Joshua M. Adkinson

Surgical Treatment of Cubital Tunnel Syndrome: Trends and the Influence of Patient and Surgeon Characteristics.

PURPOSE To examine trends in and determinants of the use of different procedures for treatment of cubital tunnel syndrome. METHODS We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Florida State Ambulatory Surgery Database for 2005 to 2012. We selected all patients who underwent in situ decompression, transposition, or other surgical treatments for cubital tunnel syndrome. We tested trends in the use of these techniques and performed a multivariable analysis to examine associations among patient characteristics, surgeon case volume, and the use of different techniques. RESULTS Of the 26,164 patients who underwent surgery for cubital tunnel syndrome, 80% underwent in situ decompression, 16% underwent transposition, and 4% underwent other surgical treatment. Over the study period, there was a statistically significant increase in the use of in situ release and a decrease in the use of transposition. Women and patients treated by surgeons with a higher cubital tunnel surgery case volume underwent in situ release with a statistically higher incidence than other techniques. CONCLUSIONS In Florida, surgeon practice reflected the widespread adoption of in situ release as the primary treatment for cubital tunnel syndrome, and its relative incidence increased during the study period. Patient demographics and surgeon-level factors influenced procedure selection. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.

Impact of Injury Mechanisms on Patterns and Management of Facial Fractures.

AbstractMechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board–approved review of our networks trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson &khgr;2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence:Therapeutic, III.

Do Patient- and Parent-reported Outcomes Measures for Children With Congenital Hand Differences Capture WHO-ICF Domains?

BackgroundPatient- and parent-reported outcome measures (PROMs) are increasingly used to evaluate the effectiveness of surgery for congenital hand differences (CHDs). Knowledge of an existing outcome measure’s ability to assess self-reported health, including psychosocial aspects, can inform the future development and application of PROMs for CHD. However, the extent to which measures used among children with CHD align with common, accepted metrics of self-reported disability remains unexplored.Questions/purposesWe reviewed studies that used PROMs to evaluate surgery for CHD to determine (1) the number of World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF) domains covered by existing PROMs; (2) the proportion of studies that used PROMs specifically validated among children with CHD; and (3) the proportion of PROMs that targets patients and/or parents.MethodsWe performed a comprehensive review of the literature through a bibliographic search of MEDLINE®, PubMed, and EMBASE from January 1966 to December 2014 to identify articles related to patient outcomes and surgery for CHD. We evaluated the 42 studies that used PROMs to identify the number and type of WHO-ICF domains captured by existing PROMs for CHD and the proportion of studies that use PROMs validated for use among children with CHD. The most common instruments used to measure patient- and parent-reported outcomes after reconstruction for CHD included the Prosthetic Upper Extremity Functional Index (PUFI), Disabilities of the Arm, Shoulder, and Hand questionnaire, Childhood Experience Questionnaire, and Pediatric Quality of Life Inventory.ResultsCurrent PROMs that have been used for CHD covered a mean of 1.3 WHO-ICF domains (SD ± 1.3). Only the Child Behavior Checklist and the Piers-Harris Children’s Self-Concept Scale captured all ICF domains (body functions and structures, activity, participation, and environmental factors). The PUFI, the only PROM validated specifically for children with congenital longitudinal and transverse deficiency, was used in only four of 42 studies. Only 13 of the 42 studies assessed patient-reported outcomes, whereas five assessed both patient- and parent-reported outcomes.ConclusionsThe PROMs used to assess patients after CHD surgery do not evaluate all WHO-ICF domains (ie, body structure, body function, environmental factors, and activity and participation) and generally are not validated for children with CHD. Given the psychological and sociological aspects of CHD illness, a PROM that encompasses all components of the biopsychosocial model of illness and validated in children with CHD is desirable.Level of EvidenceLevel III, therapeutic study.

A Systematic Review and Comparison of Outcomes Following Simple Syndactyly Reconstruction With Skin Grafts or a Dorsal Metacarpal Advancement Flap

PURPOSE Many techniques exist for simple syndactyly reconstruction. The most commonly used techniques involve either skin grafts or a dorsal metacarpal advancement flap. Our aim was to review and compare the outcomes of these 2 techniques systematically. METHODS We reviewed articles from PubMed, MEDLINE, EMBASE, and Google Scholar published between January 1966 and January 2016. We identified studies that reported outcomes after reconstruction of simple syndactyly using skin grafts and those using only a dorsal metacarpal advancement flap. Cases of complex syndactyly and those that were not clearly differentiated by technique or type of simple syndactyly were excluded. Outcomes were then stratified by technique and type of syndactyly (complete and incomplete). RESULTS We identified 693 articles and selected 34 for inclusion. No standardized outcome measure was uniformly applied in the examined studies. Overall, skin grafting procedures were associated with more complications (eg, flap necrosis/graft failure, contracture, web creep, hypertrophic scarring) and a greater need for revision. When stratified by subtype, patients with simple, complete syndactyly who underwent skin grafting had a significantly higher rate of hypertrophic scarring than those who underwent reconstruction with a dorsal metacarpal advancement flap. CONCLUSIONS Simple syndactyly reconstruction with a dorsal metacarpal advancement flap may lead to fewer complications than procedures using skin grafts. However, substantial limitations of currently available evidence do not allow for the recommendation of a specific technique. Future research should use a uniform reporting system for syndactyly classification and complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

So You Have a Research Idea: A Survey of Databases Available for Plastic Surgery Research.

