Annals of plastic surgery
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Annals of plastic surgery · May 2016
Comparative StudyComparison of Extension Orthosis Versus Percutaneous Pinning of the Distal Interphalangeal Joint for Closed Mallet Injuries.
We compared a static extension orthosis with percutaneous pinning of the distal interphalangeal joint (DIPJ) for treatment of closed mallet injuries. After receiving counsel about treatment options, 44 patients (25 women and 19 men; mean age, 57 years) freely chose orthosis and 18 patients (5 women and 13 men; mean age, 51 years) chose pinning. Both the extension orthosis and the pin remained in place for 6 weeks; the pin then was removed, and the care in both groups was transitioned to nighttime orthosis use for an additional 6 weeks. ⋯ The techniques produce satisfactory correction of extensor lag and have high patient satisfaction. Pinning allows better correction of DIPJ extensor lag and results in a smaller degree of final extensor lag. Pinning is more expensive and may result in more DIPJ stiffness (ie, loss of active flexion), but it may be justified in certain patients (eg, medical professionals, food service workers) who would have difficulty working with an orthosis.
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Annals of plastic surgery · May 2016
Comparative StudyComparing Muscle and Fasciocutaneous Free Flaps in Lower Extremity Reconstruction--Does It Matter?
Plastic surgeons are often asked to assist with the reconstruction of lower extremity wounds. These patients many times require free tissue transfer for coverage given paucity of soft tissue. Anecdotally, many orthopedic surgeons prefer muscle coverage--particularly in the setting of potentially infected bone. Today's surgeons now easily harvest and transfer fasciocutaneous flaps--a versatile option with less donor-site morbidity. We hypothesized that there would be no difference in outcomes between these 2 types of reconstruction. ⋯ Our data suggest that in essentially all clinical parameters, there is no difference between free flap type used for soft tissue coverage of the lower extremity. Patients undergoing reconstruction with a fasciocutaneous flap may return to weight bearing earlier--although they are more likely to require elective flap revisions. These results imply essentially equivalent outcomes regardless of flap type or operative indication, in contrast with some of the biases in the orthopedic community. The particular flap chosen for any reconstruction should remain solely at the discretion of the plastic surgeon.
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Annals of plastic surgery · May 2016
Comparative StudyApproaches to Distal Upper-Extremity Trauma: A Comparison of Plastic, Orthopedic, and Hand Surgeons in Academic Practice.
Hand trauma call duties at university medical centers are traditionally split among plastic surgeons and orthopedic surgeons, frequently without additional fellowship training in hand and upper-extremity surgery. Differences in operative approach between these groups have never been specifically described. The University Health Consortium-Association of American Medical Colleges Faculty Practice Solutions Center database contains comprehensive, factual, billing and coding data from 90 academic medical centers in the United States and can be used to characterize the practice patterns of various academic surgical specialties. ⋯ A large degree of variation exists in the treatment of distal upper extremity injuries, based on specialty service. Hand surgeons, not surprisingly, have the most robust clinical experience, whereas plastic surgeons and orthopedic surgeons each display varying strengths and weaknesses, perhaps a consequence of their respective training.