Advertise on podcast: Plastics in Practice (Resident Review)

https://plasticsinpractice.com/ Penile reconstruction requires separate plans for coverage, urination, sensation and rigidity. The remaining anatomy and the patient's goals determine which components are needed. In this episode of Plastics in Practice, we review reconstruction after penile tissue loss and gender-affirming options, connecting native tissue preservation, flap selection, urethral design and staged functional goals. Key takeaways: • Define the remaining skin, urethra, erectile tissue and neurovascular structures before selecting reconstruction. • Preserve viable native tissue when possible; suitable acute amputations need urgent assessment for replantation, while selected skin defects may be managed with grafted coverage. • Distinguish metoidioplasty using native erectile tissue from flap phalloplasty, and balance donor-site thickness, blood supply, sensation and morbidity. • Make urethral lengthening an explicit decision. A new urinary channel can develop fistula or stricture even when the outer shaft is viable. • Nerve coaptation can support sensory recovery, but sensation varies and is not guaranteed. • Plan rigidity separately: a soft tissue flap does not recreate native erectile bodies, and later erectile devices add implant risks and possible revision. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts: https://podcasts.apple.com/us/podcast/penile-reconstruction-match-anatomy-to-function/id1835564216?i=1000796954678 Amazon Music: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/0bf9d760-c85b-403a-87b3-5638ceee0955/plastics-in-practice-resident-review-penile-reconstruction-match-anatomy-to-function YouTube podcast: https://youtu.be/Dwmb-Xq5UdA YouTube explainer: https://youtu.be/3qJZa2k9QdM YouTube Short: https://www.youtube.com/shorts/-LEFNI7otic Instagram account: https://www.instagram.com/plasticsinpractice/ #PenileReconstruction #Phalloplasty #Metoidioplasty #ReconstructiveUrology #PlasticSurgeryEducation References: 1. European Association of Urology. EAU Guidelines on Urological Trauma. https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines 2. Oregon Health and Science University. Phalloplasty and Metoidioplasty. https://www.ohsu.edu/transgender-health/phalloplasty-and-metoidioplasty 3. Johns Hopkins Medicine. Phalloplasty for Gender Affirmation. https://www.hopkinsmedicine.org/health/expert-qa/phalloplasty-for-gender-affirmation 4. European Association of Urology. EAU Guidelines on Urethral Strictures: Disease Management in Transgender Patients. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-transgender-patients

https://plasticsinpractice.com/ Rheumatoid arthritis can threaten tendons, destabilize joints and change the mechanics of the whole hand. Reconstructive planning begins with the cause of lost function. In this episode of Plastics in Practice, we review the rheumatoid hand, from the inflammatory-arthritis differential and deformity mechanisms to tendon rupture, joint reconstruction and perioperative planning. Key takeaways: • Distinguish rheumatoid arthritis from other inflammatory and degenerative conditions using the clinical pattern, systemic findings and imaging. • Synovitis can weaken joint restraints and damage tendons; the visible finger posture may reflect a deforming force elsewhere in the hand or wrist. • Separate flexible, reducible deformity with preserved joint surfaces from fixed deformity with advanced destruction before choosing reconstruction. • New extension loss warrants prompt assessment. Distinguish tendon rupture from tendon subluxation or nerve dysfunction, and address the attritional source when reconstructing a rupture. • Silicone MCP arthroplasty can improve alignment and patient-reported function without necessarily improving grip or pinch strength. • Balance the pain, stability and motion goals of wrist reconstruction, and coordinate disease control, medications and perioperative assessment with rheumatology and anesthesia. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts episode: https://podcasts.apple.com/us/podcast/rheumatoid-arthritis-when-finger-extension-fails/id1835564216?i=1000796831957 Amazon Music episode: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/bb0a03d5-477e-467e-bad9-90fb4dd8837a/plastics-in-practice-resident-review-rheumatoid-arthritis-when-finger-extension-fails YouTube explainer (recorded human narration): https://www.youtube.com/watch?v=S3Q4n9qksLY Related YouTube Short: https://www.youtube.com/shorts/hLtLn0a5pgg Instagram account: https://www.instagram.com/plasticsinpractice/ #RheumatoidArthritis #HandSurgery #TendonReconstruction #RheumatoidHand #PlasticSurgeryEducation References: 1. American Society for Surgery of the Hand. Rheumatoid Arthritis. https://assh.my.site.com/handcare/condition/rheumatoid-arthritis 2. McIntyre et al. Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome. 2024. https://doi.org/10.1055/s-0043-1775994 3. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study. https://pmc.ncbi.nlm.nih.gov/articles/PMC4852048/ 4. Seven-Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis Prospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/27696739/ 5. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. https://pmc.ncbi.nlm.nih.gov/articles/PMC9273041/ 6. 2022 ACR/AAHKS Perioperative Guideline (elective hip and knee arthroplasty scope). https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.42140

