COA Symposium: Shoulder and Elbow - Difficult Upper Extremity Management Surgical Techniques, Ask the Experts

OrthoMedia ◽  
2022 ◽  
Keyword(s):  
Upper Extremity ◽  
Surgical Techniques

Endovascular Management of Unusual Aneurysms of the Axillary and Subclavian Arteries

1996 ◽  
Vol 3 (4) ◽  
pp. 389-395 ◽  
Author(s):  
Timothy M. Sullivan ◽  
J. Michael Bacharach ◽  
John Perl ◽  
Bruce Gray
Keyword(s):  
Upper Extremity ◽  
Advanced Cancer ◽  
Surgical Techniques ◽  
Covered Stents ◽  
Endovascular Management ◽  
The Third ◽  
Operative Repair ◽  
Brachial Vein ◽  
Palmaz Stents

Purpose: Aneurysms of the upper extremity arteries are uncommon and may be difficult to manage with standard surgical techniques. We report the exclusion of three axillary-subclavian aneurysms with covered stents. Methods and Results: Palmaz stents were covered with either polytetrafluoroethylene (2 cases) or brachial vein and deployed to exclude pseudoaneurysms in 1 axillary (ruptured) and 2 left subclavian arteries. Two of the patients had advanced cancer and died within 52 days and 3 months of treatment, but their aneurysms were occluded at the time of their death. The repair in the third patient is patent at 9 months. Conclusions: Endovascular exclusion of axillary and subclavian aneurysms with covered stents may offer a useful alternative to operative repair, particularly in patients with significant comorbidities.

scholarly journals Evolution of the rat hind limb transplant as an experimental model of vascularized composite allotransplantation: Approaches and advantages

2020 ◽  
Vol 8 ◽  
pp. 205031212096872
Author(s):  
Yoram Y Fleissig ◽  
Jason E Beare ◽  
Amanda J LeBlanc ◽  
Christina L Kaufman
Keyword(s):  
Upper Extremity ◽  
Hind Limb ◽  
Large Body ◽  
Surgical Techniques ◽  
Experimental Models ◽  
Tissue Loss ◽  
Large Animal ◽  
Solid Organ ◽  
Vascularized Composite Allotransplantation ◽  
Large Animal Models

As clinical experience with surgical techniques and immunosuppression in vascularized composite allotransplantation recipients has accumulated, vascularized composite allotransplantation for hand and face have become standard of care in some countries for select patients who have experienced catastrophic tissue loss. Experience to date suggests that clinical vascularized composite allotransplantation grafts undergo the same processes of allograft rejection as solid organ grafts. Nonetheless, there are some distinct differences, especially with respect to the immunologic influence of the skin and how the graft is affected by environmental and traumatic insults. Understanding the mechanisms around these similarities and differences has the potential to not only improve vascularized composite allotransplantation outcomes but also outcomes for all types of transplants and to contribute to our understanding of how complex systems of immunity and function work together. A distinct disadvantage in the study of upper extremity vascularized composite allotransplantation recipients is the low number of clinical transplants performed each year. As upper extremity transplantation is a quality of life rather than a lifesaving transplant, these numbers are not likely to increase significantly until the risks of systemic immunosuppression can be reduced. As such, experimental models of vascularized composite allotransplantation are essential to test hypotheses regarding unique characteristics of graft rejection and acceptance of vascularized composite allotransplantation allografts. Rat hind limb vascularized composite allotransplantation models have been widely used to address these questions and provide essential proof-of-concept findings which can then be extended to other experimental models, including mice and large animal models, as new concepts are translated to the clinic. Here, we review the large body of rat hind limb vascularized composite allotransplantation models in the literature, with a focus on the various surgical models that have been developed, contrasting the characteristics of the specific model and how they have been applied. We hope that this review will assist other researchers in choosing the most appropriate rat hind limb transplantation model for their scientific interests.

Revision Peripheral Nerve Surgery of the Upper Extremity

2021 ◽  
Vol 35 (02) ◽  
pp. 119-129
Author(s):  
Rami P. Dibbs ◽  
Kausar Ali ◽  
Shayan M. Sarrami ◽  
John C. Koshy
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Nerve Compression ◽  
Nerve Injuries ◽  
Muscle Flaps ◽  
Traumatic Injuries ◽  
Ulnar Nerve Compression ◽  
Advantages And Disadvantages

