Hand Reconstruction Research Articles

Cephalic Vein Supercharging to Prevent Venous Congestion for a Reverse Radial Forearm Flap Used in the Reconstruction of Dorsum of Hand: A Case Report

The reverse radial forearm flap is often co-opted for soft tissue reconstruction of the dorsum of hand. Venous congestion can lead to flap necrosis or failure. To improve dorsum hand reconstruction outcomes, sufficient venous drainage is very important. In this case report, we discuss the situation of a 66-year-old male patient with a serious degloving injury on the dorsum of his right hand. After reverse radial forearm flap adaptation, venous anastomosis between the cephalic vein and the dorsal superficial vein was performed prophylactically and the patient recovered well without congestion or complications. We implemented venous supercharging, which is a relatively easy and simple procedure, to prevent venous congestion. The success of the procedure shows that venous supercharging can aid in the prevention of venous congestion.

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury.

Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5–5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.

113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center

Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.

Reconstruction of mutilating hand injuries by microsurgical free tissue transfers from the foot

IntroductionThe aim of this study is to present various hand reconstruction methods and provide technical notes regarding the treatment of mutilating hand injuries using free-tissue transfers from the foot and to investigate whether these transfers provide patients with a usable hand or not. Patients and MethodsNinety patients with mutilating hand injuries were included in the study. A total of 101 procedures were performed. Patients were contacted by phone to evaluate their working status and to record any complaints regarding their donor sites. The Quickdash questionnaire was conducted for the 53 patients who could be reached. Operative techniques, secondary procedures, finger survival, and physiotherapy data were noted retrospectively. ResultsIn 36 patients, a trimmed great toe was transferred to the thumb. Second toe-to-thumb transfers were performed in 8 patients, and second toe-to-finger transfers were performed in 10 patients. In 13 patients, 2 toes from one side were transferred, and in 6 patients, 3 toes were transferred to the hand. Bilateral toe transfers were performed in 9 patients. Eight patients underwent joint transfers, of which 2 involved joint transfers from both feet. The overall finger survival rate for the transfer procedures was 95.04%. The average Quickdash score of the patients who could be reached (n = 53) was 27.49, with 62.3% of the patients being able to use their hands in their previous jobs, and 26.4% needing to change their jobs because of their hand injuries. 41.5% of the patients had no donor site complaints. 47.2% had mild complaints, and 11.3% had major donor site complaints. ConclusionMultiple-toe transfer techniques along with flap coverage options should be considered, and delicate planning is mandatory to achieve at least a basic or acceptable hand. Three toes, including the great toe, can be transferred in a single operation by dissecting both the dorsal and plantar arterial systems. Crush injuries of the dorsal side of the hand may be reconstructed using combined transfers of bones, joints, extensor tendons, and skin. In our series, 88.7% of patients with mutilating hand injuries were able to return to work after we performed tissue transfers from the foot.

Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand.

Background:Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness.Methods:This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up.Results:There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%–100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up.Conclusion:The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.

Digital Transfer for Hand Reconstruction in Cleft Hand and Foot Differences.

Digital transfer for hand reconstruction in children with cleft hand and foot differences present unique challenges with anomalous anatomy and rare opportunities to dramatically improve function of one- or two-digit hands. Medical records were reviewed for patients with cleft hand and foot treated at two pediatric institutions between 1996 and 2018. Hospital records, clinical photographs, radiographs, and alginate molds were available on all patients. Patient characteristics, indications for transfer, associated syndromes, donor and recipient anatomy, and complications were examined. Twenty digital transfers were identified in 16 patients. The mean age at time of transfer was 6 years (range: 3-18 years). Associated syndromes in this study included ectrodactyly ectodermal dysplasia clefting (EEC) syndrome and Goltz's syndrome. Recipient sites included the thumb (n = 17) and index ray (n = 3) in 10 hands with monodactyly, 6 hands with a two-digit ulnar syndactyly, and 3 hands with central deficiency and associated polydactyly or other anomalies. Donor sites included the great toe (n = 7), fifth toe (n = 9), great toe polydactyly (n = 2), thumb polydactyly (n = 1), and second toe (n = 1). All transfers survived. Revisions included tenolysis (n = 2), repeat fixation for nonunion or malunion (n = 2), and fusion for instability (n = 3). Digital transfer in cleft hand and foot patients is a functional endeavor. The transferred digits provide sensation, mobility, and stability for opposition. Technically challenging due to small structures and atypical anatomy, these rare cases represent unique opportunities to improve function and appearance in the pediatric hand. This is a therapeutic study and reflects level of evidence IV.