https://plasticsinpractice.com/ After upper-limb amputation, a surviving nerve can still carry a useful command. TMR gives that signal a new muscle target. In this episode of Plastics in Practice, we review how targeted muscle reinnervation supports prosthetic control and helps address nerve-related postamputation pain. Key takeaways: • Define the goal before choosing transfers: nerve-related pain, prosthetic control, or both. • TMR connects a residual nerve to a motor branch supplying viable, functionally expendable muscle. • For motor control, the reinnervated muscle amplifies an intended movement into a signal that surface electrodes can detect. • Preserve useful native muscle and existing control sites when planning new targets. • Neuroma-related residual-limb pain and phantom limb pain can coexist and need separate assessment. • TMR can help reduce nerve-related postamputation pain, but relief is not guaranteed. Pain-directed surgery need not depend on prosthesis use. • Coordinate surgery, socket fitting and rehabilitation. Better motor signals do not automatically restore sensation. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Editorial clarification at approximately 13:55: The French prospective series compared preemptive TMR with conventional treatment at primary amputation (neuroma burial or simple neurectomy), not with delayed TMR. Mathieu et al., 2025, PMID 39853391: https://pubmed.ncbi.nlm.nih.gov/39853391/ YouTube Short: https://youtube.com/shorts/Vc_3CT2Ysc0 Full video explainer: https://www.youtube.com/watch?v=sUN2KmZDnzA Instagram account: https://www.instagram.com/plasticsinpractice/ #TargetedMuscleReinnervation #PeripheralNerveSurgery #UpperLimbAmputation #ProstheticRehabilitation #PlasticSurgeryEducation References: 1. Eberlin et al. A Consensus Approach for Targeted Muscle Reinnervation in Amputees. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10079335/ 2. Dumanian et al. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. 2019. https://pubmed.ncbi.nlm.nih.gov/30371518/ 3. Stubblefield et al. Occupational therapy protocol for amputees with targeted muscle reinnervation. 2009. https://pmc.ncbi.nlm.nih.gov/articles/PMC3031096/

https://plasticsinpractice.com/ A visible hand difference does not tell you which operation, if any, will improve function. In this episode of Plastics in Practice, we review how examination guides syndactyly timing, thumb duplication reconstruction and camptodactyly treatment. Key takeaways: • Observe reach, grasp and thumb use, then examine the whole limb and look for associated findings. • Describe syndactyly by the digits involved and whether the connection is soft tissue alone or includes bone. • A longer finger joined to a shorter neighbor can become tethered during growth. The anatomy helps determine when separation is needed. • Adjacent-web releases are generally staged to protect the intervening digit’s blood supply. • Thumb duplication needs a plan for stability and tendon balance. Size alone does not determine which tissue is useful. • Test passive correction in camptodactyly. Mild, flexible contractures usually begin with stretching and splinting. • Reassess worsening contracture and functional loss. Surgery can add stiffness, and a residual bend may remain. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. YouTube Short: https://youtube.com/shorts/FtPgkLixl_0 YouTube Explainer: https://youtu.be/U5NRtCU7ZAg Instagram account: https://www.instagram.com/plasticsinpractice/ #CongenitalHand #Syndactyly #ThumbDuplication #Camptodactyly #HandSurgery References: 1. Seattle Children’s. Syndactyly. https://www.seattlechildrens.org/conditions/syndactyly/ 2. Children’s Hospital of Philadelphia. Thumb Duplication. https://www.chop.edu/conditions-diseases/thumb-duplication 3. Boston Children’s Hospital. Camptodactyly. https://www.childrenshospital.org/sites/default/files/2022-04/camptodactyly-factsheet.pdf

