Hand Center Recent Publications

This study examined how different causes of traumatic lower extremity injuries—such as car crashes, motorcycle collisions, blasts, crush injuries, and falls—affect surgical reconstruction outcomes in 251 patients treated at a Level I trauma center over 30 years. Researchers used statistical modeling to determine whether the type of injury independently predicted complications, need for additional surgery, or length of hospital stay. Motor vehicle collisions (MVCs) stood out as independently associated with nearly 17 additional days of hospitalization, even after accounting for injury severity and the type of reconstructive procedure used. Notably, high-energy injuries did not universally lead to worse outcomes, and crush injuries did not increase the risk of tissue death when reconstruction was appropriately timed, despite more frequently requiring complex free tissue transfer procedures. These findings suggest that injury mechanism alone is an insufficient predictor of surgical outcomes and that MVCs carry unique systemic burdens that demand greater clinical resources, which has important implications for trauma care planning and resource allocation.

This case report describes an unusual presentation of neuritis ossificans (NO), a rare condition in which abnormal bone-like calcium deposits form within a peripheral nerve, in a 70-year-old woman who developed progressive weakness and foot drop over eight years without any prior injury. Doctors used electrodiagnostic testing and advanced imaging to identify a large, calcified mass nearly 9 centimeters long that had grown around the common peroneal nerve — the nerve responsible for controlling foot movement — near the knee. During surgery, the hardened segment of nerve was carefully decompressed and a tissue sample was taken, which confirmed the diagnosis of NO under microscopic examination. Following surgery, the patient showed improvement in motor function and continued rehabilitation. This case underscores the importance of considering rare diagnoses like NO in patients with unexplained, slowly worsening nerve problems, and highlights that delayed diagnosis can lead to serious and potentially preventable neurological damage.

Peripheral nerve injuries often require surgical repair, and when the nerve gap is too large for direct reconnection, surgeons use autografts — sections of nerve taken from elsewhere in the body — though these typically produce worse outcomes than direct repair. This study investigated whether polyethylene glycol (PEG), a chemical that helps preserve nerve fibers by preventing the natural breakdown process called Wallerian degeneration, could improve recovery when used in autograft repairs compared to direct nerve repair. Researchers analyzed prospectively collected data from 48 patients who underwent PEG-assisted nerve repair — 42 direct repairs and 6 autograft repairs — tracking sensory recovery over 100 days using a standardized grading scale. Surprisingly, patients who received PEG-assisted autograft repairs showed significantly better sensory recovery scores than those who received PEG-assisted direct repairs, suggesting that PEG may be especially beneficial in the more challenging autograft setting. While the small sample size limits firm conclusions, this represents the first human study comparing these two PEG-assisted techniques and highlights a promising direction for improving outcomes in patients with serious peripheral nerve injuries.

Pyogenic flexor tenosynovitis (PFT) is a serious bacterial infection occurring within the closed tendon sheath spaces of the hand that can lead to significant long-term stiffness and disability if not properly managed. The study reviewed the recognition, diagnosis, and treatment of PFT, emphasizing that early identification through physical examination findings—when assessed together rather than individually—is key to distinguishing it from other finger infections. Notably, standard laboratory markers of inflammation are often normal in early-stage PFT, making them less reliable for diagnosis, while imaging tools like X-ray, ultrasound, and CT scans have not yet been established as routine diagnostic methods. When the condition is caught early, antibiotic treatment alone can be sufficient to resolve the infection without the need for surgery. The findings highlight that prompt diagnosis and early rehabilitation, including hand therapy and movement exercises, are critical to minimizing lasting complications such as joint contracture and reduced finger mobility.

This study examined how the racial, ethnic, and gender makeup of plastic surgery trainees changed between 2017 and 2023, comparing these trends to five other medical specialties using national application and residency data. Researchers found that women made significant gains in plastic surgery, rising from about one-third to nearly half of all applicants, and plastic surgery outpaced most peer specialties in this growth, ultimately achieving gender parity among residents. While the share of Black residents increased modestly, it remained low relative to the general population, and Hispanic residents actually declined as a proportion of trainees despite a sharp rise in Hispanic applicants—a troubling gap between interest and acceptance. These patterns were seen across both surgical and non-surgical fields, suggesting that the problem is not unique to plastic surgery but reflects broader structural barriers in medical training pipelines. The findings highlight that simply attracting a more diverse applicant pool is not enough; systemic changes in the selection and training process are needed to translate applicant diversity into a truly representative physician workforce.

Peripheral nerve injuries affecting the brachial plexus and upper and lower extremities remain among the most difficult conditions to treat in reconstructive surgery, with unpredictable outcomes and limited high-quality evidence to guide care. Surgeons currently rely on patient history, physical exams, electrodiagnostic testing, imaging, and sometimes exploratory surgery to assess injury severity and decide whether to intervene operationally or allow natural recovery. A major challenge is that outcome measures—such as muscle grading and sensory tests—are subjective and inconsistent across observers and institutions, making it hard to compare results or build reliable evidence. This review identifies critical gaps in diagnosis, intraoperative assessment, and outcomes measurement, and calls for multicenter collaborative research using standardized criteria and patient-reported outcomes to generate more reliable clinical evidence. The authors argue that aligning research efforts across institutions, while advancing imaging and biomaterial technologies, is essential to improving functional recovery and bridging the gap between surgical innovation and real-world patient outcomes.

This pilot randomized clinical trial investigated whether polyethylene glycol (PEG), a compound that helps fuse damaged nerve fibers together, could improve recovery after severe peripheral nerve injuries of the hand and forearm. Thirteen patients with complete nerve injuries (Sunderland Grade V) to either the median or ulnar nerve were randomly assigned to receive either standard nerve repair surgery or PEG-assisted nerve repair, then followed for over a year using standardized tests of sensation, muscle strength, pain, and hand function. Within the first 22 days after surgery, patients in the PEG group showed meaningfully better sensory and motor recovery compared to those who received standard repair, and they also reported less pain. Across all follow-up visits, PEG-treated patients consistently scored higher on both clinical measures of nerve function and patient-reported quality of life assessments. These early findings suggest that PEG-mediated axonal fusion may accelerate and improve functional recovery after serious peripheral nerve injuries, though larger trials are needed to confirm these results.

This study examined a surgical procedure called extensor carpi ulnaris (ECU) to extensor carpi radialis brevis (ECRB) tendon transfer as a treatment for spastic wrist flexion deformity in children with cerebral palsy, a condition where the wrist becomes chronically bent inward and weakens grip. Researchers retrospectively reviewed outcomes from 26 wrists in 24 pediatric patients who underwent this procedure, evaluating wrist position, range of motion, grip strength, and the need for any follow-up surgeries. After the operation, 85% of wrists achieved extension beyond a neutral position, averaging 28 degrees of extension, and 81% of patients reported improved grip. The procedure was designed as an alternative to the more commonly used flexor carpi ulnaris transfer, which carries a higher risk of causing the wrist to bend too far in the opposite direction. These findings suggest that ECU to ECRB tendon transfer is a safe and reliable option for improving wrist function and appearance in children with spastic cerebral palsy, with a relatively low rate of serious complications.