Negative Pressure Wound Therapy in Conjunction With Artificial Dermis for Burned Hand Reconstruction.

Proper wound care along with the use of skin grafts over deep burn wounds has been the standard treatment. However, the goal in burn wound care has shifted from achieving a satisfactory survival rate to improving long-term form and function of the healed wound, which is sometimes hindered by scar contracture. This has prompted surgeons to find alternative ways to treat burn wounds without compromising function. Among burn cases, hand injuries are the most problematic when it comes to delicate function recovery. This study presents the results of conjunctive use of a bilayer artificial dermis, negative pressure wound therapy, and split-thickness skin grafts for grafting over acute burn wounds and scar-releasing defects after severe hand burns. Three months after the operation, the scar was soft and pliable, the aesthetic outcome was good, and the patients gained much improvement in hand function and quality oflife. The combined technique achieved a good scar quality and aesthetic effect on burned hands as well as excellent functional outcome, which resulted in major improvements and an independent life for the patient.

Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction.

Full-thickness injuries to the hand require durable soft tissue coverage to preserve tendon gliding and hand motion. We aim to investigate the cost effectiveness of hand resurfacing comparing free fascial flap reconstruction versus bilaminate synthetic dermal matrices. Cost effectiveness was modeled using decision tree analysis with the rollback method. Total active range of motion was modeled as the common outcome variable based on systematic literature review. Costing was performed from a payer perspective using national Medicare reimbursements. The willingness to pay threshold was determined by average worker's compensation for hand disability. Probabilistic sensitivity analysis was conducted for range of motion outcomes and the costs using 10,000 Monte Carlo simulations. The average cost of free fascial flap reconstruction was $14,201.24 compared with $13,674.20 for Integra, yielding an incremental cost difference of $527.04. Incremental range of motion improvement was 18.0 degrees with free fascial flaps, yielding an incremental cost effectiveness ratio of $29.30/degree of motion. Assuming willingness to pay thresholds of $557.00/degree of motion, free-fascial flaps were highly cost effective. On probabilistic sensitivity analysis, free fascial flaps were dominant in 25.5% of simulations and cost effective in 32.1% of simulations. Thus, microsurgical reconstruction was the economically sound technique in 57.5% of scenarios. Free fascial flap reconstruction of complex hand wounds was marginally more expensive than synthetic dermal matrix and yielded incrementally better outcomes. Both dermal matrix and microsurgical techniques were cost effective in the base case and in sensitivity analysis. In choosing between dermal matrix and microsurgical reconstruction of complex hand wounds, neither technique has a clear economic advantage.

Reconstruction of a Mangled Hand with a Thoracodorsal Artery Perforator Free Flap: A Report of Two Cases

Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. Surgical flaps such as anterolateral thigh, radial forearm, or thoracodorsal artery flaps have been used for multiple-digit resurfacing. In this report, we describe two cases of complex defects that included multiple digits in patients who underwent reconstruction with thoracodorsal artery perforator (TDAP) free flaps. All massive soft tissue defects were completely covered with a TDAP free flap. The thinner perforator flap could be harvested, and the patients regained the ability to pinch and grasp. Therefore, the authors present two cases of mangled hands successfully treated with TDAP free flap.

Reconstruction of Hand and Wrist Soft-Tissue Defects using Radial Artery Perforator Flap

Aim: Soft-tissue defects in the hand and wrist are frequently encountered injuries that may occur due to trauma, burns, or other causes. We aimed to report our experiences in reconstruction of these defects using a radial artery perforator flap (RAPF). Materials and Methods: Eight patients who underwent surgery for reconstruction of the hand and wrist soft-tissue defects at our institution between December 2017 and December 2019 were included in the study. The patients were evaluated in terms of age, sex, etiology, flap size, defect region, and postoperative complications. Results: All defects were reconstructed by utilizing RAPF. The most common etiology of the defects was work-related accidents. The mean age of the patients was 40.4 (10–69) years. The mean flap size was 63.5 ± 14.76 cm2. Six patients healed uneventfully, while we observed partial necrosis of the RAPF flap in one of the cases and a marginal epidermolysis in another. The donor sites were skin grafted in each patient. The patient where partial necrosis observed was re-operated for debridement and skin grafting subsequentially. The duration of follow-up of the patients was 6 months. Conclusions: Radial forearm perforator flap is a reliable and effective reconstructive option to reconstruct small to moderately sized defects of the hand and wrist.

