Plastic Surgery: Volume 6: Hand and Upper Limb (Plastic Surgery, 6)

Any screen. Any time. Anywhere.\nPlastic\rSurgery\nCopyright\nContents\nVideo Contents\nLecture Video Contents\nPreface to the Fifth Edition\nList of Editors\nList of Contributors\nAcknowledgments\nDedication\n1\n	1  Anatomy and biomechanics of the hand\n		Introduction\n		Skin, subcutaneous tissue, and fascia\n		Bones and joints\n			Hand elements\n			The wrist\n			Joint motion\n			The thumb\n		Muscles and tendons\n			Extrinsic extensors (Video 1.1 )\n			Pronators and supinators\n			Extrinsic flexors (Video 1.3 )\n			The retinacular system\n			Intrinsic muscles (see Video 1.2 )\n		Blood supply\n		Peripheral nerves\n		Conclusion\n		References\n2\n	2  Examination of the upper extremity\n		Obtaining a patient history\n			Patient demographics\n			Current complaint\n			Medical history\n			Allergies and medications\n			Social history\n		Physical examination specific to the hand\n			Inspection\n				Discoloration\n				Deformity\n				Muscular atrophy\n				Trophic changes\n				Swelling\n				Skin creases\n			Palpation\n			Assessment of musculotendinous function\n				Posture\n				Motion\n				Power\n			Examination of the muscles of the hand\n				Examination of the extrinsic muscles\n					Flexor digitorum profundus muscle\n						Flexor profundus test (Video 2.1 )\n					Flexor digitorum superficialis muscle\n						Flexor sublimis test (Video 2.2 )\n					Flexor pollicis longus muscle\n						Milking test of the finger and thumb flexor tendons (Video 2.3 )\n					Extensor pollicis brevis and abductor pollicis longus muscles\n						Finkelstein test\n						Eichoff test (Video 2.5 )\n					Extensor carpi radialis longus and brevis muscles\n					Extensor pollicis longus muscle (Video 2.6 )\n					Extensor digitorum communis muscles (Video 2.7 )\n						Extrinsic tightness test\n					Extensor indicis proprius muscle\n					Extensor digiti minimi muscle\n					Extensor carpi ulnaris muscle\n				Examination of the intrinsic muscles\n					Thenar muscles (Video 2.8 )\n					Adductor pollicis muscle\n					Interosseous and lumbrical muscles (Video 2.9 )\n						Intrinsic tightness test (Bunnell)\n						Lumbrical-plus test\n					Hypothenar muscles\n			Assessment of stability\n				Scaphoid shift test (Watson) (Video 2.10 )\n				Finger extension test\n				Triquetrolunate ballottement test and the lunotriquetral shuck test\n				Distal radioulnar joint instability test\n				Ulnocarpal abutment test\n				The ulnar fovea sign (Video 2.11 )\n				Pisiform gliding test\n				Midcarpal instability test\n				Extensor carpi ulnaris synergy test\n			Assessment of peripheral nerves\n				Signs and tests for peripheral nerves\n					Tinel\'s sign\n					Phalen\'s test\n					Froment\'s test\n					Jeanne\'s sign\n					Wartenberg\'s sign\n					Other signs associated with ulnar nerve palsy\n				Tests for evaluating sensory nerve function\n					Two-point discrimination (2PD) test (Videos 2.12 and 2.13 )\n					Semmes–Weinstein monofilament test (Video 2.14 )\n					Moberg\'s pick-up test\n			Assessment of the vascular system\n				Allen\'s test (Video 2.15 )\n				Digital Allen\'s test (Video 2.16 )\n		Physical examination specific to the forearm\n			The interosseous membrane of the forearm (IOM)\n				Distal membranous portion\n				Middle ligamentous portion\n				Proximal membranous portion\n			Measurement of forearm rotation\n			Measurement of the muscle strength of the forearm\n				Supination\n				Pronation\n		Physical examinations specific to the elbow\n			Bony landmarks of the elbow\n			Ligaments of the elbow\n				Lateral ligament complex\n					Lateral ulnar collateral ligament\n					Radial collateral ligament\n					Annular ligament\n					Accessory collateral ligament\n				Medial collateral ligament complex\n			Instability of the elbow joint\n				Posterolateral rotatory instability\n					The pivot shift test\n				Measurement of malrotation of the distal humerus\n		Physical examination of thoracic outlet syndrome\n			Classification\n			Anatomy\n			Provocative maneuver\n				Adson test (Video 2.17 )\n				The neck tilting\n				The costoclavicular compression test\n				Wright test\n				Roos extended arm stress test (Video 2.18 )\n				Morley\'s test\n		Physical examination of the upper extremity in children\n		References\n3\n	3  Diagnostic imaging of the hand and wrist\n		Introduction\n		Historical perspective\n		Radiography\n			Evaluation of the hand\n			Special views in the hand\n			Pediatric hand radiographs\n			Wrist evaluation\n				Wrist evaluation in distal radius fractures\n		Ultrasonography\n			Introduction\n			Masses\n			Injuries and degenerative conditions\n			Compressive neuropathies\n			Disadvantages\n			Ultrasound at the bedside\n		Computed tomography\n			Fractures and dislocations\n			Other applications of CT\n		Magnetic resonance imaging\n			MRI basics\n			Clinical applications of MRI\n				MRI for soft-tissue masses\n				Ganglion cysts\n				Giant cell tumors of the tendon sheath (GCTTS)\n				Lipomas\n				Hemangiomas\n				Enchondromas\n				MRI for wrist and hand trauma\n				Occult scaphoid and carpal fractures\n				Ligamentous injuries of the hand and wrist\n					Thumb ulnar collateral ligament injuries\n					Scapholunate interosseous ligament injury\n				MRI for evaluating ulnar-sided wrist pain\n					TFCC tears\n					Ulnocarpal abutment\n					DRUJ instability and tendinopathies\n				MRI for evaluation of fracture nonunion\n				MRI for avascular necrosis (AVN) in scaphoid fracture non-union\n				Kienbock\'s disease\n				Osteomyelitis\n		Vascular imaging techniques for the upper extremity\n		Radionuclide imaging\n		Safety in fluoroscopy\n		Future directions – Artificial Intelligence in radiology and point of care imaging\n		References\n4\n	4  Anesthesia for upper extremity surgery\n		Introduction\n		Anatomy\n			Perineurial environment\n			Microneuroanatomy\n			Sonoanatomy\n		Pharmacology of local anesthetics\n			Pharmacokinetics\n			Toxicity\n			Vasoconstrictors\n			LA selection\n		Regional anesthesia techniques\n			Digital block\n			Wrist block\n			Intravenous regional anesthesia (Bier block)\n				Interscalene block\n			Supraclavicular block\n			Infraclavicular block\n			Axillary block\n		Wide-awake local anesthesia no tourniquet (WALANT)\n			Technique\n		Complications\n			Peripheral nerve injury\n			Local anesthetic toxicity\n			Vascular injury\n			Infection\n		Outcomes\n			Clinical outcomes and patient satisfaction\n			Operating room cost and efficiency\n		Special considerations\n			Cardiac patients\n			Pediatric patients\n		Perioperative pain management\n			Peripheral catheters\n			Preemptive analgesia\n			Chronic postoperative pain\n		References\n5\n	5  Principles of internal fixation\n		Introduction\n		Patient selection\n			Fracture considerations\n			Patient-­specific considerations\n		Preoperative imaging\n		Treatment/­surgical technique\n			Preoperative planning\n			Fracture reduction\n			Intraoperative imaging\n			Arthroscopy\n			Fixation principles\n				Absolute stability and interfragmentary compression\n				Relative stability\n			Methods of fixation\n				Kirschner wires\n				Tension band constructs\n				External fixation\n				Interfragmentary lag screws\n				Compression plating\n				Bridge plating\n				Locked plating\n		Postoperative care\n		Summary\n		References\n6\n	6  Nail and fingertip reconstruction\n		Introduction\n		Anatomy\n			Surface anatomy\n			Vascularity\n			Nerve supply\n			Physiology\n			Function\n		Acute injury\n			Epidemiology\n			Subungual hematoma\n				Treatment\n			Lacerations\n				Treatment\n				Postoperative care\n			Distal phalanx fractures\n				Initial evaluation\n				Treatment\n				Secondary procedures\n					Reconstruction\n			Nail ridge\n			Split nail\n				Treatment\n			Pterygium\n				Treatment\n			Nonadherence (onycholysis)\n				Treatment\n			Nail absence (anonychia)\n				Treatment\n			Cornified nail bed\n				Treatment\n			Nail spikes and cysts\n				Treatment\n			Hooked nail\n				Treatment\n			Eponychial deformities\n				Treatment\n			