentation | 604 | ||
| Patient selection | 604 | ||
| History | 604.e1 | ||
| Treatment/surgical technique | 605 | ||
| Creation of a web | 606 | ||
| Treating the lateral soft tissue defects | 606 | ||
| Separation of the fingertips | 608 | ||
| Postoperative care | 608 | ||
| Outcomes, prognosis, and complications | 608 | ||
| Secondary procedures | 609 | ||
| Poland syndrome | 609 | ||
| Introduction | 609 | ||
| Basic science/disease process | 609 | ||
| Diagnosis/patient presentation | 609 | ||
| Patient selection | 610 | ||
| Treatment/surgical technique | 610 | ||
| Postoperative care | 610 | ||
| Outcomes, prognosis, and complications | 610 | ||
| Secondary procedures | 610 | ||
| History | 609.e1 | ||
| Apert syndrome | 610 | ||
| Introduction | 610 | ||
| Basic science/disease process | 610 | ||
| Diagnosis/patient presentation | 610 | ||
| Patient selection | 612 | ||
| History | 610.e1 | ||
| Treatment/surgical technique | 612 | ||
| Separation of fingers | 612 | ||
| Thumb and first web | 612 | ||
| Additional procedures | 614 | ||
| Postoperative care | 614 | ||
| Outcomes, prognosis, and complications | 614 | ||
| Complications | 614 | ||
| Secondary procedures | 614 | ||
| Synostosis | 614 | ||
| Introduction | 614 | ||
| Basic science/disease process | 615 | ||
| Diagnosis/patient presentation | 615 | ||
| Patient selection/treatment/surgical technique | 615 | ||
| Postoperative care | 616 | ||
| Outcomes, prognosis, and complications | 616 | ||
| Secondary procedures | 616 | ||
| History | 615.e1 | ||
| Polydactyly | 616 | ||
| Introduction | 616 | ||
| History | 616.e1 | ||
| Basic science/disease process | 616 | ||
| Genetic aspects | 616 | ||
| Diagnosis/patient presentation | 617 | ||
| Radial polydactyly | 617 | ||
| Ulnar polydactyly | 618 | ||
| Central polydactyly | 618 | ||
| Patient selection | 618 | ||
| Treatment/surgical technique | 619 | ||
| Radial polydactyly | 619 | ||
| Radial polydactyly at the IPJ (Wassel type II) | 619 | ||
| Radial polydactyly at the MCPJ (Wassel type IV) | 619 | ||
| Ulnar polydactyly | 619 | ||
| Central polydactyly | 622 | ||
| Mirror hand | 622 | ||
| Postoperative care | 622 | ||
| Outcomes, prognosis, and complications | 622 | ||
| Secondary procedures | 623 | ||
| Triphalangeal thumb | 623 | ||
| Introduction | 623 | ||
| Basic science/disease process | 624 | ||
| Diagnosis/patient presentation | 624 | ||
| Patient selection | 624 | ||
| History | 624.e1 | ||
| Treatment/surgical technique | 624 | ||
| Author’s preferred method of treatment | 625 | ||
| Delta middle phalanx | 625 | ||
| Rectangular middle phalanx and five fingered hand | 627 | ||
| First web deficiency | 627 | ||
| Postoperative care | 627 | ||
| Outcomes, prognosis, and complications | 627 | ||
| Secondary procedures | 627 | ||
| Camptodactyly | 628 | ||
| Introduction | 628 | ||
| Basic science/disease process | 628 | ||
| Diagnosis/patient presentation | 628 | ||
| Patient selection | 629 | ||
| Treatment/surgical technique | 629 | ||
| Postoperative care | 630 | ||
| Outcomes, prognosis, and complications | 630 | ||
| Secondary procedures | 630 | ||
| History | 628.e1 | ||
| Clinodactyly | 630 | ||
| Introduction | 630 | ||
| Basic science/disease process | 630 | ||
| Diagnosis/patient presentation | 630 | ||
| Patient selection | 631 | ||
| Treatment/surgical technique | 631 | ||
| Postoperative care | 632 | ||
| Outcomes, prognosis, and complications | 632 | ||
| History | 630.e1 | ||
| Secondary procedures | 632 | ||
| Acknowledgments | 632 | ||
| References | 632 | ||
| References | 633.e1 | ||
| 29 Congenital hand V: | 634 | ||
| Introduction | 634 | ||
| Macrodactyly | 634 | ||
| Macrodactyly and proteus syndrome | 635 | ||
| Brachydactyly | 635 | ||
| Other causes of brachydactyly | 637 | ||
| Treatment considerations | 637 | ||
| Brachymesophalangy | 639 | ||
| Brachymetacarpia | 640 | ||
| Clinodactyly with brachydactyly | 640 | ||