AbstractPeripheral nerve injuries of the upper extremity can result from a wide array of etiologies, with the two most common being compression neuropathy and traumatic injuries. These types of injuries are common and can be psychologically, functionally, and financially devastating to the patient. A detailed preoperative evaluation is imperative for appropriate management. Traumatic injuries can typically be treated with local burial techniques, targeted muscle reinnervation, and regenerative peripheral nerve interfaces. Median nerve compression is frequently managed with complete release of the antebrachial fascia/transverse carpal ligament and/or use of flap coverage such as the hypothenar fat pad flap and local muscle flaps. Ulnar nerve compression is commonly managed via submuscular transposition, subcutaneous transposition, neurolysis, and nerve wrapping. In this review, we discuss the preoperative evaluation, surgical techniques, and advantages and disadvantages of each treatment modality for patients with compressive and traumatic upper extremity nerve injuries.

scholarly journals Forequarter amputation for malignant tumours of the upper extremity: Case report, techniques and indications

2007 ◽  
Vol 15 (2) ◽  
pp. 83-85 ◽  
Author(s):  
Vanessa Dimas ◽  
Jennifer Kargel ◽  
John Bauer ◽  
Peter Chang
Keyword(s):  
Case Report ◽  
Upper Extremity ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Malignant Tumours ◽  
Traumatic Injuries ◽  
Classic Case ◽  
Forequarter Amputation ◽  
Interscapulothoracic Amputation ◽  
Surgical Option

Forequarter (interscapulothoracic) amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity. Currently, it is most commonly used in the treatment of malignant tumours of the arm. With the advent of limb-sparing techniques, primary forequarter amputation is performed less frequently, but remains a powerful surgical option in managing malignant tumours of the upper extremity; therefore, surgeons should be familiar with this procedure. A classic case report of forequarter amputation, with emphasis on indications and surgical techniques, is presented.

scholarly journals The relationship between lymphedema severity and awareness of lymphedema surgery

2021 ◽  
Vol 48 (5) ◽  
pp. 534-542
Author(s):  
Hyun Seung Lee ◽  
Yong Chan Bae ◽  
Su Bong Nam ◽  
Chang Ryul Yi ◽  
Jin A Yoon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Indocyanine Green ◽  
Upper Extremity ◽  
Surgical Techniques ◽  
Cancer Center ◽  
Limited Knowledge ◽  
Early Stages ◽  
Md Anderson ◽  
The Relationship

Background During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients’ awareness of surgical treatment for secondary upper extremity lymphedema (UEL).Methods Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups.Results Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003).Conclusions If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

scholarly journals Relationships Among Manual Body Functions, Manual Capacity, and Bimanual Performance Using the Prosthetic Upper Extremity Functional Index in Children With Congenital Hand Differences

2014 ◽  
Vol 94 (6) ◽  
pp. 767-775 ◽  
Author(s):  
Monique S. Ardon ◽  
Wim G.M. Janssen ◽  
Steven E.R. Hovius ◽  
Henk J. Stam ◽  
Magdalena Murawska ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Hand Function ◽  
Surgical Techniques ◽  
Pinch Strength ◽  
Dominant Hand ◽  
Functional Index ◽  
Cross Sectional ◽  
Nondominant Hand ◽  
Bimanual Performance ◽  
Cross Sectional Design

Background Most surgical techniques intervene at the level of body functions of the upper limb, aiming to improve manual capacity and activity performance. However, the nature of the relationships among these levels of functioning and evidence for hand function variables predicting performance have scarcely been investigated. Objective The primary aim of this study was to assess aspects of hand function and manual capacity that influence bimanual performance in children with congenital hand differences (CHDs), ranging from surgically corrected polydactyly or syndactyly to radial dysplasia. A secondary aim was to assess whether the number of items on the Prosthetic Upper Extremity Functional Index (PUFI) can be reduced without losing information on bimanual performance in this population. Design A cross-sectional design was used. Methods One hundred six 10- to 14-year-old children with CHD participated in the study, which was conducted in a university hospital's outpatient clinic. Bimanual performance was evaluated with child self-reports on an adapted version of the PUFI, calculating ease of performance and actual use of the affected hand. Additionally, hand function and manual capacity were assessed. Results The median score on ease of performance was high, and, on average, the children used their affected hand actively in 97% of all activities. Manual capacity of the nondominant hand and lateral pinch strength of the dominant hand predicted attainment of maximum PUFI scores. Nonmaximum PUFI scores were predicted by opposition strength of the nondominant hand and lateral pinch strength of the dominant hand. In addition, in this patient group, only 6 items of the PUFI explained all variance in PUFI scores. Limitations The generalizability of the results is limited by the carefully selected age range. Second, the cross-sectional design of the study limits statements on causality on the relationships found. Conclusion Children with a CHD generally have good bimanual performance and, on average, perform activities with active use of the affected hand. Therapy directed toward increasing manual capacity and finger muscle strength might assist in improving bimanual performance in children with CHD. Furthermore, the number of items on the PUFI could be reduced from 38 to 6 items in children with CHD.