Hyponychial defects\n				Treatment\n			Pigmented lesions\n				Patient presentation\n			Subungual melanoma\n				Treatment\n			Pincer nail\n				Treatment\n		Reconstruction of fingertip injuries\n			Reconstructive principles\n			Flap selection\n			Skin grafting\n				Patient selection\n				Treatment: Local flaps\n					Volar V–­Y advancement (Atasoy, Kleinert)\n					Lateral V–­Y advancement flaps (Kutler)\n					Visor flap\n					Homodigital flaps\n						Reverse homodigital flap\n					Moberg flap\n					Heterodigital flaps\n						The cross-­finger flap\n						Thenar crease flap\n						Littler neurovascular island flap\n						Dorsal metacarpal artery flaps\n		Additional considerations\n			Completion amputation\n			Healing by secondary intention\n			Antibiotics\n		Summary\n		References\n7\n	7  Hand fractures and joint injuries\n		Introduction\n		Anatomy\n		Classification of fractures and dislocations\n		Fracture stabilization/­fixation and return to function\n		Pediatric fractures\n		Open fractures\n		Bone gaps\n		Diagnosis\n		Treatment: fingers\n			Phalangeal fractures and dislocations\n			DIP joint fractures and dislocations\n			Middle phalanx shaft fractures\n			PIP joint injuries\n			Middle phalanx base articular fractures\n				External fixation\n				Technique of external fixation\n				Internal fixation\n				Technique of HHRA (Video 7.2 )\n			Proximal phalanx head fractures\n				Technique of open reduction and internal fixation (ORIF) of unicondylar fractures\n			Proximal phalanx shaft and base fractures\n			MCP joint fractures and dislocations\n			Metacarpal fractures\n				Indications for operative treatment of metacarpal fractures\n				Metacarpal head fractures\n				Metacarpal neck fractures\n				Metacarpal shaft fractures\n				Multiple metacarpal fractures\n				Technique of ORIF of multiple metacarpal fractures\n			CMC dislocations/­fracture dislocations\n		Treatment: thumb\n			MCP joint injuries\n			Stener lesion\n			Surgical repair of an acute UCL tear\n			Reconstruction of chronic UCL tear with tendon graft\n			Thumb metacarpal fractures\n			Thumb CMC joint injuries\n			Pediatric fractures\n			Proximal phalanx neck fractures\n		Complications\n		Secondary procedures\n			Malunion correction\n			Non-­union correction\n		Hardware removal, tenolysis, capsulotomy\n		Future directions\n		References\n8\n	8  Fractures and dislocations of the wrist and distal radius\n		Introduction\n		Historical perspective\n		Basic science/­disease process\n			Anatomy\n			Biomechanics\n			Mechanisms of injury\n		Diagnosis/­patient presentation\n			History\n			Physical examination\n			Diagnostic tests\n		Patient selection\n		Treatment and surgical techniques\n			Scaphoid fractures\n			Scaphoid non-­union\n			Scapholunate ligament injury\n			Lunotriquetral ligament injury\n			Perilunate dislocation\n			Distal radius fractures\n			Ulnar styloid fractures\n		Future directions\n		References\n9\n	9  Flexor tendon injuries and reconstruction\n		Introduction\n		Historical perspective\n		Basic science\n			Anatomy\n			Flexor tendon healing\n			Biomechanics of tendon repairs and gliding\n		Diagnosis\n		Treatment/­surgical techniques\n			Primary and delayed primary repairs\n			Indications and contraindications\n			Anesthesia\n			Surgical techniques\n				Zone 1 injuries\n				Zone 2 injuries (Videos 9.1–­9.6)\n				Zone 3, 4, and 5 injuries\n				FPL injuries\n				Injuries in children\n				Partial tendon lacerations\n				Closed rupture of the flexor tendons and pulleys\n		Postoperative care\n			Duran–­Houser method\n			Early active motion\n			Author\'s preferred combined passive–­active method (Nantong regimen)\n			Delayed motion exercises\n		Outcomes, prognosis, and complications\n		Secondary procedures\n			Free tendon grafting\n				Indications and contraindications\n				Donor tendons\n				Operative techniques\n			Staged tendon reconstruction\n				Indications\n				Techniques\n					The first stage\n					The second stage\n			Tenolysis\n				Indications\n				Anesthesia\n				Operative techniques\n				Postoperative treatment\n		Future directions\n		References\n10\n	10  Extensor tendon injuries\n		Introduction\n		Historical perspective\n		Basic science/disease process\n			Anatomy of the extensor tendons\n				Extrinsic muscles\n				Intrinsic muscles\n			Functional anatomy\n				Linked chains\n				Functions of the intrinsic muscles\n				Extrinsic muscle function\n				Mechanisms of joint extension\n		Diagnosis/patient presentation\n			Elson test\n		Patient selection\n		Treatment/surgical technique\n			Suturing techniques\n			Zone I\n				The mallet finger\n				Open injuries\n				Chronic injuries\n			Zone II\n			Zone III (Video 10.1 )\n				Closed injuries\n				Open lacerations\n			Zone IV\n			Zone V\n				Human bite injuries\n				Sagittal band injuries\n			Zone VI\n			Zone VII\n			Zones VIII/IX\n		Postoperative care\n			Short arc motion\n			Dynamic splinting with passive extension\n			Relative motion splinting\n		Outcomes, prognosis, and complications\n			Outcomes\n			Complications\n		Secondary procedures\n			The mallet finger\n			The swan-neck deformity\n			The boutonnière deformity\n				Preoperative considerations\n				Tenotomy\n				Secondary reconstruction of the extensor tendon\n			Delayed sagittal band reconstruction (Video 10.2 )\n			The missing tendon: tendon transfers versus tendon grafting (Video 10.3 )\n			Soft-tissue management and staged reconstruction in combined injuries\n		Conclusion\n		Future directions\n		References\n11\n	11  Replantation\n		Introduction\n		Basic science/­disease process\n			Pathophysiology of ischemia and reperfusion\n			Historical perspective\n		Diagnosis/­patient presentation\n			Transportation\n			Replant centers\n		Patient selection\n			Indications and contraindications\n		Treatment/­surgical technique\n			Operative sequence\n			Bone fixation\n			Tendon repair\n			Artery repair\n			Vein repair\n			Nerve repair\n			Skin closure\n			Special circumstances\n				Thumb replantation\n				Multiple digits\n				Proximal amputations\n				Distal amputations\n				Ring avulsion injuries/­degloving injuries/­avulsion amputation\n				Ectopic transplantation\n				Pediatric replantation\n		Postoperative care\n			Anticoagulation\n			Postoperative monitoring\n			Postoperative therapy\n			Psychosocial aspects of replantation\n		Future directions\n		References\n12\n	12  Reconstructive surgery of the mutilated hand\n		Introduction\n		Goal of management of mutilated hand injury\n		Assessment of the mutilated hand\n		To salvage or not to salvage? Value of scoring and classification systems\n		Debridement\n		Envisioning the plan of reconstruction\n		Vascular reconstruction in the mutilated upper extremity\n		Stabilization of the skeleton\n		Soft-­tissue cover\n			Timing of soft-­tissue cover\n			The role of negative pressure wound therapy (NPWT) in a mutilated hand\n			Type of cover\n			Making the final choice\n				Pedicled groin flaps\n					Anatomy\n					Technique\n				Lower abdominal flaps\n					Anatomy\n					Technique\n				Pedicled radial forearm flap\n					Anatomy\n					Technique\n				Posterior interosseous reverse forearm flap\n					Anatomy\n					Technique\n				Lateral arm free flap\n					Anatomy\n					Technique\n				Anterolateral thigh free flap\n					Anatomy\n					Technique\n				Gracilis free flap (for cover and for function)\n					Anatomy\n					Technique\n		Major degloving injuries of the upper limb\n			Basic principles\n			Degloving injury of the hand\n				Degloving injury of the thumb\n				Degloving injury of the fingers\n			Degloving of the proximal upper limb\n			Muscle, tendon, and nerve repair\n			Total primary reconstruction vs. staged reconstruction\n			Secondary reconstruction\n				Secondary procedures on bones and joints\n				Coverage of large defects around the elbow\n				Free fibula transfer for long segment proximal bone defects\n					Anatomy\n					Technique\n				Secondary reconstruction of musculotendinous units\n			Restoration of motion at the elbow\n				Pedicled pectoralis major flap\n				Pedicled latissimus dorsi