| Symbrachydactyly | 640 | ||
| Constriction band syndrome | 641 | ||
| Surgical treatment | 641 | ||
| Bone grafting, lengthening, and toe transplantation | 642 | ||
| Generalized skeletal abnormalities | 642 | ||
| Other skeletal anomalies | 644 | ||
| Poland syndrome | 644 | ||
| Apert syndrome | 644 | ||
| Haas syndrome | 645 | ||
| Congenital alopecia | 646 | ||
| Pierre–Robin syndrome | 646 | ||
| Freeman–Sheldon syndrome | 646 | ||
| Mohr–Wriedt syndrome | 646 | ||
| Madelung’s deformity | 646 | ||
| Conclusions | 647 | ||
| Addendum: Congential trigger thumb Michael Tonkin | 648 | ||
| Etiology | 648 | ||
| Management | 648 | ||
| References | 649 | ||
| References | 650.e1 | ||
| 30 Growth considerations in pediatric upper extremity trauma and reconstruction | 651 | ||
| Introduction | 651 | ||
| Basic science/disease process | 651 | ||
| Anatomy and physiology of the epiphyseal growth plate | 651 | ||
| Vascular anatomy of the growth plate | 652 | ||
| Growth plate closure and skeletal age assessment during puberty | 652 | ||
| Diagnosis/patient presentation | 654 | ||
| Conditions affecting the growth plate | 654 | ||
| Trauma | 654 | ||
| Incidence and distribution in the upper extremity | 654 | ||
| Classification of physeal fractures | 654 | ||
| Treatment of physeal fractures | 655 | ||
| Tumor | 655 | ||
| Bone sarcoma involving the epiphysis | 655 | ||
| Congenital chondrodysplasia | 655 | ||
| Patient selection | 656 | ||
| Treatment/surgical technique | 656 | ||
| Treatment of physeal arrest | 656 | ||
| Observation | 657 | ||
| Completion of a partial physeal arrest and epiphysiodesis | 657 | ||
| Physeal distraction | 657 | ||
| Bar resection | 657 | ||
| Corrective osteotomies, lengthening or shortening | 658 | ||
| Epiphyseal transfer of the proximal fibular epiphysis | 659 | ||
| Indications | 659 | ||
| Vascular supply of the proximal fibular epiphysis | 660 | ||
| Historical perspective | 651.e1 | ||
| Harvest technique of the proximal fibula based on the tibialis anterior artery (video) | 660 | ||
| Skin incision | 661 | ||
| Exposure of the anterior tibial pedicle | 661 | ||
| Dissection of the peroneal nerve at the fibular neck | 661 | ||
| Section of the interosseous membrane and distal osteotomy | 662 | ||
| Harvest of the biceps femoris tendon and capsulotomy of the proximal tibiofibular joint | 662 | ||
| Final dissection of the proximal portion of the vascular pedicle | 662 | ||
| Postoperative care | 664 | ||
| Donor site | 664 | ||
| Recipient site | 664 | ||
| Outcomes, prognosis, and complications | 664 | ||
| Secondary procedures | 665 | ||
| Donor site | 665 | ||
| Recipient site | 665 | ||
| References | 666 | ||
| References | 666.e1 | ||
| 31 Vascular anomalies of the upper extremity | 667 | ||
| Introduction | 667 | ||
| History and classification | 667 | ||
| Diagnosis/patient presentation | 669 | ||
| Treatment/surgical technique | 669 | ||
| Vascular tumors | 672 | ||
| Infantile hemangioma (IH) | 672 | ||
| Basic science/disease process | 672 | ||
| Diagnosis/patient presentation | 672 | ||
| Treatment/surgical technique | 673 | ||
| Congenital hemangioma (CH) | 673 | ||
| Basic science/disease process | 673 | ||
| Diagnosis/patient presentation | 674 | ||
| Treatment/surgical technique | 674 | ||
| Pyogenic granuloma | 674 | ||
| Basic science/disease process | 674 | ||
| V Paralytic Disorders | 694 | ||
| 32 Peripheral nerve injuries of the upper extremity | 694 | ||
| Introduction | 694 | ||
| Basic science and natural history | 695 | ||
| Anatomy | 695 | ||
| Gross anatomy: the upper extremity | 695 | ||
| The neuron and supporting cells | 695 | ||
| The nerve trunk | 695 | ||
| Blood supply | 696 | ||
| Physiology | 696 | ||
| Degeneration and regeneration | 697 | ||
| The distal nerve segment | 697 | ||
| Diagnosis and presentation | 698 | ||
| Formal classification of injury | 698 | ||