Summary: Plastic surgery research using large databases has increased dramatically over the past 20 years. With the magnitude and breadth of information available in these databases, researchers are able to more easily answer a wide variety of research questions. This study sought to provide a comprehensive comparative analysis of the relevant databases for plastic surgery research. Database information, data collection methods, acquisition details, and variable availability were collected for 19 large databases. Examples of potential future research utility were ascribed to each database based on this comprehensive analysis. With a greater understanding of the content, strengths, and limitations of these databases, researchers will be better equipped to select the most appropriate database to answer a specific research question.

Congenital hand differences

Congenital hand differences are frequently encountered by pediatric plastic surgeons. These anomalies may cause significant emotional and functional challenges for children. Pediatric plastic surgery nurses should have a basic understanding of common congenital hand differences and related treatment options to facilitate patient education and postoperative care. This article discusses clinical findings and management of 4 of the most common hand anomalies: syndactyly, polydactyly, thumb hypoplasia, and cleft hand. The goals of surgical treatment are to maximize hand function and aesthetics with minimal adverse outcomes.

The Impact of Prenatal Diagnosis of an Upper Extremity Anomaly onPregnancy Outcome

Objective: Upper extremity anomalies (UEA) occur when there is an interruption in the normal process of embryonic limb development. The prenatal diagnosis of an UEA may impact the decision to deliver or terminate the pregnancy. We sought to elucidate factors associated with pregnancy outcome in the setting of a known UEA. Methods: We reviewed electronic medical records at three affiliated hospitals to identify mothers with an UEA diagnosed by prenatal ultrasound. Maternal demographics, anomaly type, and clinical management variables were collected. Patients were stratified by primary outcome of either delivery or elective termination. Multivariate analysis was performed to identify factors associated with pregnancy termination. Results: Thirty mother/child dyads were confirmed to have an UEA by prenatal ultrasound. Fourteen pregnancies resulted in live birth of the fetus (47%) and 16 pregnancies were terminated (53%). Pregnancies with multiple anomalies (P<0.05) and/or bilateral UEAs (P<0.05) were more likely to undergo termination. Consultation with an upper extremity surgeon was associated with delivery (P<0.05). Maternal demographics were not associated with pregnancy outcome. Conclusions: Fetal anomaly characteristics are associated with pregnancy outcome. Although prenatal consultation with an upper extremity surgeon was associated with delivery, this subset of patients were more likely to have isolated, unilateral anomalies.

Postoperative Patient- and Parent-Reported Outcomes for Children with Congenital Hand Differences: A Systematic Review

Background: Patient- and parent-reported outcomes are increasingly considered as measures of treatment effectiveness for congenital conditions. The authors’ specific aim was to review the use of patient- and parent-reported outcomes of quality of life, activities of daily living, perception of hand appearance, and satisfaction after reconstruction for congenital hand differences. Methods: The authors reviewed articles addressing congenital hand differences from PubMed, MEDLINE, and EMBASE published between January of 1966 and October of 2016. The authors excluded studies that did not include reconstruction or lacked patient- or parent-reported outcomes. Investigators reviewed 48 studies and extracted the following: study type, level of evidence, type of congenital hand differences, sample size, procedure performed, length of follow-up, and domains and results of patient-satisfaction questionnaires. Results: Multiple studies across several types of congenital hand differences showed that a majority of patients and parents report improvements and are satisfied with postoperative outcomes. However, there were several patient cohorts (e.g., thumb duplication, thumb hypoplasia, radial longitudinal deficiency) who expressed dissatisfaction with outcomes and continue to experience decreased health-related quality of life. Conclusions: Overall, patient satisfaction and reports of health-related quality of life among children with congenital hand differences are favorable. Patients seem to cope and adapt well, but teasing and social relationships remain problematic, particularly as children enter school. This article highlights addressing these concerns before embarking on reconstruction.

Pediatric Hand Injuries.

Pediatric hand injuries are extremely common. Although many hand injuries are adequately managed in the emergency department, some may need evaluation and treatment by a pediatric hand surgeon to ensure a good functional outcome. This article discusses the diagnosis and management of the most common pediatric hand maladies: fingertip injuries/amputation, tendon injuries, and phalangeal and metacarpal fractures. The plastic surgery nurse should be familiar with hand injuries that require intervention to facilitate efficient management and optimal postoperative care.

Head and Neck Vascular Anomalies: A Practical Case-Based Approach.

Head and Neck Vascular Anomalies: A Practical CaseBased Approach is a comprehensive text that covers the vascular anomalies encountered in the head and neck. This book is organized into 6 categories: infantile hemangiomas, other vascular tumors, capillary malformations, venous malformations, lymphatic malformations, and arteriovenous malformations. Each category is further divided into various case studies, each of which walks the reader through a representative case and discusses the differential diagnoses, diagnostic workup, and management of each case. This text is a useful resource for physicians in all fields and at all levels of training. The cases are well presented, and the flow of each case study is extremely readable while still providing a comprehensive overview of each topic. The high-quality illustrations are well organized and a critical adjunct to the text, expertly representing the lesion discussed and thereby enhancing the reader’s understanding of the presentation/postoperative appearances of the lesions. Furthermore, each case study is succinctly summarized in a bulleted list, which allows the reader to hone in on the major key points for each case. This text also provides extensive references, not just from otolaryngology journals but also from plastics, pediatrics, and dermatology journals, highlighting the multidisciplinary approach for many of the head and neck vascular anomalies. This text will serve useful for pediatric otolaryngologists, pediatricians, and other physicians who encounter vascular anomalies in their practice.