Surgical intervention and customised dressings in an extremity wound caused by necrotising fasciitis: a case study

2019 ◽  
Vol 28 (Sup5) ◽  
pp. S21-S27
Author(s):  
Jessica Collins
Keyword(s):  
Upper Extremity ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Surgical Intervention ◽  
Surgical Techniques ◽  
Skin Grafting ◽  
Necrotising Fasciitis ◽  
Upper Arm ◽  
Wound Therapy ◽  
Limb Function

Necrotising fasciitis can result in extensive loss of soft tissue and limb function. Therefore, surgical intervention requires a balance between extensive tissue removal and saving the limb. A 56-year-old male presented with necrotising fasciitis of the upper extremity. Debridement resulted in a full-thickness wound of the forearm and upper arm, an exposed olecranon and two proximally-based skin flaps. Reconstruction required multiple debridements to optimise the wound for skin grafting and to obtain flap adherence to underlying tissues of the upper arm. Conventional dressings over the flaps proved unsuccessful. Therefore, a customised versatile dressing to address each area of the wound was developed. Negative pressure wound therapy (NPWT) was applied over the exposed muscle (no exposed bone or tendon) of the lower arm and anterior upper arm; a hydropolymer foam dressing covered the elbow region. Closed incision negative pressure wound therapy (ciNPT) was applied over the incision on the posterior upper arm. Ultimately, complete wound closure was achieved, with normal/near-normal range of motion for all joints of the affected limb. There was complete take of skin grafts on the wrist, lower arm and anterior upper arm. ciNPT was effective in holding the incision together and promoting healing of the posterior upper arm, and the hydropolymer foam dressing aided with healing and coverage of the elbow region. In this case, healing of a large, complex upper extremity wound and restored limb function were achieved following use of a combination of surgical techniques and customisation of wound therapy modalities.

scholarly journals Current Concepts in Reconstruction of Hand Function in Tetraplegia

2008 ◽  
Vol 97 (4) ◽  
pp. 341-346 ◽  
Author(s):  
J. Fridén ◽  
C. Reinholdt
Keyword(s):  
Upper Extremity ◽  
Hand Function ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Muscle Contractions ◽  
The Past ◽  
Recent Developments ◽  
Common Observation ◽  
Further Development ◽  
Active Training

Several recent developments in the field of reconstructive hand surgery in tetraplegia have created a foundation for further refinements of both surgical techniques and postoperative training strategies to improve the outcome of restoration of upper extremity functions. A remarkable means of improving function is the immediate activation of transferred muscle after surgery. Early active training of new motors not only prevents the formation of adhesions but facilitates the voluntary recruitment of motors powering new functions before swelling and immobilization-induced stiffness restrain muscle contractions. A common observation internationally over the past years is that the number of incomplete tetraplegics increases. This shift towards more incomplete injuries with spasticity as a common feature in addition to the paralysis has expanded and changed the spectrum of surgeries in this group of patients and also emphasizes the need for a revisit and further development of the different strategies for reconstruction of hand function.

scholarly journals Building a Hand and Upper Extremity Transplantation Program: Lessons Learned From the First 20 Years of Vascularized Composite Allotransplantation

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 224-233 ◽  
Author(s):  
Shaun D. Mendenhall ◽  
Stav Brown ◽  
Oded Ben-Amotz ◽  
Michael W. Neumeister ◽  
L. Scott Levin
Keyword(s):  
Upper Extremity ◽  
Patient Selection ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
Lessons Learned ◽  
Hand Transplantation ◽  
Transplantation Program ◽  
Recent Addition ◽  
Patient Selection Criteria

Background: Upper extremity transplantation is a quality-of-life enhancing treatment for select patients with upper extremity loss. This article reviews the preoperative, intraoperative, and postoperative challenges in the upper extremity transplantation process and the lessons learned from the first 2 decades of hand transplantation. Methods: Key components of the author’s hand transplantation protocol including patient selection, donor screening, surgical rehearsal, donor procurement, transplantation, immunosuppression, and patient outcome reporting/follow-up are reported to assist other teams who wish to establish a hand transplantation program. Results: There have been many advancements in the first 20 years of hand transplantation including better patient selection criteria, the recent addition of pediatric patients, improved surgical techniques such as the use of virtual surgical planning, and improved immunosuppression protocols. Improvement has also taken place in the tracking and reporting of hand transplant outcomes, but more work is clearly needed to fully define the benefits of transplantation, especially for pediatric patients. Conclusions: Over the past 20 years, significant progress has been made in upper extremity transplantation although a number of challenges remain including how to best document and share outcome measures, optimize immunosuppression, and diagnose/treat rejection. The authors encourage upper extremity transplant programs to report their experience and protocols to advance hand transplantation as standard of care for properly selected individuals.

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