flap\n					Anatomy\n					Technique\n			Management of compartment loss\n				Free functioning muscle transfer (FFMT)\n			Nerve reconstruction\n			Secondary reconstruction of digital losses: toe transfers\n				Thumb reconstruction\n				Second toe for thumb reconstruction\n		Complications\n		References\n13\n	13  Thumb reconstruction: Non-­microsurgical techniques\n		Introduction\n		Historical perspective\n		Basic science/­disease process\n		Diagnosis/­patient presentation\n		Patient selection\n		Treatment/­surgical technique\n			Distal third\n			Middle third\n			Proximal third\n			Prosthetics\n		Postoperative care\n		Outcomes, prognosis, and complications\n			Secondary procedures\n		Future directions\n		References\n14\n	14  Thumb reconstruction: Microsurgical techniques\n		Introduction\n		Historical perspective\n		Diagnosis/patient presentation\n			The initial operation\n		Patient selection\n			Patient factors\n			Timing: primary versus secondary reconstruction\n			Injury factors\n				Decision-making for the thumb\n				Decision-making for fingers\n				Decision-making for the metacarpal hand\n		Treatment/surgical technique\n			General principles in vascular dissection\n			General principles in recipient preparation\n			General guidelines in donor closure\n			General principles in flap inset\n			Specific operations\n				Trimmed great toe (Video 14.1 )\n				Second toe: total and partial (Video 14.2 )\n				Third toe\n				Modified wraparound flaps: great and second toes\n				Neurosensory lateral great-toe pulp flaps\n				First-web neurosensory flap\n				Combined second- and third-toe transplantation (Video 14.3 )\n				Vascularized joint transfer for metacarpophalangeal joint reconstruction of the thumb\n		Postoperative care\n			Immediate postoperative period\n			Motor rehabilitation\n			Sensory rehabilitation\n		Outcomes, prognosis, and complications\n			Outcomes and prognosis\n				Range of motion\n				Strength assessment\n				Appearance and sensory outcomes\n				Donor site outcome evaluation\n			Complications\n		Secondary procedures\n		Debates in thumb reconstruction with toe-to-hand surgery\n		Future directions\n		References\n15\n	15  Infections of the hand\n		Introduction\n		Historical perspective\n		Basic science/­disease process\n			Causative organisms\n		Diagnosis/­patient presentation\n			Fingertip\n				Fingertip infections\n					Paronychia\n					Felon\n			Finger\n				Pyogenic flexor tenosynovitis\n			Hand\n				Deep space infections\n			Wrist/­forearm\n				Necrotizing soft-­tissue infection\n			Joints\n				Septic arthritis\n			Bone\n				Osteomyelitis\n			Atypical infections\n				Mycobacterial infections\n				Fungal infections\n			Mimics of infection\n				Gout\n				Pseudogout\n				Pyogenic granuloma\n				Pyoderma gangrenosum\n		Patient selection\n		Postoperative care\n		Outcomes, prognosis, and complications\n		Secondary procedures\n		Future directions\n		References\n16\n	16  Tumors of the hand\n		Introduction\n		Basic science/disease process\n		Diagnosis/patient presentation\n			Patient history\n			Physical examination\n			Laboratory studies\n			Imaging\n			Biopsy\n			Resection\n			Utility of multidisciplinary team approach\n		Treatment/surgical treatment by tissue of origin\n			Skin tumors\n				Cutaneous horn\n				Epidermal inclusion and sebaceous cysts\n				Verruca vulgaris\n				Nevi\n				Keratoacanthoma\n				Dermatofibroma\n				Seborrheic keratosis\n				Actinic keratosis\n				Basal cell carcinoma\n				Squamous cell carcinoma\n				Melanoma\n				Merkel cell carcinoma\n			Synovial lesions\n				Ganglion cysts\n				Giant cell tumor (pigmented villonodular synovitis)\n			Nerve tumors\n				Schwannoma/neurilemoma\n				Neurofibroma\n				Lipofibromatous hamartoma\n			Fat tumor: lipoma\n			Fibrous tissue lesions\n				Benign lesions\n				Sarcomas\n			Vascular lesions\n				Hemangioma\n				Vascular malformations\n				Glomus tumor\n				Pyogenic granuloma\n			Muscle lesions\n				Myositis ossificans\n				Osteoid osteoma\n				Leiomyoma\n				Rhabdomyosarcoma\n			Cartilage and bone tumors\n				Enchondroma\n				Osteochondroma\n				Solitary unicameral bone cyst\n				Aneurysmal bone cyst\n				Giant cell tumor of bone\n				Osteosarcoma\n				Chondrosarcoma\n				Staging and treatment of musculoskeletal sarcomas\n			Metastases\n		Postoperative care\n		Outcomes, prognosis, and complications\n		Future directions\n		References\n17\n	17  Dupuytren’s disease\n		Basic science and disease process\n			Heredity\n			Cellular and molecular processes\n				Genes and epigenetic modifications\n				Inflammation\n				Myofibroblasts, fibroblasts and extracellular matrix (ECM)\n		Surgical anatomy of the palmar fascia in the hand and fingers and involvement in Dupuytren’s disease\n		Clinical disease process\n		Clinical assessment\n			Differential diagnosis\n			Grading\n			Indications for treatment\n			Shared decision-making\n		Treatments\n			Early stage DD\n				Steroids\n				Radiotherapy\n			Late stage DD\n				Non-surgical\n					Collagenase clostridium histolyticum (CCH)\n				Surgical\n					Percutaneous needle fasciotomy (PNF)/needle aponeurotomy (NA)\n					Open fasciotomy\n					Fasciectomy\n						Skin\n						Fascia\n						Dermofasciectomy\n						Joints\n					Others\n						External fixation and distraction\n						Amputation\n		Rehabilitation\n		Outcome, prognosis, and complications\n			Repeated procedures\n			Complications\n				Collagenase (CCH)\n				Percutaneous needle fasciotomy (PNF)/needle aponeurotomy (NA)\n				Fasciectomy\n				Dermofasciectomy (DF)\n			Salvage surgery\n				Arthrodesis of the PIP joint\n				Amputation\n		Future directions\n		Acknowledgments\n		References\n18\n	18  Osteoarthritis in the hand and wrist\n		Introduction/epidemiology\n		Historical perspective\n		Basic science/disease process\n		Pathophysiology\n		Diagnosis\n		Management of OA of the fingers\n		Distal interphalangeal joint (DIP) arthritis\n			Diagnosis\n			Indications for surgery\n			Cheilectomy\n			Biomechanical effects of DIP fusion\n			DIP arthrodesis\n				Indications\n				Techniques\n					Interosseous wiring\n					K-wire fixation\n					Tension band wiring\n					Axial compression screw\n				Complications of DIP fusion\n					Infection\n					Non-union\n			DIP arthroplasty\n			Mucous cyst\n		Proximal interphalangeal (PIP) joint arthritis\n			Management\n			PIP arthrodesis\n				Techniques\n					Crossed K-wire technique\n					Tension band wire technique\n					Compression screw\n					Plating\n			PIP arthroplasty\n				Silicone interposition arthroplasty\n					Technique\n				Surface replacement arthroplasty with nonconstrained implants\n					Patient selection\n					Technique for nonconstrained or semiconstrained PIP arthroplasty\n				Postoperative therapy for PIP arthroplasty\n				Outcomes and complications of PIP arthroplasty\n		Metacarpophalangeal (MCP) joint arthritis\n			Anatomy and biomechanics\n			Resection and resurfacing arthroplasty\n			Implant arthroplasty\n				Hinged prostheses\n				Silicone constrained prostheses\n				Surface replacement prostheses\n				PyroCarbon arthroplasty\n					Technique for MCP joint arthroplasty with PyroCarbon implant\n			MCP arthrodesis\n			Vascularized joint transfer/costochondral replacement\n		Management of OA of the thumb\n			Thumb metacarpophalangeal (MCP) joint arthritis\n			Trapeziometacarpal arthritis\n				Etiology and epidemiology\n				Anatomy and biomechanics\n				Diagnosis and classification\n				Nonoperative treatment\n				Surgical procedures for stage I disease\n					Thumb TMC arthroscopy\n					Dorsal wedge extension osteotomy\n					Volar ligament reconstruction\n					Technique for Eaton–Littler procedure\n				Procedures for stage II–IV disease\n					Trapeziectomy alone\n					Surgical technique for simple trapeziectomy\n					Trapeziectomy with ligament reconstruction and/or tendon interposition\n				Prosthetic arthroplasty\n				Trapeziometacarpal arthrodesis\n					Technique for arthrodesis\n		OA of the wrist\n			Etiology\n			Patient evaluation\n			Surgical treatment\n				Technique for dorsal approach to the