https://plasticsinpractice.com/ A closed burn wound can still leave a hand that barely moves. In this episode of Plastics in Practice, we review how to recognize threatened circulation, reassess burn depth, and protect hand function while the wound heals. Key takeaways: • After immediate trauma priorities, remove rings and assess circulation, sensation and movement. • Cool fingers, worsening sensation, delayed refill or deteriorating Doppler signals need urgent burn surgical assessment. Do not wait for pulse loss. • Reassess depth and healing progress; a potentially deep hand burn needs early specialist input. • Typical dorsal burns need wrist extension, knuckle flexion, straight interphalangeal joints and an open thumb web. Palmar injuries may need a different position. • Combine edema control with supervised movement when the wound and deeper structures permit; protect vulnerable grafts and tendons. • Follow finger flexion, extension and first web opening alongside wound closure. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. Apple Podcasts: https://podcasts.apple.com/us/podcast/management-of-the-burned-hand-preserve-function/id1835564216?i=1000795827856 Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/4efe33f7-ad92-4404-a609-1a9327ba513c/plastics-in-practice-resident-review-management-of-the-burned-hand-preserve-function YouTube Short: https://www.youtube.com/shorts/OUw3t8iLu-w YouTube Explainer: https://www.youtube.com/watch?v=ACCIT9VLjo8 Instagram account: https://www.instagram.com/plasticsinpractice/ #HandBurns #BurnCare #HandSurgery #BurnRehabilitation #PlasticsInPractice References: 1. American Burn Association. Guidelines for Burn Patient Referral. https://www.ameriburn.org/burn-care-team/resources/guidelines-for-burn-patient-referral 2. NSW Agency for Clinical Innovation. Escharotomy for burn patients: a guide for clinicians. 2025. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/162633/ACI-Escharotomy-for-Burn-Patients.pdf 3. NSW Agency for Clinical Innovation. Burn physiotherapy and occupational therapy: clinical practice guide. 2025. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0018/236151/ACI-Burn-physiotherapy-and-occupational-therapy-guide.pdf

https://plasticsinpractice.com/ Poor perfusion needs an explanation beyond the word spasm. In this episode of Plastics in Practice, we review how to distinguish reversible narrowing from structural and mechanical problems, recognize threatened perfusion, and match treatment to the cause. Key takeaways: • Raynaud attacks do not always show the complete white-blue-red sequence; interpret the history, examination and nailfold findings together. • Persistent pain, cold pallor, new sensory loss or tissue injury requires urgent assessment for threatened perfusion. • Consider proximal arterial disease, emboli and trauma-related ulnar injury rather than attributing every ischemic digit to spasm. • For systemic sclerosis-associated Raynaud, calcium channel blockers are first-line; consider PDE5 inhibitors and specialist IV iloprost for appropriate severe or refractory disease. • Do not combine nitrates, including topical nitrate, with PDE5 inhibitors because of serious hypotension risk. • Botulinum toxin has negative randomized trial results for routine SSc-Raynaud treatment; selected severe or refractory ulcer use and sympathectomy need specialist judgment and clear discussion of uncertainty. • In microsurgical compromise, inspect inflow, outflow and the whole pedicle; supportive measures must not delay correction of a mechanical problem. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience. YouTube Short: https://www.youtube.com/shorts/mKttuP9TwF4 YouTube explainer: https://www.youtube.com/watch?v=1JRVgx-zJC4 Apple: https://podcasts.apple.com/us/podcast/management-of-vasoconstriction-look-beyond-spasm/id1835564216?i=1000795187132 Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/2e14ba0e-7529-4f03-bba5-8378691e40e6/plastics-in-practice-resident-review-management-of-vasoconstriction-look-beyond-spasm Instagram account: https://www.instagram.com/plasticsinpractice/ #RaynaudPhenomenon #DigitalIschemia #Microsurgery #HandSurgery #PlasticsInPractice References: 1. Maverakis et al. International consensus criteria for the diagnosis of Raynaud’s phenomenon. https://pmc.ncbi.nlm.nih.gov/articles/PMC4018202/ 2. EULAR recommendations for the treatment of systemic sclerosis: 2023 update. https://ard.bmj.com/content/early/2024/10/17/ard-2024-226430 3. British Society for Rheumatology guideline for management of systemic sclerosis, 2024. https://academic.oup.com/rheumatology/article/63/11/2956/7750184 4. Senet et al. Botulinum toxin versus placebo for SSc-associated Raynaud phenomenon. https://pubmed.ncbi.nlm.nih.gov/36066501/ 5. World Scleroderma Foundation recommendations for local management of digital ulcers, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12084219/

