Abstract:
BACKGROUND: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. OBJECTIVE:To characterize and compare the clinical experience of academic plastic, orthopedic, and hand surgeons in addressing traumatic distal upper extremity injuries (using the Faculty Practice Solutions Center data set). METHODS:Annual data for CPT defined procedures related to traumatic injuries of the nail bed, finger, hand, wrist, and forearm performed by plastic, orthopedic, and hand surgeons during calendar years 2010 to 2013 were included in the study. RESULTS:From 2010 to 2013, the experience of fellowship-trained hand surgeons in treating traumatic distal upper extremity injuries was consistently greater than that of plastic surgeons and general orthopedic surgeons across all categories. Injuries of the nail bed were repaired more frequently by plastic surgeons than orthopedic surgeons (average 1.3 annual procedures per surgeon for plastic surgeons compared with 0.3 for orthopedic surgeons). Fractures and dislocations involving the phalanx and metacarpal were repaired equally by both groups, with plastic surgeons using predominantly percutaneous (38%) or open methods (45% of repairs), and orthopedic surgeons using mostly closed reduction (59% of repairs), splinting, and casting. Fractures and dislocations involving the carpal bones, radius, and ulna were more frequently repaired by orthopedic surgeons (average 23.2 procedures versus 2.6 for plastic surgeons), whereas tendon repairs in all segments were performed more frequently by plastic surgeons (average 13.7 procedures versus 2.5 for orthopedic surgeons). Replantation and repair of neurovascular injuries were exceedingly rare (less than 1 occurrence) in all groups for all years and are not specifically reported in Table 1. Similarly, incision and drainage procedures and decompressive fasciotomies of the distal upper extremity were uncommonly performed and also not included (Table 1 displays the mean annual procedures per surgeon by grouped CPT coded procedures, with overall averages displayed to the right. Figure 1 displays the proportions of intra-articular and extra-articular bony hand injuries treated by closed, open, and percutaneous methods by each specialty). CONCLUSIONS: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.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Dasari CR,Sandhu M,Wisner DH,Wong MSdoi
10.1097/SAP.0000000000000804subject
Has Abstractpub_date
2016-05-01 00:00:00pages
S162-4eissn
0148-7043issn
1536-3708journal_volume
76 Suppl 3pub_type
杂志文章abstract::Intraoperative navigation is a tool that provides surgeons with real-time, interactive access to their patient's diagnostic imaging studies while in the operating room. This modality allows for anatomic localization and facilitates intraoperative planning and diagnosis. The application of intraoperative navigation to ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31822a3ec3
更新日期:2012-09-01 00:00:00
abstract::This study was performed to determine the degree of shrinkage over time in nipple projection after reconstruction. Nipple-areolar reconstruction was performed using the modified Anton-Hartrampf technique, and pigmentation was achieved with tattooing. This study looked at 28 consecutive patients with nipple reconstruct...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199911000-00001
更新日期:1999-11-01 00:00:00
abstract::The pectoralis major is reliable for reconstruction of large defects in the head and neck area. In 2001, we introduced a muscle-sparing technique with preservation of the clavicular part of the muscle. So far, we did not report on its reliability and clinical outcome at the receptor site.Fifty-four pedicled segmental ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SAP.0b013e31818938bb
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Since obtaining FDA approval for postsurgical pain management in 2011, a number of well-designed studies have reported favorably on the safety and efficacy of liposomal bupivacaine (LB). However, the literature lacks adequate reports of patient perception of postoperative pain and subjective satisfaction. M...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000444
更新日期:2015-06-01 00:00:00
abstract::Soft tissue defects in the periolecranon region are difficult to manage by standard techniques such as closure by approximation, split-thickness skin grafting, or healing by secondary intention. We employed cadaver injections and dissections to study the vascular anatomy of the periolecranon region in search of a suit...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198504000-00010
更新日期:1985-04-01 00:00:00
abstract::The morphology of macrostomia and a method of myoplasty and commissuroplasty are described. The important operative considerations are accurate commissure positioning, muscle reconstruction, obliteration of the lateral subdermal groove, placement of a vermilion flap across the commissure, and Z-plasty of skin in the n...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198108000-00010