wrist\n				Radial styloidectomy\n				Neurectomy\n				Proximal row carpectomy\n				Four-corner fusion\n				Radioscapholunate fusion\n				Total wrist arthrodesis and total wrist arthroplasty\n		Future directions\n		References\n19\n	19  Rheumatologic conditions of the hand and wrist\n		Introduction\n		Basic science/disease process\n			Etiology\n			Pathogenesis\n			Medical management\n		Diagnosis/presentation\n			Wrist involvement\n			Finger and thumb involvement\n		Patient selection\n			Perioperative considerations\n			Goals of surgery\n			Sequence of surgery\n		Treatment/surgical technique\n			Operations at the wrist level\n				Wrist synovectomy/dorsal tenosynovectomy\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				Distal ulna resection (Darrach procedure)\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				Partial wrist arthrodesis (radioscapholunate arthrodesis)\n					Postoperative care\n				Complete wrist arthrodesis\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				Total wrist arthroplasty\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n			Operations for the hand and fingers\n				MCP synovectomy and soft-tissue reconstruction\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				MCP arthroplasty (silicone)\n					Postoperative care\n				PIP arthroplasty\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				MCP and IP arthrodesis\n					Postoperative care\n					Outcomes, prognosis, and complications\n				Correction of swan-neck deformity\n					Postoperative care\n				Correction of boutonnière deformity\n					Postoperative care\n					Outcomes, prognosis, and complications\n				Correction of thumb deformities\n					Postoperative care\n					Outcomes, prognosis, and complications\n			Tendon surgery and carpal tunnel syndrome\n				Carpal tunnel syndrome\n					Postoperative care\n					Outcomes, prognosis, and complications\n					Secondary procedures\n				Flexor tendon ruptures\n					Postoperative care\n					Outcomes, prognosis, and complications\n				Trigger fingers\n					Postoperative care\n					Outcomes, prognosis, and complications\n				Extensor tendon ruptures\n					Postoperative care\n					Outcomes, prognosis, and complications\n			Other rheumatologic disorders of the hand and wrist\n				Seronegative spondyloarthropathies\n				Systemic lupus erythematosus\n				Scleroderma\n					Postoperative care\n				Crystalline arthropathy (gout)\n				Crystalline arthropathy (pseudogout)\n				Differentiating acute gout or pseudogout attack from septic arthritis\n					DECT scan\n					JAK inhibitors\n		Summary\n		Future directions\n		References\n20\n	20  Occupational disorders of the hand\n		Introduction\n		Patient history and examination\n		Knowledge of the disease process and its causation\n		The role of force and repetition\n			Specific occupational disorders of the hand and wrist\n				Tendinopathies\n					Lateral epicondylitis\n					Trigger finger\n					De Quervain’s tenosynovitis\n					Extensor carpi ulnar tendinitis\n					Flexor carpi radialis tenosynovitis and flexor carpi ulnaris tenosynovitis\n				Nerve compression\n					Median neuropathy: carpal tunnel syndrome (CTS)\n				Vascular disorders\n					Hypothenar hammer syndrome\n					Hand–arm vibration syndrome (HAVS)\n				Bone and joint problems\n					Osteoarthritis\n					Distal interphalangeal joint arthritis\n					Proximal interphalangeal joint arthritis\n					Metacarpophalangeal joint arthritis\n					Carpometacarpal joint arthritis\n		Return to work\n		Measuring impairment\n		Summary and future directions\n		References\n21\n	21  Nerve entrapment syndromes\n		Pathophysiology of chronic nerve compression\n			Double-crush syndrome\n		Clinical examination of upper extremity nerve entrapments\n			Manual muscle testing algorithm (Video 21.1 )\n				Scratch collapse test (Video 21.2 )\n		Electrodiagnostic studies (EDS)\n		Median nerve entrapments\n			Carpal tunnel syndrome\n				Anatomy\n				Etiology\n				History\n				Clinical examination\n				Other diagnostic tools\n				Patient selection\n					Non-operative treatment\n				Treatment/surgical technique\n					Wide-awake OCTR\n					Endoscopic carpal tunnel release (ECTR)\n					OCTR vs. ECTR\n				Ultrasound-guided carpal tunnel release (usCTR)\n				Outcomes and complications\n			Median nerve entrapments in the elbow and forearm\n				Background\n				Lacertus syndrome\n					Anatomy\n					History\n					Clinical examination\n					Non-operative treatment\n					Wide-awake surgical release\n				Superficialis syndrome – AIN syndrome\n				History\n				Clinical examination\n				Non-operative treatment\n				Surgical release\n		Ulnar nerve entrapments\n			Ulnar nerve compression in Guyon\'s canal\n				Background\n				Anatomy\n				History\n				Clinical examination\n				Surgical release\n			Cubital tunnel syndrome\n				Anatomy\n				History\n				Clinical examination\n				Non-surgical treatment\n				Surgical release\n					In situ decompression – the authors\' preferred technique\n					Simple decompression\n					Endoscopic decompression\n					Submuscular–subcutaneous transposition\n					Medial epicondylectomy\n				Outcomes and complications\n		Radial nerve entrapments\n			Wartenberg\'s syndrome – entrapment of the SBRN\n				Anatomy\n				History and clinical examination\n				Non-surgical treatment\n				Surgical release\n			Radial tunnel syndrome – PIN compression in the proximal forearm\n				Anatomy\n				History\n				Clinical examination\n					Non-operative treatment\n				Surgical release\n				Outcomes following surgery\n			Lateral intermuscular syndrome – radial compression in the distal upper arm\n				Anatomy\n				History and clinical examination\n				Non-surgical treatment\n				Surgical release\n			Triangular interval syndrome – radial compression in the proximal upper arm\n				Anatomy\n				History and clinical examination\n				Non-surgical treatment\n				Surgical release\n		Other nerve compressions of the upper extremity\n			Quadrilateral space syndrome – axillary nerve entrapment\n				Anatomy and etiology\n				History\n				Clinical examination\n				Other diagnostic tools\n				Non-surgical treatment\n				Surgical release\n			Musculocutaneous nerve compression\n				Anatomy and etiology\n				History and clinical examination\n				Non-surgical treatment\n				Surgical release\n			Suprascapular nerve compression\n				Anatomy and etiology\n				History and clinical examination\n				Other diagnostic tools\n				Non-surgical treatment\n				Surgical release\n			Dorsal scapular nerve compression\n				Anatomy and etiology\n				History and clinical examination\n				Non-surgical treatment\n				Surgical release\n		Future directions\n		R­ef­er­en­ces\n22\n	22  Peripheral nerve repair and reconstruction\n		Introduction\n		Basic science and natural history\n			Anatomy\n				Gross anatomy: the upper extremity\n				The neuron and supporting cells\n				The nerve trunk\n				Blood supply\n			Physiology\n				Degeneration and regeneration\n				The distal nerve segment\n		Diagnosis and presentation\n			Formal classification of injury\n			Neuropraxia\n				First-degree injury\n			Axonotmesis\n				Second-degree injury\n				Third-degree injury\n			Neurotmesis\n				Fourth-degree injury\n				Fifth-degree injury\n				Sixth-degree injury\n		Clinical examination\n			Functional evaluation\n			Electromyography/neurography\n			Wound inspection\n		Patient selection\n			Type of nerve injury\n			Condition of the wound\n		Treatment and surgical techniques\n			Immediate compared with delayed nerve repair\n				General principles\n				Timing\n				Surgical approach\n			Principles of nerve repair\n				General principles (Videos 22.1 & 22.2 )\n				Epineurial compared with fascicular repair\n				End-to-side nerve repair\n				Wound closure and immobilization\n			Nerve reconstruction\n				Autografts\n				Approach and preparation\n				Nerve ends\n				The gap\n				Length of graft\n				Harvest of the graft\n				Coaptation and maintenance\n			Donor nerves\n				Sural nerve\n				Medial and lateral antebrachial cutaneous nerves\n				The terminal branch of the