https://plasticsinpractice.com/ A small, painless hand mass can still need a carefully planned diagnosis before excision. In this episode of Plastics in Practice, we review how imaging and biopsy planning help clarify an unexplained hand mass while protecting later treatment options and hand function. Key takeaways: • Most hand masses are benign, but small size and lack of pain do not exclude sarcoma. • An enlarging, firm, deep or otherwise unexplained mass deserves further assessment rather than an assumed benign diagnosis. • Ultrasound can help distinguish cystic from solid tissue; that distinction alone is not a cancer test. • MRI can define a suspicious lesion’s extent and its relationship to tendons, nerves and vessels. • Involve the team that would treat a sarcoma before biopsy or excision of a suspicious mass. • Plan the biopsy route with definitive surgery in mind. Unplanned dissection can enlarge the later treatment field and put functional structures at risk. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. YouTube explainer: https://www.youtube.com/watch?v=getLckvMB0M Instagram account: https://www.instagram.com/plasticsinpractice/ #HandTumors #HandSurgery #Sarcoma #BiopsyPlanning #PlasticsInPractice References: 1. European Society of Musculoskeletal Radiology. Soft tissue tumor imaging in adults: guidelines 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC11213759/ 2. British Sarcoma Group. UK guidelines for the management of soft tissue sarcomas. https://pmc.ncbi.nlm.nih.gov/articles/PMC11724041/ 3. Early Complications of Planned Resection Versus Unplanned Excision of Sarcomas in the Distal Upper Extremity. 2024. https://pubmed.ncbi.nlm.nih.gov/39166192/

https://plasticsinpractice.com/ A fascial cord can tether the finger, but releasing it does not resolve every part of the deformity. In this episode of Plastics in Practice, we review assessment of Dupuytren’s disease, secondary joint stiffness, altered neurovascular anatomy, and treatment choices that balance correction, recovery and recurrence. Key takeaways: • Dupuytren’s affects the palmar and digital fascia. The cord is diseased fascia, not a shortened flexor tendon. • Start with function. Consider the patient’s priorities, joint stiffness and perioperative risks before choosing treatment. • Longstanding proximal interphalangeal deformity can leave secondary stiffness after cord release. Full straightening is not guaranteed. • A spiral cord can draw the digital neurovascular bundle toward the finger’s midline and closer to the skin. Anticipate altered anatomy. • Needle fasciotomy divides a cord, collagenase weakens it, and limited fasciectomy removes diseased fascia. Balance recovery demands, risks and durability with the patient’s priorities. • Treatment addresses contracture without eliminating the tendency to form disease. Counsel about recurrence, rehabilitation and useful hand function. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. 🎧 Explore this episode: Instagram account: https://www.instagram.com/plasticsinpractice/ YouTube explainer: https://youtube.com/watch?v=VpB79uxvhXc YouTube Short: https://youtube.com/shorts/btGTqCDy3EE #DupuytrensDisease #HandSurgery #HandAnatomy #PlasticSurgeryEducation #PlasticsInPractice References: 1. American Academy of Orthopaedic Surgeons. Dupuytren’s Disease. OrthoInfo. https://www.orthoinfo.org/diseases--conditions/dupuytrens-disease/ 2. Macey and Thomas. The Serpentine Zone: A Surgeon’s Guide to the Surface Anatomy of the Digital Neurovascular Spiral in Dupuytren’s Contracture. 2018. https://pubmed.ncbi.nlm.nih.gov/29706740/ 3. Misra et al. Predicting the outcome of surgery for the proximal interphalangeal joint in Dupuytren’s disease. 2007. https://pubmed.ncbi.nlm.nih.gov/17275601/ 4. Räisänen et al. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture: A Randomized Controlled Trial. 2024. https://pubmed.ncbi.nlm.nih.gov/38346307/ 5. Dias et al. Collagenase Injection versus Limited Fasciectomy for Dupuytren’s Contracture. 2024. https://www.nejm.org/doi/abs/10.1056/NEJMoa2312631 6. XIAFLEX U.S. prescribing information. Revised March 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=805cecd0-fd1f-11dd-87af-0800200c9a66