The primary role of dorsal metacarpal artery perforator flap for hand and finger soft-tissue reconstruction

Background: The authors present their experience about the soft-tissue reconstruction of hands and fingers with dorsal metacarpal artery (DMA) perforator flap. Materials and Methods: Patients who were treated by DMA perforator flaps from 2017 to 2019 were evaluated. Results: There were 17 patients with average age of 36 years. DMA flaps were harvested in a fasciocutaneus fashion in all patients except one. The mean flap size was 3.3 cm × 1.8 cm, and the largest flap was 5 cm × 2 cm. The donor area was repaired primarily except for one patient. The bridge skin incision was used to prevent complications caused by compression or edema. The average time for returning to work was 48 days. Conclusion: The DMA perforator flap allows repair of soft-tissue defects of the distal hand and finger neither with sacrificing any major artery nor a major donor site morbidity. Rapid learning curve and relatively stable anatomical structure are the other important entities that make the DMA perforator flap convenient.

Severe or not so severe? The gravity of geriatric trauma.

Background:Due to associated comorbidities, the elderly population is more vulnerable to injuries with complications. This study was done to assess the severity of trauma and outcome of injuries among these patients presenting to the Emergency Department (ED).Materials and Methods:This was a retrospective cohort study. We included all patients aged more than 60 years, who presented to the ED with trauma in the year 2018. Details of the mode of trauma, severity of injuries and outcome were analysed.Results:During the study period a total of 7666 trauma patients presented to ED, among which 879 (879/7666: 11.4%) were in the geriatric age group. The mean age was 68.9 (SD: 7) years with 90.8% being young-old (60–79 years) and 9.2% being old-old (>80 years). Common modes of injuries were road traffic accidents (RTA) (64%) fall on level ground (FLG) (20%) and fall from height (FFH) (8%). Most of them had Injury Severity Score (ISS) and New Injury Severity Score (NISS) score of 0–7, i.e.: 62% and 51%, respectively. On multivariate logistic regression analysis RTA, FFH FLG and triage priority 1 patients were associated with trauma in the old-old as compared to the young–old age groups significantly. Independent risk factors associated with severe trauma were seen RTA, FLG and priority 1 patients. Forty-four per cent patients were managed by the ED team alone. Trauma speciality departments referred to included orthopaedics (47%), neurosurgery (22%), trauma surgery (14%), plastic surgery (8%) and hand reconstruction surgery (6%). About half of the population under study was discharged stable (44%), of which the majority belonged to the young-old category (44.1%). The in-hospital mortality rate was 0.5% (4/879).Conclusion:This study shows the gravity of multiple injuries sustained by the geriatric age group with RTA, FLG and FFH being the predominant causes of trauma. The NISS highlights the severity of injuries in the old and the frail.

Retrospective Study of 20 Patients that has Treated with Pedicled Groin Flap in Reconstruction in Hand Injuries

Pedicled groin flap has long been playing an important role in reconstructive hand surgery. This flap is a reliable method for closing the defects of the soft tissue loss of the hand and is used in many clinical conditions. This study aims to evaluate the epidemiology and geographic aspects of the patients that required the treatment with pedicled groin flap and to assess the outcomes achieved by the Children’s Surgical Centre to help guide the future practice. We studied of 20 patient that has treated with pedicled groin flap reconstruction of the hand injuries between 2009 and 2019 at the Children’s Surgical Centre, Kien Klerng, Phnom Penh, Cambodia. In this study pedicled groin flap was used in 20 patients aged between 7 to 56 years, with a mean of 31 years or 40 % of all patients. The sex ratio M/F was 1.5 which was 12 male patients (60 %) and 08 female patients (40 %). The main cause of patient hand defects was from contracture related to burn sequelae which is 70 %.