| Neuropraxia | 698 | ||
| First-degree injury | 698 | ||
| Axonotmesis | 698 | ||
| Second-degree injury | 698 | ||
| Third-degree injury | 700 | ||
| Neurotmesis | 700 | ||
| Fourth-degree injury | 700 | ||
| Fifth-degree injury | 700 | ||
| Sixth-degree injury | 700 | ||
| Clinical examination | 700 | ||
| Functional evaluation | 700 | ||
| Electromyography/neurography | 700 | ||
| Wound inspection | 702 | ||
| Patient selection | 702 | ||
| Type of nerve injury | 702 | ||
| Condition of the wound | 703 | ||
| Treatment and surgical techniques | 703 | ||
| Immediate compared with delayed nerve repair | 703 | ||
| General principles | 703 | ||
| Timing | 703 | ||
| Surgical approach | 703 | ||
| Principles of nerve repair | 704 | ||
| General principles | 704 | ||
| Epineurial compared with fascicular repair | 706 | ||
| End-to-side nerve repair | 707 | ||
| Wound closure and immobilization | 707 | ||
| Nerve reconstruction | 707 | ||
| Autografts | 707 | ||
| Approach and preparation | 707 | ||
| Nerve ends | 708 | ||
| The gap | 708 | ||
| Length of graft | 708 | ||
| Harvest of the graft | 708 | ||
| Coaptation and maintenance | 708 | ||
| Donor nerves | 708 | ||
| Sural nerve | 708 | ||
| Medial and lateral antebrachial cutaneous nerves | 709 | ||
| The terminal branch of the posterior interosseous nerve | 710 | ||
| Superficial sensory branch of the radial nerve | 710 | ||
| Other | 710 | ||
| Tubular repair and artificial conduits | 710 | ||
| Biological conduits | 711 | ||
| Nondegradable conduits | 712 | ||
| Biodegradable conduits | 712 | ||
| Fillers | 713 | ||
| Other techniques | 713 | ||
| Nerve transfers | 713 | ||
| Postoperative care | 713 | ||
| General aspects | 713 | ||
| Postoperative movement training | 713 | ||
| Sensory re-education | 714 | ||
| Cortical reorganization | 714 | ||
| Sensory re-education in phase 1 | 714 | ||
| Improving effects of sensory re-education – phase 2 | 714 | ||
| Outcome | 714 | ||
| Assessment of outcome | 714 | ||
| General aspects | 715 | ||
| BMRC | 716 | ||
| The Rosen score | 716 | ||
| Factors that affect outcome | 716 | ||
| General aspects | 716 | ||
| Age | 716 | ||
| Digital nerves | 716 | ||
| Nerve trunks | 716 | ||
| Level of injury | 717 | ||
| Type of repair | 717 | ||
| Type of injury | 717 | ||
| Postoperative dysfunction | 717 | ||
| General aspects | 717 | ||
| Complex regional pain syndrome | 717 | ||
| Other | 717 | ||
| Future perspectives | 718 | ||
| Acknowledgments | 718 | ||
| References | 718 | ||
| References | 718.e1 | ||
| 33 Nerve transfers | 719 | ||
| Introduction | 719 | ||
| Basic science | 719 | ||
| Historical perspective | 719.e1 | ||
| Diagnosis and patient presentation | 720 | ||
| History | 720 | ||
| Physical examination | 725 | ||
| Imaging | 725 | ||
| Electrodiagnostic testing | 725 | ||
| Patient selection | 726 | ||
| Examples of nerve transfer procedures for specific injury patterns | 727 | ||
| Upper plexus injury | 727 | ||
| Specific patient exam findings | 727 | ||
| Reconstruction techniques | 727 | ||
| Use of spinal accessory nerve (cranial nerve XI) to suprascapular nerve transfer (motor) | 727 | ||
| Use of triceps to axillary nerve transfer (motor component) | 728 | ||
| Use of the double fascicular (ulnar/median redundant branches to biceps brachii and brachialis branches of the musculocutaneous) nerve transfer (motor) | 731 | ||
| Other potential donors (medial pectoral nerve and thoracodorsal nerve) | 731 | ||
| Lower plexus injury | 732 | ||
| VI Rehabilitation | 843 | ||
| 38 Upper extremity composite allotransplantation | 843 | ||
| Introduction | 843 | ||
| Evolution of upper extremity allotransplantation | 844 | ||
| Immunology of composite tissue allografts | 844 | ||
| Experimental background and scientific basis | 844 | ||
| Chronology of clinical upper extremity allotransplantation | 845 | ||
| Historical development and milestones | 844.e1 | ||