https://plasticsinpractice.com/ Rebuilding a thumb means restoring useful pinch and grasp. Length is only part of the problem. In this episode of Plastics in Practice, we review functional assessment, sensate coverage, and reconstruction choices after thumb tissue loss or amputation. Key takeaways: • Restore useful pinch and grasp. Assess length, stability, motion and sensation alongside the carpometacarpal joint, thenar function, first web space and remaining fingers. • An acute thumb amputation needs urgent specialist replantation assessment. Feasibility, injury pattern and patient priorities guide the decision. • Distinguish coverage needs from missing structural components. Skin coverage alone cannot replace lost bone, tendon, nerve or joint function. • Durable sensate pulp matters. A Moberg flap can cover selected distal palmar defects, but its reach is limited and joint motion must be considered. • Toe transfer and pollicization offer options for selected major losses. Selection depends on the remaining hand, donor effects and the patient’s goals. • Plan for rehabilitation and the tasks that matter to the patient. Thumb length, appearance and survival do not by themselves guarantee useful function. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. 🎧 Explore this episode: Instagram account: https://www.instagram.com/plasticsinpractice/ Apple: https://podcasts.apple.com/us/podcast/thumb-reconstruction/id1835564216?i=1000793038307 YouTube: https://youtu.be/zSBh7AqWxDo Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/3a0799b8-467e-4c02-a881-ea1a45079e83/plastics-in-practice-resident-review-thumb-reconstruction #ThumbReconstruction #HandSurgery #Microsurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. British Society for Surgery of the Hand. Revascularisation/Replantation trauma standard. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/6%20Revascularisation%20final.pdf 2. Baumeister et al. Functional outcome after the Moberg advancement flap in the thumb. 2002. https://pubmed.ncbi.nlm.nih.gov/11810623/ 3. Jindal et al. Cadaveric Study of a Z-Plasty Modification to the Moberg Flap for Increased Advancement and Decreased Morbidity. 2016. https://pubmed.ncbi.nlm.nih.gov/26910670/ 4. Wei et al. Microsurgical thumb reconstruction with toe transfer: selection of various techniques. 1994. https://pubmed.ncbi.nlm.nih.gov/8310027/ 5. Preisser and Partecke. Comparison of functional results after reconstruction of the thumb. 2003. https://pubmed.ncbi.nlm.nih.gov/12772058/

https://plasticsinpractice.com/ A surviving replant is only the beginning. The goal is a hand that can feel, move, and serve the patient’s needs. In this episode of Plastics in Practice, we review patient selection, preservation, injury assessment, reconstruction, monitoring, and rehabilitation after upper-extremity amputation. Key takeaways: • Useful function is the goal. Consider sensation, motion, pain, hand demands, and rehabilitation alongside the likelihood of survival. • Stabilize the patient and seek early specialist assessment. Preserve a detached part in saline-moistened gauze inside a sealed waterproof bag cooled in ice water; prevent direct tissue contact with ice or water. • Thumb loss, multiple-digit loss, and amputations in children merit careful replantation consideration. The final decision remains individualized. • Crush and avulsion can extend vessel injury beyond the visible wound. Debride to healthy tissue and plan a tension-free repair or an appropriate graft. • Arterial inflow and venous drainage are both necessary. A pale, cool digit with delayed refill or a swollen, blue digit with brisk refill needs urgent assessment by the replant team. • Protect the reconstruction while planning hand therapy. Survival, useful motion, sensory recovery, and return to activity are separate outcomes. This content is for educational purposes only and is not medical advice. The podcast audio is generated with Google NotebookLM using AI voices. The accompanying Short and explainer use recorded human narration and original AI-assisted teaching animations and anatomical illustrations. These visuals are educational reconstructions, not patient footage. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #Replantation #Microsurgery #HandTrauma #HandSurgery #UpperExtremity #PlasticSurgeryEducation #PlasticsInPractice References: 1. American Society for Surgery of the Hand. Arm, Hand and Finger Replantation. https://assh.my.site.com/handcare/condition/hand-arm-finger-replantation 2. British Society for Surgery of the Hand and GIRFT. Amputations pathway. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/girft/girft-amputations.pdf 3. American Academy of Orthopaedic Surgeons. Replantation. https://www.orthoinfo.org/treatment/replantation 4. Chung KC et al. Patient-Reported and Functional Outcomes After Revision Amputation and Replantation of Digit Amputations: The FRANCHISE Multicenter International Retrospective Cohort Study. JAMA Surg. 2019. doi:10.1001/jamasurg.2019.0418 5. Lee ZH et al. Survival after digit replantation and revascularization is not affected by the use of interpositional grafts during arterial repair. Plast Reconstr Surg. 2019. doi:10.1097/PRS.0000000000005343