posterior interosseous nerve\n				Superficial sensory branch of the radial nerve\n				Other\n			Tubular repair and artificial conduits\n				Biological conduits\n			Processed nerve allografts (Video 22.3 )\n				Non-degradable conduits\n				Biodegradable conduits\n				Fillers\n				Other techniques\n				Nerve transfers\n		Postoperative care\n			General aspects\n			Postoperative movement training\n			Sensory re-education\n				Cortical reorganization\n				Sensory re-education in phase 1\n				Improving effects of sensory re-education – phase 2\n		Outcome\n			Assessment of outcome\n			General aspects\n			BMRC\n			The Rosen score\n			Factors that affect outcome\n				General aspects\n				Age\n				Digital nerves\n				Nerve trunks\n				Level of injury\n				Type of repair\n				Type of injury\n		Postoperative dysfunction\n			General aspects\n			Complex regional pain syndrome\n			Other factors\n		Future perspectives\n			Acknowledgments\n		References\n23\n	23  Brachial plexus injuries: adult and pediatric\n		Introduction\n		History of brachial plexus reconstruction\n		Adult brachial plexus injury\n			General principles in BPI management\n			Anatomy\n				Gross anatomy\n				Microanatomy\n			Level of brachial plexus injury\n			Patterns of brachial plexus injury\n			Pathophysiology and degree of nerve injury\n			Timing of brachial plexus exploration\n			Clinical evaluation\n				Etiology of adult brachial plexus injury\n				Patient history\n			Preoperative evaluation and diagnosis\n				Motor examination\n				Sensory examination\n				Plain X-ray and imaging studies\n				Electrodiagnostic studies\n			Vascular injury\n			Surgical treatment and techniques\n				Different incision lines for different approaches\n				Landmarks and key points for supraclavicular dissection\n				Landmarks and key points for infraclavicular dissection\n			Surgical techniques\n				Level I injury\n					Nerve transfer\n						Extraplexus nerve transfer\n						Intraplexus nerve transfer\n						Closed-target nerve transfer (or distal nerve transfer)\n						End-to-side neurorrhaphy nerve transfer\n					Reconstructive strategies\n						Shoulder\n						Elbow\n						Finger\n					Pedicled muscle transfer\n					Functioning free muscle transplantation (FFMT)\n				Level II injury\n				Level III injury\n				Level IV injury\n			Postoperative management and rehabilitation\n			Palliative reconstruction for sequelae deformities\n			Outcome evaluation\n			Conclusion\n			Future directions\n		Pediatric brachial plexus injury (obstetric brachial plexus palsy)\n			Introduction\n			Infant obstetric brachial plexus palsy\n			Clinical presentation\n			Clinical examination\n			Timing of surgery\n				Preoperative preparation\n			Surgical technique\n			Reconstructive strategies\n				Pure rupture injury\n				Rupture injury associated with root avulsion\n			Postoperative management\n			Outcome assessment\n			Results\n			Sequelae obstetric brachial plexus palsy\n				Shoulder deformity reconstruction\n				Elbow deformity reconstruction\n				Forearm and hand deformity reconstruction\n			Conclusion\n			Future directions\n		R­ef­er­en­ces\n24\n	24  Tetraplegia\n		Introduction\n		Basic science/disease process\n		Classification of the tetraplegic upper extremity\n		Patient presentation and patient selection\n			Forming a team\n			Timing\n			Patient evaluation/selection\n			Treatment/surgical technique (Table 24.2)\n				General guidelines for reconstruction\n				Tendon transfers\n				Nerve transfers\n		Surgical reconstruction\n			IC group 0 (high cervical spinal cord injuries)\n			Elbow extension\n				Biceps-to-triceps tendon transfer\n					Surgical technique\n					Postoperative rehabilitation\n				Deltoid-to-triceps transfer36\n					Surgical technique (Fig. 24.7)\n					Postoperative rehabilitation\n			Nerve transfer for elbow extension\n			IC groups 1 and 2\n				Improving wrist extension\n					Postoperative rehabilitation\n					Side-to-side sutures\n				Restoring key pinch\n				Split FPL-to-EPL interphalangeal stabilization\n				ELK-tenodesis\n				Flexor pollicis longus tenodesis (passive key pinch)\n					Postoperative rehabilitation\n				Nerve transfers\n			IC group 2 and some IC group 3\n				Restoring active key pinch by BR-to-FPL transfer\n					Surgical planning\n					Operative procedure\n					Postoperative rehabilitation\n			IC groups 3, 4, and 5\n				Restoring active key pinch, grasp, and release in one operative stage\n					The single-stage grip and release procedure55 (Video 24.1 )\n					Surgical order of procedures\n					Intrinsic stabilization\n					Zancolli “lasso” procedure\n					House intrinsic tenodesis\n					ECU tenodesis\n					Postoperative rehabilitation\n					Other considerations\n				Nerve transfers for hand function\n					Supinator to posterior interosseus nerve transfer\n					Patient selection\n					Surgical technique\n					Postoperative care\n					Nerve transfer for pinch and grasp\n			IC groups 6, 7, 8, and 9\n			Spasticity\n		Future directions\n			Functional neuromuscular stimulation\n			Outcomes and complications\n		Conclusions\n		References\n25\n	25  Tendon transfers\n		Introduction\n		General principles of tendon transfers\n			Bone and soft-­tissue healing\n			Selection of donor muscle–­tendon\n				Expendability\n				Strength\n				Amplitude\n			Direction of transfer and integrity\n			Timing of tendon transfers\n			Surgical techniques\n		Radial nerve palsy\n			Indications\n			Timing\n			Operations\n				Standard FCU transfer (Figs. 25.3–­25.6)\n				FCR transfer (Fig. 25.8)\n				Boyes flexor digitorum superficialis transfer (Fig. 25.9)\n			Outcomes\n		Low median nerve palsy\n			Anatomical considerations\n			Timing\n			Operations\n				Burkhalter extensor indicis proprius transfer (Fig. 25.10)\n				Bunnell ring finger flexor digitorum superficialis transfer (Fig. 25.12)\n				Camitz palmaris longus transfer (Fig. 25.15)\n				Other opposition tendon transfers (Table 25.3)\n		High median nerve palsy\n			Indications\n			Operations\n			Outcomes\n		Low ulnar nerve palsy\n			Indications\n			Timing\n			Static procedures to correct clawing of the fingers\n			Tendon transfers to correct clawing\n			Modified Stiles–­Bunnell transfer (see Fig. 25.27)\n			Brand EE4T transfer (Fig. 25.28)\n			Brand EF4T transfer (Fig. 25.29)\n			Fritschi PF4T transfer\n			Tendon transfer to correct ulnar deviation of the small finger\n			Tendon transfers to provide adduction of the thumb\n			Ring finger flexor digitorum superficialis adductor transfer\n			Smith extensor carpi radialis brevis adductor transfer (Fig. 25.31)\n			Tendon transfers to provide index finger abduction\n			Neviaser accessory abductor pollicis longus and free tendon graft (Fig. 25.32)\n		High ulnar nerve palsy\n			Outcomes\n		Tendon transfers for combined nerve injuries\n			Tendon transfers for low median–­low ulnar nerve palsy\n			Tendon transfers for high median–­high ulnar nerve palsy\n			Tendon transfers for reconstruction after trauma\n			Tendon transfers to restore thumb extension\n			Tendon transfers to restore finger extension\n			Tendon transfers to restore thumb flexion\n			Tendon transfers to restore finger flexion\n		Summary\n		Future directions\n		References\n26\n	26  Nerve transfers\n		Introduction\n		Basic science\n		Diagnosis and patient presentation\n			Patient history\n			Physical examination\n			Imaging\n			Electrodiagnostic testing\n		Patient selection\n		Examples of nerve transfer procedures for specific injury patterns\n			Upper plexus injury\n				Specific patient exam findings\n				Reconstruction techniques\n					Use of spinal accessory nerve (cranial nerve XI) to suprascapular nerve transfer (motor)\n					Use of triceps to axillary nerve transfer (motor component)\n					Use of the double fascicular nerve transfer (motor)\n					Other potential donors to restore elbow flexion\n			Lower plexus injury\n				Specific patient exam findings\n				Reconstruction techniques\n			Complete/­near-­complete plexus injury\n				Specific patient exam findings\n				Reconstruction techniques\n					Use of spinal accessory and intercostal nerves as donors (motor)\n					Discussion of cross C7 transfer, phrenic nerve transfers (motor)\n			Median nerve injury\n				Specific patient exam findings\n				Reconstruction techniques\n					Use of radial to median branch nerve transfers (motor)\n					Use of brachialis branch to AIN branch nerve transfer\n					Use of adjunct tendon transfers to augment nerve transfers\n			Ulnar nerve injury\n				Specific patient exam findings\n				Reconstruction techniques\n					Use of median to ulnar branch nerve transfers (motor)\n					Use of adjunct tendon transfers to augment nerve transfers\n			Radial nerve injury\n				Specific patient exam findings\n				Reconstruction techniques\n					Use of median to radial branch nerve transfers\n					Use of adjunct tendon transfers to augment nerve transfers\n			Sensory nerve injury\n				Restoration of key sensory functions\n					Use of ulnar to median branch nerve transfers (sensory)\n					Use of median to ulnar branch nerve transfers (sensory)\n					Use of median and ulnar nerve transfers to restore first webspace sensation in C5–­C6 root level brachial plexus injury (se ...