更新日期:1981-08-01 00:00:00
abstract::Thirty cases of constriction band syndrome diagnosed and treated with surgery at Ramathibodi Hospital, Bangkok, during 1973 to 1986 are reported. The incidence of this congenital anomaly could not be verified in this series because the number of cases was limited and the cause could not be concluded. The less frequent...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198811000-00017
更新日期:1988-11-01 00:00:00
abstract::Using an enzyme-linked immunosorbent assay, we investigated the amount of cell surface fibronectin and the amount released to the culture medium in human skin fibroblasts during successive cultivation. Cell surface fibronectin did not show a remarkable change in quantity through early and midpassage, but it decreased ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198503000-00010
更新日期:1985-03-01 00:00:00
abstract:PURPOSE:Little is known about professional burnout among plastic surgeons. Our purpose is to describe its prevalence among a large national sample of plastic surgeons and identify contributing factors. METHODS:A mailed, self-administered survey was sent to 708 plastic surgeons who were randomly sampled from the Americ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000056
更新日期:2014-03-01 00:00:00
abstract::Reconstruction of extensive, deep burns of the face is a challenging problem in plastic surgery. The authors report the use of tissue expanders placed in the upper chest for facial resurfacing after burn injuries in 4 patients. The expanders are hyperinflated. The flap is then advanced upward to resurface an aesthetic...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200045010-00001
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:The growth and acceptance of smartphones among clinicians has been remarkable over the last decade. Over 87% of doctors use a smartphone or tablet capable of running third-party software known as applications (apps). In the field of plastic surgery, apps have been designed for personal practice development, ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0000000000000792
更新日期:2016-01-01 00:00:00
abstract::Groin lymphoceles and lymphorrhea are a rare complication of medial thigh lift procedures. The author describes a case in which a very thin patient developed groin lymphorrhea after an uncomplicated medial thigh lift procedure. Initial treatment interventions, including edema control and the placement of a drain with ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200202000-00017
更新日期:2002-02-01 00:00:00
abstract::One important complication of tracheostomy procedure is the depressed scar left after the airway is removed. The problem is more challenging for the surgeon if tracheal tug accompanies. Six male patients with unaesthetic, depressed tracheostomy scars due to late removal of tracheostomy tubes after maxillofacial high-v...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000116246.16674.e5
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:In most children with a unilateral cleft lip (UCL), because lateral lip tissue on the cleft side is congenitally short, the lateral lip element should be appropriately excised during primary cheiloplasty so that symmetric nasolabial features are obtained after surgery. The purpose of this study was to measur...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002358
更新日期:2020-08-01 00:00:00
abstract::Prostaglandin E1 has been proven to be useful in the treatment of vascular diseases of the lower leg. Plastic surgeons have been aware of its usefulness in augmenting flap survival and have used it intraarterially or intravenously. We attempted to enhance the effect of prostaglandin E1 with heparin by local continuous...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199302000-00010
更新日期:1993-02-01 00:00:00
abstract::The thickness of the upper eyelid is a bothersome condition that can be alleviated by blepharoplasty in Asians. Preseptal fat lies widely deep to the orbicularis oculi in the lower part of the upper eyelid, and the retro-orbicularis oculus fat (ROOF) pad lies in the lateral supraorbital area. We demonstrate the effect...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000263094.74682.5f
更新日期:2008-02-01 00:00:00
abstract:PURPOSE:Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aim...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000173
更新日期:2014-05-01 00:00:00
abstract::The purpose of our retrospective study was to evaluate the outcomes of scaphoid fracture nonunion treated with a pronator quadratus pedicled vascularized bone graft and a headless compression screw with regard to early wrist and thumb mobilization. From January 2008 to June 2011, 27 patients (20 men and 7 women; mean ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000025