https://plasticsinpractice.com/ A mangled upper extremity can look unsalvageable before resuscitation, perfusion, and debridement reveal what function remains. In this episode of Plastics in Practice, we build a practical limb-salvage sequence—from life-threatening priorities and early antibiotics to revascularization, compartment assessment, reconstruction, and rehabilitation. Key takeaways: • Put life before limb. Complete trauma resuscitation, control hemorrhage, and document perfusion, motor function, and sensation before committing to salvage or amputation. • A MESS of seven is a risk signal, not an upper-extremity amputation verdict. A 2024 meta-analysis suggested that at least one in five patients above the included studies’ MESS amputation thresholds underwent limb salvage.[1] • For an open long-bone fracture within BOAST's scope, give intravenous prophylactic antibiotics as soon as possible, ideally within one hour of injury. Hand, wrist, and digit injuries are outside this BOAST’s scope and may be managed locally using similar principles.[2] • If the limb is ischemic, restore flow as soon as possible. When timely definitive vascular repair is not feasible because of patient physiology or skeletal instability, a temporary vascular shunt can rapidly restore perfusion while stabilization proceeds.[6] • In adults with traumatic extremity injury, on repeated or continuous monitoring, delta pressure equals diastolic blood pressure minus intracompartmental pressure. A value above thirty millimeters of mercury may assist in ruling out acute compartment syndrome; thirty or less is concerning but not diagnostic and must be integrated with serial examination.[3] • Functional salvage requires meticulous debridement, stable bone, vascular repair, coordinated tendon and nerve reconstruction, durable soft-tissue coverage, and rehabilitation planned from the beginning.[4,5] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #MangledUpperExtremity #LimbSalvage #OpenFracture #Revascularization #CompartmentSyndrome #HandTrauma #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Yoneda H, Takeda S, Saeki M, et al. Utility of severity scoring systems for mangled upper limb salvage: a systematic review and meta-analysis. Injury. 2024;55(4):111447. doi:10.1016/j.injury.2024.111447 2. British Orthopaedic Association. BOAST - Open Fractures. Published December 2017. https://www.boa.ac.uk/resource/boast-4-pdf.html 3. American Academy of Orthopaedic Surgeons. Management of Acute Compartment Syndrome Evidence-Based Clinical Practice Guideline. 2025. https://www.aaos.org/acscpg2025 4. Macrì M, Pugliese P, Accardo G, et al. Current principles in the management of a mangled hand. J Hand Surg Glob Online. Published online August 21, 2024. doi:10.1016/j.jhsg.2024.07.009 5. Nayar SK, Alcock HMF, Edwards DS. Primary amputation versus limb salvage in upper limb major trauma: a systematic review. Eur J Orthop Surg Traumatol. 2022;32(3):395-403. doi:10.1007/s00590-021-03008-x 6. Wahlgren CM, Aylwin C, Davenport RA, et al. European Society for Vascular Surgery 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. Eur J Vasc Endovasc Surg. 2025;69(2):179-237. doi:10.1016/j.ejvs.2024.12.018