Challenging Difficulties of Flap Reconstruction in the Hand

In reconstructive hand surgery, flaps and therefore microsurgical techniques are inevitable to provide the best functional and aesthetic results. There are various complications of defect repair with microsurgical methods. We aimed to classify subacute and late unexpected complications that develop after defect repair by microsurgical methods and to present the management. Patients who underwent microvascular flap surgery for upper extremity tissue defects between 2014-2018 were included in the study. Complications other than total flap loss were retrospectively investigated and recorded. 8 patients (6 Male, 2 Female) were included to the study. 5 left and 3 right hand defects were detected. 3 fingers, 3 hand dorsum, 1 wrist and 1 forearm defects were detected. 2 marginal necrosis, 2 partial flap loss, 1 venous insufficiency, 1 nonunion, 1 skin contracture and 1 burn were the determined complications. Most defects present with different traumas in hand. The trauma zone is almost always close to the area of microvascular repair, moreover the recipient artery may not always be intact. How the bone fixation is performed is very important, covering the bone should be provided with well-blooded tissues. While providing all these, this coverage should not be bulk and should not restrict the range of motion in the hand. Having grasping function necessitates a repair that puts the function in the foreground compared to other areas in the body. Subclinical infections of hand in patients presenting with post-traumatic defects may cause nutritional problems, which may impair wound healing. Such a problem can also be confused with the arterial deprivation of the flap. The absolute sense requirement distinguishes the hand area from the reconstruction of many areas. All these are challenging difficulties in choosing flap for defects in the hand.

The Superficial Inferior Epigastric Artery Based Abdominal Flap for Reconstruction of Extensive Defects of the Hand and Forearm: A Modified Design With Primary Closure of the Donor Site.

The reconstruction of the hand and forearm targets the restoration of their function and aesthetic appearance. Inferiorly based abdominal flaps are reliable and versatile flaps that can cover large defects of the forearm and hand. Here we present a modified abdominal flap design based exclusively on the superficial inferior epigastric artery (SIEA) to reconstruct the hand and forearm's extensive defects. The donor site is closed primarily. This is a retrospective study of the patients who underwent reconstruction of hand and forearm defects with SIEA flap from 2006 to 2018. The flap was designed on the ipsilateral hemiabdomen with a narrow pedicle based on the SIEA. We describe the anatomical basis and the outcomes of SIEA flap for reconstruction of the hand and forearm's extensive defects. Forty-eight soft tissue defects of the hand and forearm were reconstructed with the SIEA-based abdominal flap. Twenty-nine (60.41%) dorsal defects, 4 (8.33%) volar defects, 4 (8.33%) circumferential defects, 6 (12.5%) hand amputation stump, and 5 (10.41%) finger and thumb defects were covered using the SIEA flap. Forty-seven (97.91%) flaps had complete survival, whereas 1 (2.08%) flap had distal necrosis at the time of division. One (2.08%) flap had marginal necrosis, and 1 (2.08%) flap had distal necrosis after the division. The donor site was closed primarily in all patients. One (2.08%) patient had wound dehiscence at the abdominal donor site. All flaps gave excellent coverage with a satisfactory contour. Abdominal flap based on SIEA is a safe, reliable, and versatile flap for the reconstruction of extensive soft-tissue defects of the hand and forearm. An ability to provide a large amount of skin and soft tissue and the abdominal donor site's primary closure make it a favorable option for upper limb reconstruction in regions with limited resources and technical expertise.

VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.

Deformation representation based convolutional mesh autoencoder for 3D hand generation

Due to its flexible joints and self-occlusion, representation and reconstruction of 3D human hand is a very challenging problem. Although some parametric models have been proposed to alleviate this problem, these representation models have limited representation ability, like not being able to represent complex gestures. In this paper, we presented a new 3D hand model with powerful representation ability and applied it to high accuracy monocular RGB-D/RGB 3D hand reconstruction. To achieve this, we firstly build a large scale high-quality hand mesh data set based on MANO with a novel mesh deformation method. We train a VAE based on this data set, and get the low-dimensional representation of hand meshes. By using our HandVAE model, we can recover a 3D human hand by giving a code within this latent space. We also build a framework to recover 3D hand mesh from RGB-D/RGB data. Experimental results have demonstrated the powerfulness of our hand model in terms of the reconstruction accuracy and the application for RGB-D/RGB reconstruction. We believe that our 3D hand representation could be further used in other related human hand applications.