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Stromal vascular fraction (SVF) cells were used to increase the efficacy of a newly formed adipose tissue in a collagen gel in vitro. However, the outcome of the seeded cells in the collagen gel in vivo remains unknown. We traced the SVF cells in the host tissue and evaluated the efficacy of SVF for fat tiss...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000687
更新日期:2016-03-01 00:00:00
abstract::Twenty-nine fractures of the mandible were studied by standard radiographs and axial computed tomographic scans (hard copy). Independent reviewers analyzed each study in a blinded, non-paired fashion. When radiographic diagnostic sensitivities were compared on the basis of known surgical findings, the plain films were...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199208000-00002
更新日期:1992-08-01 00:00:00
abstract::Despite the advances in laser treatment of port wine stains (PWS), re-emergence of these lesions still occurs. We carried out a retrospective audit of all children that received laser treatment of PWS between 1997 and 2000 using the flashlamp-pumped dye laser with a 585-nm wavelength. Out of 110 patients treated, 15 r...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000221620.83178.fc
更新日期:2006-09-01 00:00:00
abstract::During a 56-month period, 1,348 patients with either basal cell or squamous cell carcinoma of the skin underwent microscopically controlled excision (Mohs' fresh-tissue technique) by a dermatologic surgeon. Of these 1,348 patients, 394 required various types of wound reconstruction by a plastic surgeon. The average di...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198508000-00003
更新日期:1985-08-01 00:00:00
abstract::Microsurgical free tissue transfer is playing a critical role in reconstruction of the soft tissue around the knee to salvage the limb, especially when the defects exist with a wide zone of injury or with a poor soft tissue condition, where local flaps are unavailable. For a successful free flap transfer, proper selec...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e31824e5e6e
更新日期:2013-10-01 00:00:00
abstract::Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0000000000001374
更新日期:2018-03-01 00:00:00
abstract::Traditional gastrocnemius flap harvest requires a long skin incision, starting from the popliteal fossa to the mid leg. The authors designed three instruments to facilitate harvest of this flap through a small incision without the help of an endoscope in 10 patients. All 10 gastrocnemius muscle flaps survived with a 1...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200108000-00005
更新日期:2001-08-01 00:00:00
abstract::The authors demonstrate successful cases of stepladder dorsal metacarpal V-Y advancement and rotation-advancement flaps for reconstructing defects on the dorsum of the finger and hand. One side of the flap is designed in a multilobed shape, and each lobed flap is designed on the dorsum of adjacent fingers. These flaps...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200201000-00007
更新日期:2002-01-01 00:00:00
abstract::The principles and techniques of gene transfer are presented. Common concepts are defined, and the frequently used transfer vectors are described herein. Several gene transfer applications are discussed briefly. Areas of particular interest to the plastic surgeon such as gene transfer to skin and wounds are included. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-199510000-00018
更新日期:1995-10-01 00:00:00
abstract::The authors describe a case of microvascular ear replantation with repair of the artery only and medicinal leech therapy that survived for 14 days but ultimately failed as a result of the absence of development of venous channels between the replant and the recipient bed. A 35-year-old man presented with complete avul...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200104000-00016
更新日期:2001-04-01 00:00:00
abstract::Ischemia/reperfusion injury (IRI) after free tissue transfer of the small intestine results in transmural tissue damage. This study examined the effects of IRI on the jejunum. Wistar rats served either as controls (N=10) or underwent clamping of the infrarenal aorta for 1 hour followed by 1 hour of reperfusion (N=10)....
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199806000-00008
更新日期:1998-06-01 00:00:00
abstract::The development of the external oblique rectus musculofascial turnover flap has recently received a great deal of attention. With this method, the upper part of the external oblique muscle is lifted off the lower thoracic wall along with a segment of the rectus muscle, pedicled in the sixth intercostal space and subse...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199101000-00015
更新日期:1991-01-01 00:00:00