https://plasticsinpractice.com/ A normal-looking radiograph can hide a ligament injury that becomes stiffness, deformity, or arthritis if it is missed.In this episode of Plastics in Practice, we connect reduction, stability testing, imaging, early motion, and operative decision points across finger, thumb, carpal, and distal radioulnar joint injuries.Key takeaways:• Treat the PIP joint as a motion emergency: permanent stiffness can develop within about two weeks. After reduction, confirm congruity and stability, then begin early protected motion when the joint is stable.[1]• Use the thirty-fifty rule as a guide for dorsal PIP fracture-dislocations: less than thirty percent articular involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Clinical stability still overrides fragment size.[1]• Avoid axial traction during reduction of a dorsal finger MCP dislocation. Traction can pull the volar plate into the joint and convert a simple injury into an irreducible complex dislocation.• For a thumb UCL injury, no firm endpoint is the strongest red flag for a complete tear; angle thresholds vary. A Stener lesion places the adductor aponeurosis between the ligament and bone, blocking anatomic healing.[2,3]• A scapholunate gap around three millimeters or more, an angle above seventy degrees, or dorsal lunate tilt above fifteen degrees supports instability, but normal static films do not exclude a dynamic injury.[4]• On the lateral wrist radiograph, trace the radius, lunate, and capitate. Loss of collinearity plus median nerve symptoms is the perilunate warning pattern; outcomes are better when treatment begins within seven days than after delay.[5]This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #HandLigamentInjury #WristInstability #PIPJoint #SkierThumb #Scapholunate #Perilunate #HandSurgery #PlasticSurgeryEducation #PlasticsInPracticeReferences:1. Elfar J, Mann T. Fracture-dislocations of the proximal interphalangeal joint. J Am Acad Orthop Surg. 2013;21(2):88-98. doi:10.5435/JAAOS-21-02-882. Dean B, Rodrigues J, Riley N, et al. Guideline on managing thumb ulnar collateral ligament injuries: the British Society for Surgery of the Hand Evidence for Surgical Treatment findings and recommendations. J Hand Surg Eur Vol. 2024;49(10):1195-1201. doi:10.1177/175319342412746123. Qamhawi Z, Shah K, Kiernan G, et al. Diagnostic accuracy of ultrasound and magnetic resonance imaging in detecting Stener lesions of the thumb: systematic review and meta-analysis. J Hand Surg Eur Vol. 2021;46(9):946-953. doi:10.1177/17531934219930154. Dietrich TJ, Toms AP, Cerezal L, et al. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol. 2021;31(12):9446-9458. doi:10.1007/s00330-021-08073-85. van der Oest MJW, Duraku LS, Artan M, et al. Perilunate injury timing and treatment options: a systematic review. J Wrist Surg. 2022;11(2):164-176. doi:10.1055/s-0041-1735841

https://plasticsinpractice.com/ A tendon transfer can be perfectly woven and still fail if the joint is stiff, the tissue bed is scarred, or the donor cannot match the lost motion. In this episode of Plastics in Practice, we build a practical framework for tendon transfers—from donor selection and tensioning to radial, median, and ulnar nerve palsy reconstruction and postoperative retraining. Key takeaways: • Make the hand ready first: joints must be supple, and the transfer must glide through a quiet soft-tissue bed. A contracture release and tendon transfer require incompatible rehabilitation and should not be combined. • Match excursion and power: finger flexors provide about seventy millimeters of excursion, finger extensors fifty, and wrist motors thirty; a donor can lose up to one motor grade after transfer.[1,4] • Favor an expendable donor, a direct line of pull, synergistic motion, one donor for one function, and tension near the donor's working length.[1,4] • For high radial palsy, the classic FCR set restores wrist extension with PT to ECRB, finger MCP extension with FCR to EDC, and thumb extension with PL to a rerouted EPL. A fused wrist favors an FDS donor because tenodesis cannot supplement FCR excursion.[1,2] • Median palsy opponensplasty commonly uses FDS or EIP; the donor and pulley must recreate palmar abduction, flexion, and pronation rather than abduction alone.[3] • In ulnar palsy, a positive Bouvier test identifies simple clawing that may accept a static MCP block; a negative test signals complex clawing that needs dynamic intrinsic replacement. • Protect the transfer for four weeks, add passive stretching around week six, begin strengthening around week eight, and progress toward unrestricted activity at three months.[1] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #TendonTransfer #RadialNervePalsy #MedianNervePalsy #UlnarNervePalsy #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Gardenier J, Garg R, Mudgal C. Upper extremity tendon transfers: a brief review of history, common applications, and technical tips. Indian J Plast Surg. 2020;53(2):177-190. doi:10.1055/s-0040-1716456 2. Jain NS, Barr ML, Kim D, Jones NF. Tendon transfers, nerve grafts, and nerve transfers for isolated radial nerve palsy: a systematic review and analysis. Hand (N Y). 2024;19(3):343-351. doi:10.1177/15589447221150516 3. Coulshed N, Xu J, Graham D, Sivakumar B. Opponensplasty for nerve palsy: a systematic review. Hand (N Y). 2024;19(7):1037-1043. doi:10.1177/15589447231174481 4. Coulet B. Principles of tendon transfers. Hand Surg Rehabil. 2016;35(2):68-80. doi:10.1016/j.hansur.2015.12.011

