Current Practice of Microsurgery by Members of the American Society for Surgery of the Hand

Payatakes, Alexander; Zagoreos, N.; Fedorcik, Gregory G.; Ruch, David S.; Levin, L. Scott

doi:10.1016/j.jhsa.2006.12.006

Cited by 115 publications

(114 citation statements)

References 5 publications

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“…However, results from this study are in conformity with results from previously published studies on knowledge and skills similar to those examined in this study. For example, Payatakes et al demonstrated that significantly more graduates of PS RRCaccredited fellowships performed digital replantations and the results from this study similarly demonstrated that >60 % of the median frequency tally for digital replantations were performed by graduates of PS RRC-accredited fellowships (Table 5) [23]. Moreover, Sears et al demonstrated that program directors of OS RRC-accredited fellowships had significantly higher preference for considering knowledge of forearm fractures as essential to hand surgery competency and results from this study reflect this preference (Table 4) [3].…”

Section: Discussionsupporting

confidence: 67%

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Aliu

Chung

2014

Hand (New York, N,Y.)

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Background We examined the fellowship experience of hand surgeons in the USA to identify gaps and variations in exposure to essential skills and knowledge during hand fellowship. Methods We conducted a web-based survey of the entire American Society for Surgery of the Hand and American Association for Hand Surgery membership. We inquired about the level of exposure received to 170 knowledge topics and procedures during fellowship. We used factor analysis to group the knowledge topics and procedures into 79 scales of related items and calculated mean exposure ratings for each scale. We compared the ratings between graduates of plastic surgery (PS) and orthopedic surgery (OS) Residency Review Committee (RRC)-accredited fellowships. Results Our response rate was 21 % (n=562). Plastic surgery RRC-accredited fellowship graduates reported inadequate exposure for proficiency in 22 % (17/79) of the knowledge topic and procedure scales whereas graduates of OS RRCaccredited fellowships reported inadequate exposure for proficiency in 10 % (8/79) of the scales. Moreover, 11 and 21 % of graduates from PS RRC-accredited fellowships reported receiving no exposure in distal radius/ulna and forearm conditions, respectively, whereas only 1 and 2 % of graduates from OS RRC-accredited fellowships reported receiving no exposure in the same domains, respectively.

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Section: Discussionsupporting

confidence: 67%

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Aliu

Chung

2014

Hand (New York, N,Y.)

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“…Devastating hand and limb injuries, such as replants or vascular injuries, are often appropriately transferred to tertiary referral centers, as successful outcomes are dependent on an experienced team approach [5,7,10]. The Emergency Medical Treatment and Active Labor Act (EMTALA) was created in 1986 to facilitate such transfers and also to protect patients from being denied medical care due to lack of financial resources or insurance [1,3,11].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Appropriateness of Patient Transfers for Hand and Microsurgery to a Level I Trauma Center

Friebe

Isaacs

Mallu

et al. 2013

Hand (New York, N,Y.)

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Background The transfer of patients for hand and microsurgical emergencies to level I trauma centers is a common practice. Many of these transfers do not actually require a hand specialist and could be taken care of at most regional hospitals. In this study, we will evaluate the appropriateness of patient transfers for hand trauma and determine if there is a correlation between inappropriate transfers and undesirable factors, such as insurance status and off-hour's presentation. Methods A retrospective chart review was performed in all patients transferred to a level I trauma center for hand and microsurgical trauma over a 22-month period. Collected data included indication for transfer, mode of transfer, time and day of the week, patient demographics, insurance status, and whether the transferring facilities had surgical coverage available. A synopsis, including treatment details, of each transfer was created, and a survey was sent to a review committee who rated the appropriateness of the transfers. Statistical analysis was performed to determine whether appropriateness of transfers was influenced by nonmedical variables. Results Over a 22-month period, a total of 95 hand or microsurgical patients were transferred to a single tertiary referral center. Of these, 66 % of the transfers were considered inappropriate by the surveyed physicians. Inappropriate transfers were statistically more likely to be under insured or transferred during nonbusiness hours. Conclusion A large percentage of patients are being transferred to tertiary care centers for reasons other than medical necessity, generating a large burden on already strained medical resources.

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“…3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6 Of the hospitals that do offer replantation procedures, most perform fewer than 10 operations per year. 5,6 Consequently, only 14% of finger amputations injuries in the US are treated with replantation.…”

mentioning

confidence: 99%

“…5,6 Of the hospitals that do offer replantation procedures, most perform fewer than 10 operations per year. 5,6 Consequently, only 14% of finger amputations injuries in the US are treated with replantation. [5][6][7] Whereas in Japan, replantation is attempted in 29% of digit amputation cases 8 There is little data comparing the results of finger replantation and revision amputation.…”

mentioning

confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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Purpose-Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.Methods-We created a survey to assess surgeons' experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting.Results-100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as "poor." Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees.Conclusion-There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.Corresponding author and reprint requests sent to: Kevin C Chung, MD, MS, Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, 2130 Taubman Center, 1500 W Medical Center Dr, Ann Arbor, MI 48109-0530, Phone: 734-615-3435, kecchung@umich.edu. Hand injuries pose a worldwide burden. Much of the world relies on manual labor such as farming and factory work for sustenance and income. In these cases, revision amputation, which allows for quicker return to work while largely maintaining function, is the preferred treatment. Despite more oversight by many countries in developing safety measure to protect workers, amputation of digits occurs frequently, even in highly developed countries such as the US and Japan. In these regions surgeons are engaged in intense microsurgical training and have access to advanced surgical technology and are able to replant amputated digits successfully. The use of this procedure is variable, however. In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6...

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Current Practice of Microsurgery by Members of the American Society for Surgery of the Hand

Cited by 115 publications

References 5 publications

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Evaluation of Appropriateness of Patient Transfers for Hand and Microsurgery to a Level I Trauma Center

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

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