\n					Use of median to radial nerve transfers (sensory)\n					Use of radial to axillary nerve transfers (sensory)\n		Postoperative care\n			Postoperative wound care\n			Complications\n			Rehabilitation\n		Postoperative patient evaluation\n		Outcomes and prognosis\n		Secondary procedures\n		Future directions\n		References\n27\n	27  Free-functioning muscle transfer\n		Introduction\n		Historical perspective\n		Patient selection\n		Preoperative planning\n			Selecting the donor muscle\n			Selecting the axon source\n		Surgical technique of the free-functioning gracilis transfer\n			Preparing the recipient site\n			Harvesting the gracilis muscle\n			Muscle transfer to restore finger flexion\n			Muscle transfer to restore finger extension\n			Muscle transfer to restore thumb opposition\n			Muscle transfer to restore elbow flexion\n		Complications\n		Future directions\n		References\n28\n	28  The ischemic hand\n		Introduction\n		Historical perspective\n		Raynaud’s phenomenon\n		Basic science\n			Anatomy\n				Embryology\n				Arterial system in the forearm, hand, and digits\n					Superficial palmar arch\n					Deep palmar arch\n					Surgical landmarks of superficial and deep palmar arch\n					Digital arteries\n				Micro-arterial system\n				Physiology of blood flow\n					Hemodynamics\n					Cellular control mechanisms\n					Pathophysiology\n					Emboli\n					Trauma\n					Systemic disease\n		Diagnosis/patient presentation\n			Evaluation\n			History and physical examination\n			Diagnostic investigations\n				Capillaroscopy\n				Ultrasound\n				Duplex ultrasonography\n				Isolated cold stress testing\n				Infrared thermography\n				Laser speckle contrast imaging\n				Conventional angiography\n				MR and CT angiography\n		Patient selection\n			Acute ischemia\n				Acute arterial injury\n				Arterial emboli\n				Iatrogenic injuries\n					Cannulation injury\n					Arterial injection injuries\n					Acquired arteriovenous fistula\n			Chronic ischemia\n				Arterial thrombosis\n				Aneurysm\n				Buerger’s disease\n				Connective tissue disorders\n				Vasospastic disease\n		Treatment\n			Non-surgical treatment\n				Environmental modification\n				Medical management\n					Pharmacological agents\n					Thrombolytic therapy\n					Botulinum toxin A therapy\n					Biofeedback\n			Surgical treatment\n				Embolectomy\n				Sympathectomy\n				Leriche sympathectomy (arteriectomy)\n				Periarterial sympathectomy\n					Classic sympathectomy\n					Extended or radical digital sympathectomy\n				Arterial reconstruction\n					Wrist inflow artery reconstruction (ulnar artery, radial artery, and superficial palmar arch)\n					Digital artery reconstruction\n			Other surgical options\n				Balloon angioplasty with stenotic lesion\n				Venous arterialization\n				Fat grafting\n		Treatment algorithm\n		Postoperative care\n		Outcomes, prognosis, and complications\n		Future directions\n		References\n29\n	29  The spastic hand\n		Introduction\n			Cerebral palsy\n			Cerebrovascular accident (CVA)\n			Traumatic brain injury (TBI)\n			Spinal cord injury\n		Patient presentation\n			Clinical examination\n				Resting posture of the upper limb\n				Evaluation of spasticity\n				Muscle contracture\n				Joint deformity\n				Motor assessment\n				Sensory examination\n				Functional assessment\n			General preoperative assessment\n				Other neurological impairments\n			Imaging and electromyography\n			The role of botulinum toxin\n				Technique\n		Patient selection and timing of surgery\n		Treatment\n			Rebalancing the forces\n				Reducing spasticity\n					Partial neurectomy\n					Neurosurgical procedures\n				Muscle contracture\n					Tenotomy\n					Muscle release\n				Joint contracture\n				Tendon transfers\n			Most frequent procedures\n				At the elbow level\n				At the forearm level\n				At the wrist level\n				At the finger level\n					Swan-neck deformity\n					Intrinsic contracture\n				At the thumb level\n		Future directions\n		Conclusions\n		References\n30\n	30  The stiff hand\n		Introduction\n		Etiology, basic science, anatomy, and clinical examination\n		Treatment\n			Nonoperative intervention\n				PIP joint flexion contracture\n				PIP joint extension contracture\n				MCP joint extension contracture\n				Tendon gliding\n				PIP joint extension lag\n				Motor retraining\n			Operative intervention\n				Anesthesia\n				MCP joint extension contracture\n				PIP joint flexion contracture\n				PIP joint extension contracture\n		Outcomes\n		Future directions\n		References\n31\n	31  The painful hand\n		Introduction\n		Assessment\n			Mechanism of injury\n				Penetrating injury\n				Blunt or “closed” injuries\n			Subjective descriptors\n			Patient-­reported measures\n			Clinical examination\n		Diagnosis/­pathologies\n			Neuritis\n			Neurostenalgia\n			Symptomatic post-­traumatic neuroma\n			Spinal nerve root avulsion (deafferentation)\n			Causalgia\n			Complex regional pain syndrome\n			Atraumatic neuropathy\n		Non-­surgical management\n			Physical therapies\n			Psychological therapies\n				Co-­occurring psychiatric and psychological disorders\n				Features of psychological assessment\n				Patient-­reported measures\n					Pain Catastrophizing Scale (PCS)\n					Pain Self-­Efficacy Questionnaire (PSEQ)\n				Psychological therapeutic interventions\n					Cognitive Behavioral Therapy\n					Acceptance and Commitment Therapy\n			Pharmacological therapies\n				Specific medications\n					Gabapentinoids\n					Tricylic antidepressants (TCAs)\n					Nonsteroidal anti-­inflammatory drugs and opioids\n					Infusions and topical treatments\n				Abuse and withdrawal\n				Side-­effects and interactions\n		Surgical treatment\n			Operative procedures\n				Treatment for neurostenalgia: neurolysis\n				Treatment of symptomatic post-­traumatic neuroma\n					Graft reconstruction\n					Neuroma relocation\n					Targeted muscle re-­innervation\n					Spinal nerve root re-­implantation after brachial plexus avulsion injury\n					Dorsal root entry zone procedure\n		Summary\n		References\n32\n	32  Congenital hand I: Embryology, classification, and principles\n		Introduction\n			Limb development\n			Classification\n			Assessment and principles of treatment\n		Limb development (embryology)\n			Overview of upper limb morphogenesis\n			The molecular control of limb outgrowth and patterning\n				Limb vasculature\n				Skeletogenesis\n				Myogenesis\n				Innervation\n		The development/differentiation of specific tissues\n		Anomalies of limb development and their classification\n			Background\n			Problems of the Swanson classification\n			The OMT classification\n		Assessment of the child and family\n			The clinic\n			History\n			Examination\n			Investigations\n		Diagnosis\n		Principles of surgical management\n			Indications\n				Function\n				Appearance\n				Timing\n		References\n33\n	33  Congenital hand II: Malformations – whole limb\n		Poland syndrome\n			Introduction\n			