https://plasticsinpractice.com/ Radial wrist pain, a locking digit, and lateral elbow pain can all be called overuse—but a few centimeters can change the diagnosis, treatment, and surgical target. In this episode of Plastics in Practice, we map de Quervain tenosynovitis, intersection syndrome, trigger finger, and lateral elbow tendinopathy from focused examination through splinting, injection, rehabilitation, and surgical release. Key takeaways: • Map radial-sided symptoms by location: de Quervain disease localizes at the radial styloid, while intersection syndrome produces dorsoradial pain and often crepitus four to six centimeters proximal to Lister tubercle. • De Quervain disease involves the APL and EPB in the first dorsal compartment; a separate EPB subcompartment can explain incomplete response after injection or release. • Current evidence supports considering corticosteroid injection plus three to four weeks of thumb-spica immobilization as first-line management for de Quervain disease; ultrasonography can help target anatomic subcompartments.[1,2] • Trigger finger localizes to the A1 pulley near the volar metacarpal head—even when the patient feels the click at the PIP joint. • Corticosteroid injection succeeds in roughly two thirds of trigger digits in pooled randomized trials; persistent locking, fixed contracture, or failed conservative care should prompt evaluation for A1 pulley release.[3] • Lateral epicondylitis is better framed as lateral elbow tendinopathy: confirm focal pain with grip or resisted wrist extension, consider radial tunnel symptoms, and avoid promising a rapid cure from any single intervention.[4] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #Tenosynovitis #TriggerFinger #DeQuervain #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Challoumas D, Ramasubbu R, Rooney E, et al. Management of de Quervain tenosynovitis: a systematic review and network meta-analysis. JAMA Netw Open. 2023;6(10):e2337001. doi:10.1001/jamanetworkopen.2023.37001 2. He KS, He KS, Cheah A, et al. Unblinding de Quervain: a systematic review of ultrasound-guided injection of corticosteroids for treatment of stenosing tenosynovitis of the first extensor compartment. J Med Radiat Sci. 2023;70(3):319-326. doi:10.1002/jmrs.681 3. Pathak SK, Salunke AA, Menon PH, et al. Corticosteroid injection for the treatment of trigger finger: a meta-analysis of randomised control trials. J Hand Surg Asian Pac Vol. 2022;27(1):89-97. doi:10.1142/S242483552250014X 4. Lowdon H, Chong HH, Dhingra M, et al. Comparison of interventions for lateral elbow tendinopathy: a systematic review and network meta-analysis for Patient-Rated Tennis Elbow Evaluation pain outcome. J Hand Surg Am. 2024;49(7):639-648. doi:10.1016/j.jhsa.2024.03.007

https://plasticsinpractice.com/ Extensor tendon injuries are easy to underestimate: a small dorsal wound can conceal a complete laceration, a contaminated MCP joint, or a central slip injury that declares itself later. In this episode of Plastics in Practice, we review the examination, zone-based repair strategy, rehabilitation, complications, and reconstruction of extensor tendon injuries. Key takeaways: • Use the eight-zone map to localize injury and choose a repair and rehabilitation plan; odd-numbered zones lie over joints. • Test beyond simple active extension: juncturae can mask a complete zone-six EDC laceration, the Elson test assesses the central slip, and table-top thumb lift helps isolate EPL function. • Repair lacerations involving more than half of the tendon in zone two, the zone-three central slip, and zone four; avoid unnecessary bulk or shortening in the thin distal mechanism. • Treat a zone-five fight bite as a contaminated joint injury—explore the capsule, debride and irrigate, and defer tendon repair until the wound is clean. • Match rehabilitation to repair strength: zones one and two usually need continuous extension protection for six to eight weeks, while stronger repairs in zones four through eight can support protected early motion. Recent randomized trials support relative-motion extension protocols for selected zone-four to zone-six repairs.[1,2] • Anticipate extensor lag, loss of flexion, adhesions, and tendon rupture; consider tenolysis only after a sustained therapy plateau and use grafts or tendon transfers selectively. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #ExtensorTendonSurgery #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #PlasticsInPractice References: 1. Cela-López M, Méndez-Pérez C, Domínguez-Prado DM, et al. Relative motion extension orthosis versus classic immobilization in extensor tendon repairs (zones IV-VI of the hand): a randomized controlled trial. Hand (N Y). Published online February 27, 2026. doi:10.1177/15589447261422483 2. Hirth MJ, Hunt I, Briody K, et al. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: a randomized equivalence trial. J Hand Ther. 2023;36(2):347-362. doi:10.1016/j.jht.2021.06.006