| Experience with upper extremity allotransplantation | 845 | ||
| Program, patient, procedural and protocol-related considerations | 845 | ||
| Program establishment and implementation | 845 | ||
| Donor and recipient selection | 845 | ||
| Procedural aspects | 846 | ||
| Donor limb procurement | 846 | ||
| Recipient surgery | 847 | ||
| Protocol-related considerations | 847 | ||
| Maintenance immunosuppression | 847 | ||
| Rehabilitation and functional assessment after hand transplantation | 848 | ||
| Assessment for rejection (host versus graft reaction) | 849 | ||
| Immunomonitoring | 850 | ||
| World experience and outcomes (graft and patient survival, function, and complications) | 850 | ||
| Upper extremity transplantation versus replantation | 851 | ||
| Unique aspects of composite tissue allotransplantation | 852 | ||
| Emerging insights in composite tissue allotransplantation | 852 | ||
| Cortical plasticity and neuro-integration | 852 | ||
| Chronic rejection | 852 | ||
| Tolerance approaches and immunomodulatory strategies | 853 | ||
| The future of upper extremity reconstructive transplantation | 854 | ||
| References | 854 | ||
| References | 854.e1 | ||
| 39 Hand therapy | 855 | ||
| Introduction | 855 | ||
| Tenets of hand therapy | 855 | ||
| Evaluative guidelines | 855 | ||
| Rehabilitation following nerve injury/surgery | 856 | ||
| Compression neuropathies | 856 | ||
| Carpal tunnel syndrome | 856 | ||
| Postoperative care | 856 | ||
| Cubital tunnel syndrome | 857 | ||
| Postoperative care | 857 | ||
| Nerve repair | 857 | ||
| Early postoperative care | 857 | ||
| Late rehabilitation | 858 | ||
| Sensory re-education | 858 | ||
| Motor re-education | 858 | ||
| Nerve transfers | 859 | ||
| Rehabilitation following tendon injury/surgery | 861 | ||
| Flexor tendon injuries | 861 | ||
| Extensor tendon injuries | 862 | ||
| Tenolysis | 865 | ||
| Tendon transfers | 865 | ||
| Rehabilitation following skeletal injury/surgery | 866 | ||
| Proximal phalanx fractures | 866 | ||
| Metacarpal fractures | 867 | ||
| Thumb carpometacarpal osteoarthritis | 867 | ||
| Conclusion | 869 | ||
| References | 869 | ||
| References | 869.e1 | ||
| 40 Treatment of the upper extremity amputee | 870 | ||
| Introduction | 870 | ||
| Aesthetic prostheses | 870 | ||
| Control of upper extremity prosthetic devices | 870 | ||
| Historical perspective | 870.e1 | ||
| Prosthetic implications of upper limb amputation surgery | 872 | ||
| Finger amputation | 872 | ||
| Partial hand | 872 | ||
| Wrist disarticulation and transradial amputation | 873 | ||
| Elbow disarticulation and long transhumeral amputation | 874 | ||
| Proximal transhumeral and shoulder disarticulation | 875 | ||
| Surgery of the residual limb | 875 | ||
| Soft-tissue improvement | 875 | ||
| Neuroma management | 876 | ||
| Targeted muscle reinnervation | 876 | ||
| Transhumeral level | 876 | ||
| Shoulder disarticulation level | 877 | ||
| Transradial level | 879 | ||
| Comparison of prosthetics with composite tissue allotransplantation | 879 | ||
| References | 880 | ||
| References | 880.e1 | ||
| Index | i1 | ||
| A | i1 | ||
| B | i11 | ||
| C | i30 | ||
| D | i51 | ||
| E | i53 | ||
| F | i59 | ||
| G | i79 | ||
| H | i82 | ||
| I | i95 | ||
| J | i99 | ||
| K | i99 | ||
| L | i100 | ||
| M | i108 | ||
| N | i120 | ||
| O | i131 | ||
| P | i136 | ||
| Q | i149 | ||
| R | i149 | ||
| S | i158 | ||
| T | i172 | ||
| U | i187 | ||
| V | i195 | ||
| W | i199 | ||
| X | i202 | ||
| Y | i203 | ||
| Z | i203 | ||
| Index | e1 | ||
| A | e1 | ||
| B | e2 | ||
| C | e4 | ||
| D | e9 | ||
| E | e10 | ||
| F | e11 | ||
| G | e14 | ||
| H | e14 | ||
| I | e24 | ||
| J | e24 | ||
| K | e24 | ||
| L | e25 | ||
| M | e25 | ||
| N | e27 | ||
| O | e31 | ||
| P | e31 | ||
| Q | e35 | ||
| R | e35 | ||
| S | e37 | ||
| T | e38 | ||
| U | e44 | ||
| V | e49 | ||
| W | e50 | ||
| X | e51 | ||
| Z | e52 |