Basic sciences/disease processes\n			Diagnosis/patient management\n			Patient selection, treatment, and surgical plan\n				Emergent complications\n				Psychosocial concerns\n				Functional and aesthetic problems\n				Management of the underdeveloped or absent pectoralis major\n				Management of hand differences\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary and additional procedures\n			Future directions\n		Ulnar dimelia and mirror hand\n			Introduction\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment and surgical technique\n			Outcome, prognosis, and complications\n			Secondary procedures\n		Radioulnar synostosis\n			Introduction\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n				Osteotomy through synostosis\n				Osteotomies through the diaphyseal portion of radius and ulna\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n			Future directions\n		Madelung deformity\n			Introduction\n			Basic science/disease process\n				Genetic associations\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n				Physiolysis and ligament release\n				Radial osteotomy\n				Ulnar epiphysiodesis\n				Ulnar osteotomy\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n			Future directions\n		References\n34\n	34  Congenital hand III: Malformations – abnormal axis differentiation – hand plate: proximodistal and radioulnar\n		Proximodistal\n			Brachydactyly\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Treatment/surgical technique\n				Postoperative care\n				Outcome, prognosis, and complications\n			Symbrachydactyly\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Treatment/surgical technique\n				Non-vascularized toe phalanx transfers\n					Free vascularized toe-to-hand transfers\n					Distraction lengthening\n				Postoperative care\n				Outcome, prognosis, and complications\n			Transverse deficiency\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Outcome, prognosis\n			Cleft hand\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Treatment/surgical technique\n					Transverse bones\n					Border digit syndactyly\n					First webspace reconstruction\n					Cleft closure\n					Thumb reconstruction\n				Postoperative care\n				Outcome, prognosis, and complications\n		Radioulnar\n			Radial longitudinal deficiency, hypoplastic thumb\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n					Type 1 thumb hypoplasia\n					Type 2 thumb hypoplasia\n					Type 3A thumb hypoplasia\n					Type 3B thumb hypoplasia\n					Type 4 thumb hypoplasia\n					Type 5 thumb hypoplasia\n				Patient selection\n				Treatment/surgical technique (see Algorithms 34.1 & 34.2)\n					Type 1 hypoplastic thumbs\n					Type 2 and 3A hypoplastic thumbs\n						First webspace deepening\n						Opposition transfer\n							ADM (Huber) opposition transfer\n							FDS opposition transfer with UCL reconstruction\n					Type 3B, 4, and 5 hypoplastic thumbs\n						Pollicization\n					Type 0 and 1 RLD forearms\n						Joint release and tendon transfer\n					Type 2 RLD forearms\n						Radius lengthening\n					Type 3, 4, and 5 RLD forearms\n						Soft-tissue release and bilobed flap\n						Precentralization soft-tissue distraction\n						Centralization\n						Ulna osteotomy\n				Postoperative care\n					Opposition transfer, collateral ligament reconstruction\n					Pollicization\n					Joint release and tendon transfer (type 0 and 1 RLD forearm)\n					Soft-tissue release and bilobed flap\n					Precentralization soft-tissue distraction, centralization\n				Outcome, prognosis, and complications\n				Secondary procedures\n			Ulnar longitudinal deficiency\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n			Polydactyly\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Treatment/surgical technique\n					Radial polydactyly\n						Type I and II\n						Type III and IV\n						Type V and VI\n					Ulnar polydactyly\n						Type A\n						Type B\n				Postoperative care\n				Outcome, prognosis, and complications\n				Secondary procedures\n			Triphalangeal thumb\n				Introduction\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Patient selection\n				Treatment/surgical technique\n					Abnormally shaped phalanx (delta, trapezoid, rectangle, angular epiphysis)\n						Delta middle phalanx\n						Trapezoid or rectangle middle phalanx\n						Angular epiphysis\n					Five-fingered hand\n					Narrow first webspace\n					Thumb opposition\n					Associated polydactyly, primarily radial polydactyly\n				Outcome, prognosis, and complications\n			Future directions\n		References\n35\n	35  Congenital hand IV: Malformations – abnormal axis differentiation – hand plate: unspecified axis\n		Syndactyly\n			Introduction\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n				Creation of a web\n				Treating the lateral soft tissue defects\n				Separation of the fingertips\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n		Clinodactyly\n			Introduction\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n		Kirner deformity\n			Introduction\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n		Apert hand\n			Introduction\n			History\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical technique\n				Separation of fingers\n				Thumb and first web\n				Additional procedures\n				Feet\n			Postoperative care\n			Outcomes, prognosis, and complications\n				Complications\n			Secondary procedures\n		References\n36\n	36  Congenital hand V: Deformations and dysplasias – variant growth\n		OMT classification of deformation\n		Pediatric trigger thumb\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection (Algorithm 36.1)\n			Treatment/surgical technique (Fig. 36.1)\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n		Congenital trigger fingers\n			Basic science/disease process\n			Diagnosis/patient presentation (Algorithm 36.2)\n			Patient selection\n			Treatment/surgical technique (see Video 36.2 Algorithm 36.3)\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n		Constriction ring sequence\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n				In utero diagnosis (Algorithm 36.4)\n				Postnatal presentation (Algorithm 36.5)\n			Later presentations (Algorithm 36.6)\n			Treatment/surgical technique\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n		OMT classification of dysplasia\n		Macrodactyly\n			Basic science/disease process\n			Diagnosis/patient presentation (Algorithm 36.7)\n				Flatt type 1: Macrodactyly with fibrolipomatous hamartoma\n				Flatt type 2: Macrodactyly with neurofibromatosis\n				Flatt type 3: Osteohypertrophic macrodactyly\n				Flatt type 4: Macrodactyly with hemihypertrophy\n			Treatment/surgical technique\n				Strategies to slow growth\n				Treatment of the nerves and blood vessels\n				Strategies to reduce volume\n				Amputation\n			Postoperative care\n			Outcome, prognosis, and complications\n			Secondary procedures\n		Future directions\n		References\n37\n	37  Congenital hand VI: Dysplasias – tumorous conditions\n		Introduction\n		Diagnosis/patient presentation\n		Treatment/surgical technique\n		Postoperative care\n		Vascular anomalies\n		Vascular tumors\n			Infantile hemangioma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Congenital hemangioma (CH)\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n		Vascular tumors\n			Pyogenic granuloma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Capillary malformation\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Lymphatic malformation\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n				Outcomes, prognosis, and complications\n			Venous malformation\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n					Conservative treatment\n					Minimally invasive treatment\n					Surgical treatment\n				Outcomes, prognosis, and complications\n			Arteriovenous malformation\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Fibro-adipose vascular anomaly (FAVA)\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Vascular malformations with overgrowth – CLOVES syndrome\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n		Peripheral nerve tumors\n			