Apert Hand Reconstruction: Do Partial-Thickness Skin Grafts Result in Flexion Scar Contracture?

Hand reconstruction for patients with Apert syndrome is a critical step in comprehensive care and enables this population to gain significant hand function. Digit separation for Apert syndrome, as described in most algorithms, is finalized using local flaps and full-thickness skin grafts. The objective of this study is to report our experience using local flaps and partial-thickness skin grafts after digit separation for Apert hand reconstruction. An observational retrospective study was performed with Apert patients whose hands were reconstructed between January 2007 and July 2019 using local flaps and partial-thickness skin grafts after digit separation. Demographic data and outcome data were verified and recorded. Out of a total of 75 Apert patients who underwent hand reconstruction, 12 underwent hand reconstruction utilizing local flaps and partial-thickness skin grafts. The average patient age at the time of the first procedure was 1.9 years. These 12 patients were stratified according to Upton hand severity, 3 being type I (25%), 3 being type II (25%) and 6 being type III (50%). Mean follow up provided to all patients in this study was 1.8 years and donor site-related complications were seen in 2 patients (16.6%). No flexion scar contracture was observed in any of the patients who received partial-thickness skin grafts. The use of local flaps along with partial-thickness skin grafts to finalize digit separation for patients with Apert syndrome is an effective technique that reduces donor site morbidity and does not result in flexion scar contracture.

Dorsal Metacarpal Artery Flap: An Underrated Workhorse Flap for Reconstruction of Dorsal Finger Defects

The dorsal metacarpal artery (DMCA) flap is a versatile option in the armamentarium of the reconstructive hand surgeon, especially for resurfacing dorsal finger defects where the flap options are limited. The flap fulfills most of the reconstructive principles such as “to replace like with like” and is simple, reliable, and easy to harvest with minimal donor site morbidity. In this report, we discuss the case of a 37-year-old male patient who presented with a partially healed wound over the right middle finger. Several variations of the DMCA flap have been described in the literature, and these are briefly described here along with their applications and vascular basis.

Improving Outcome Collection Following International Surgery Trips: A Proof of Concept From a Pediatric Hand Reconstruction Trip to Peru

BACKGROUND: Plastic surgeons frequently participate in international surgical trips. This model of care is often criticized due to a lack of postoperative follow-up, which limits outcome measurement and decreases surgeon accountability. This study assessed the efficacy of collecting outcomes from international pediatric patient parents using the social media application “WhatsApp.” METHODS: All patients in this study were operated on during a pediatric hand surgery trip to Lima, Peru, in May 2019. All parents of patients receiving surgery were invited to participate in the study. General follow-up and a satisfaction survey utilizing a Likert scale (1–5) was sent to patient providers through WhatsApp at 3- and 6-week intervals. RESULTS: Forty-five patient providers agreed to participate in this study. Eighty percent (36/45) responded fully to surveys at 3-week postoperatively, and 51% (23/45) responded fully at 6 weeks. Patients reported high levels of satisfaction with the outcome of operations (4.3/5), attitude of the treatment team (4.6/5), and changes in quality of life (4.3/5), hand appearance (4.1/5), and hand function (4.1/5). Of those who responded at 3 weeks, 50% (17/34) sent postoperative photos, and 50% (17/34) had specific unanswered questions related to their care. Four patients had concerns of limited finger mobility (8.9%), 3 had continued contracture (6.7%), and 1 patient (2.2%) was rehospitalized following surgery for prolonged infection. CONCLUSION: The parents of international pediatric hand surgery patients had access and were responsive to provider communication through the WhatsApp application. Although most parents reported high levels of satisfaction, many still had unanswered questions related to their care, highlighting the importance of our postoperative follow-up. All plastic surgeons operating internationally should consider using WhatsApp and other related messaging tools for outcome collection and the improvement of patient care. Future studies will aim to establish a more standardized and robust model for this type of outcome collection.