Neurofibroma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Schwannoma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Adipose lesions of nerve\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Malignant peripheral nerve sheath tumor\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n		Connective tissue dysplasias\n			Infantile digital fibromatosis\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Juvenile aponeurotic fibroma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Infantile myofibromatosis\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Lipoblastoma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Infantile fibrosarcoma\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n		Skeletal dysplasias\n			Osteochondromatoses – multiple hereditary exostosis\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Osteochondromatoses – metachondromatosis\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Enchondromatoses – multiple enchondromatosis (Ollier disease)\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n			Enchondromatoses – Maffucci syndrome\n				Basic science/disease process\n				Diagnosis/patient presentation\n				Treatment/surgical technique\n		Future directions\n		References\n38\n	38  Congenital hand VII: Dysplasias – congenital contractures\n		Arthogryposis\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical care\n				Humeral external rotation osteotomy\n				Elbow extension contracture release\n				Active elbow flexion transfers\n				Wrist contracture correction\n				Finger and thumb contracture correction\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n			Future directions\n		Camptodactyly\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical care\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n			Future directions\n		Thumb-in-palm deformity\n			Basic science/disease process\n			Diagnosis/patient presentation\n			Patient selection\n			Treatment/surgical care\n			Postoperative care\n			Outcomes, prognosis, and complications\n			Secondary procedures\n			Future directions\n		References\n39\n	39  Growth considerations in the pediatric upper extremity\n		Introduction\n		Basic science/disease process\n			Anatomy and physiology of the epiphyseal growth plate\n			Vascular anatomy of the growth plate\n			Growth plate closure and skeletal age assessment during puberty\n		Diagnosis/patient presentation\n			Conditions affecting the growth plate\n				Trauma\n					Incidence and distribution in the upper extremity\n					Classification of physeal fractures\n					Treatment of physeal fractures\n				Tumor\n					Bone sarcoma involving the epiphysis\n					Congenital chondrodysplasia\n			Patient selection\n		Treatment/surgical technique\n			Treatment of physeal arrest\n				Observation\n				Completion of a partial physeal arrest and epiphysiodesis\n				Physeal distraction\n				Bar resection\n				Corrective osteotomies, lengthening or shortening\n			Epiphyseal transfer of the proximal fibular epiphysis\n				Indications\n				Vascular supply of the proximal fibular epiphysis\n				Harvest technique of the proximal fibula based on the tibialis anterior artery (Video 39.1)\n					Skin incision\n					Exposure of the anterior tibial pedicle\n					Dissection of the peroneal nerve at the fibular neck\n					Section of the interosseous membrane and distal osteotomy\n					Harvest of the biceps femoris tendon and capsulotomy of the proximal tibiofibular joint\n					Final dissection of the proximal portion of the vascular pedicle\n		Postoperative care\n			Donor site\n			Recipient site\n		Outcomes, prognosis, and complications\n		Secondary procedures\n			Donor site\n			Recipient site\n		Future directions\n		References\n40\n	40  Treatment of the upper extremity amputee\n		Introduction\n		Principles of prosthetic reconstruction\n			Improve the soft tissues to help wear a prosthesis\n			Understand that the type of prosthetic is based on patient needs and amputation level\n				Passive/aesthetic devices\n				Body-powered devices\n				Externally powered prosthesis\n					Hybrid devices\n			Understand prosthetic attachment systems\n			Plan for the means of prosthetic control\n			Treat upper extremity pain and phantoms\n		Treatment of upper extremity amputees\n			Principles of acute upper extremity amputation surgery\n			Surgery for the shoulder disarticulation level amputee\n			Surgery for the transhumeral amputee\n			Surgery for the transradial level amputee\n			Surgery for the wrist disarticulation amputee\n			Surgery for the partial hand amputee\n			Surgery for the patient with digit amputations\n		Future directions\n		Conclusion\n		References\n41\n	41  Upper extremity composite allotransplantation\n		Introduction\n			Evolution of upper extremity vascularized composite allotransplantation\n			Immunology of vascularized composite allotransplantation\n			Experimental background and scientific basis for upper extremity transplantation\n			Chronology of clinical upper extremity allotransplantation\n			Historical development and milestones\n		Clinical experience with upper extremity allotransplantation\n			Program, patient, procedural, and protocol-related considerations\n				Program establishment and implementation\n				Donor and recipient selection\n				Procedural aspects\n					Donor limb procurement\n					Recipient surgery\n				Protocol-related considerations\n					Maintenance immunosuppression\n					Rehabilitation and functional assessment after upper extremity allotransplantation\n					Assessment for rejection (host-versus-graft reaction)\n					Immunologic monitoring\n			World experience and surgical outcomes\n			Unique aspects of vascularized composite allotransplantation\n		Emerging insights in vascularized composite allotransplantation\n			Cortical plasticity and neuro-integration\n			Chronic rejection\n			Tolerance approaches and immunomodulatory strategies\n		Future directions of upper extremity reconstructive transplantation\n		References\n42\n	42  Aesthetic hand surgery\n		Introduction\n		Relevant anatomy\n		Basic aesthetics of the hand\n		The aging process\n		Grading systems\n		Patient management\n		Rejuvenation of the epidermis and dermis\n			Non-surgical management\n				Topicals\n				Chemical peels\n				Microdermabrasion\n				Laser therapy\n				Q-switch lasers\n				Intermittent pulsed light\n				Photodynamic therapy\n				Non-ablative non-fractionated lasers\n				Non-ablative fractionated lasers\n				Ablative lasers\n				Radiofrequency\n		Dorsal vein prominence\n			Non-surgical management\n				Sclerotherapy\n				Endovenous ablation\n			Surgical management\n				Phlebectomy\n		Volume restoration\n			Non-surgical management\n				Injectables\n					Hyaluronic acid\n					Poly-L-lactic acid\n					Calcium hydroxyapatite\n					Injection technique\n			Surgical management\n				Autologous fat grafting\n					Author’s preferred technique\n				Skin excision\n				Arthroplasty/arthrodesis\n		Skin excess\n		Articular aging\n		Future directions\n			Adipose-derived stem cells\n			Platelet-rich plasma\n				Allograft adipose matrix\n		Conclusions\n		References\n43\n	43  Hand therapy\n		Patient evaluation\n			Occupation-based assessments\n			Impairment-based assessments\n		Rehabilitation following tendon injury\n			Extensor tendon injury\n				Zone I/II\n				Zone III/IV\n				Zone V–VII\n				Thumb\n			Flexor tendon injury\n				Timing\n				Positioning\n				Motion\n			Tenolysis\n			Tendon transfer\n		Rehabilitation following nerve injury\n			Nerve decompression\n				Carpal tunnel release\n				Cubital tunnel release\n			Nerve repair\n				Sensory re-education\n				Desensitization\n			Nerve transfer\n				Motor re-education\n				Anterior interosseous nerve to ulnar motor nerve\n		Rehabilitation following fractures\n			Protective phase\n			Restorative phase\n			Strengthening and functional phase\n			Metacarpal fractures\n			Proximal/middle phalanx fractures\n			Distal phalanx fractures\n		Rehabilitation following replantation\n		Future directions\n		References\nConfidence is ClinicalKey