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ZusammenfassungDiese Arbeit klärt den Anspruch auf die Urheberschaft der Erstbeschreibung des heterodigitalen neurovaskulären Insellappens, stellt beschriebene Varianten vor und präsentiert eine Serie von 15 Fällen mit klinischen Beispielen.

ZusammenfassungSeit Beginn erfolgreicher mikrochirurgischer Fingerreplantationen Anfang der 60er Jahre des letzten Jahrhunderts zeigt sich eine Evolution in den Techniken zur Wiederherstellung der Durchblutung der amputierten Finger. Initial wurden bei den ersten Fingerreplantationen End-zu-End-Anastomosen der Arterien und Venen durchgeführt. Später wurden bei schwierigen Avulsionsverletzungen Gefäßinterponate – in erster Linie Veneninterponate –mit Erfolg eingesetzt. Diese Gefäßinterponate wurden bei gleichzeitigen Weichteilverlusten durch Lappenplastiken im Sinne von Durchflusslappen erweitert. Eine Weiterentwicklung der Techniken stellt die Replantation von amputierten Fingern mit Hilfe von fabrizierten chimären Lappenplastiken dar. Dabei wird der amputierte Finger noch vor der eigentlichen Replantation in Tabula, auf dem Operationstisch, mit den Gefäßen einer Lappenplastik mikrochirurgisch anastomosiert und erst dann diese Chimera fabricata als Konstrukt replantiert. Die bisher letzte Entwicklung ist die heterotope Replantation mit sekundärer Replantation als fabrizierte chimäre Lappenplastik. Wir beschreiben im Sinne einer Einführung 3 Fälle, bei welchen wir dieses Konzept der fabrizierten chimären Lappenplastik bei orthotopen Replantationen erfolgreich angewendet haben.

Adhesions between the interosseous and lumbrical muscles involving the deep transverse metacarpal ligament (dTML) can be a cause of chronic pain and reduced range of motion. New reports on this condition are rare. We identified five patients experiencing pain, swelling and decreased range of motion in the metacarpophalangeal (MCP) joints during manual load. The condition was caused by a direct trauma. After not responding to conservative treatment, patients underwent surgery. Time between trauma and surgery was on average 16 months and the mean postoperative follow-up was 8 months. The lumbrical-interosseus junction was exposed by volar or dorsal incision, adhesions were widely released and the distal third of the dTML was resected. This resulted in normal passive excursion of the muscles and the tendon junction. At the mean follow-up time 8.2 months (3-18) after surgery, all patients were pain-free and had gained near normal range of motion in the MCP joints. Interosseous-lumbrical adhesions may be more common than reflected by the literature. Hand surgeons should keep this condition in mind in cases with chronic inter-metacarpal pain after trauma or infection. Surgical exploration is relatively straight forward and tends to lead to gratifying results. Level of Evidence: IV (therapeutic).

Background The aim of this study was to evaluate the effectiveness and safety of free corticoperiosteal medial femoral condyle (MFC) flap for ankle, hindfoot and midfoot reconstruction in patients with recalcitrant nonunion. Methods Patients who underwent ankle and foot reconstruction using the MFC flap at our clinic were recruited for assessment of the union rate, time to union and functional outcome. Furthermore, a clinical and radiological examination of the donor knee was performed using both computed tomography and magnetic resonance imaging. Results Thirteen patients with a mean follow-up time of 2.5 years were included; 10 of them had a previously failed ankle and foot arthrodesis. Union was achieved in 11 patients in an average time of 10 months after MFC flap surgery. Donor site morbidity was minor with no radiological evidence for soft tissue or bone complication. Conclusion MFC flaps are a useful and safe reconstructive tool and may be considered after failed ankle and foot arthrodesis.

Silastic spacer replacement for the treatment of destroyed finger joints due to degenerative, post-traumatic or rheumatoid osteoarthritis has been well established for years. In acute severely traumatized hands silastic spacer replacement is seldomly performed We report five consecutive patients in whom a defect injury of a finger joint was replaced by a silicone implant without complications during primary care. We reviewed all our patients with a follow up of at least 8 months. In all patients healing was uneventful, with no infections and a functional range of motion. No patient complained about instability. With the right patient selection, joint replacement with silastic spacers is a valuable alternative to arthrodesis in acute destroyed finger joints.Fingergelenksarthroplastiken mit Silikonimplantaten zur Behandlung einer degenerativen, rheumatischen oder posttraumatischen Gelenksdestruktion werden seit Jahren mit gutem Erfolg durchgeführt. Bei akut schwer traumatisierten Händen erfolgt der Einsatz von Silikonimplantaten selten. Wir berichten über 5 konsekutive Patienten, bei denen bei einer Defektverletzung eines Fingergelenkes bei der Primärversorgung das defekte Gelenk durch ein Silikonimplantat komplikationslos ersetzt wurde. Die Nachbeobachtungszeit betrug mindestens 8 Monate. Bei allen Patienten verlief die Heilung ereignislos ohne Infektionen und mit einem funktionellen Bewegungsumfang. Kein Patient klagte über Instabilität. Bei richtiger Patientenselektion ist der Gelenkersatz mit Silikonimplantaten auch in der akuten Unfallsituation eine sinnvolle Alternative zur Arthrodese von zerstörten Fingergelenken.

Introduction There is growing evidence of the superior ability of muscular tissue to clear bacterial bone infection. Unfortunately, in the hand, there are almost no small local muscular flaps, and muscular transfers to the hand are mainly microsurgical free transfers. In this report, we present the results of the use of a chimeric posterior interosseous flap including part(s) of the forearm muscles to treat osteomyelitis and soft tissue defect of hand from a series of patients. Patients and methods Four male patients with an average age of 32 years (range 20-46 years), were affected by acute osteomyelitis in hand. Previous fracture fixation with percutaneous K-wires was the cause of bone infection in three case. In one case, the osteomyelitis was a consequence of an open fracture. The bones affected were four metacarpals and one proximal phalanx, all with a minimal cortical defect (from the K-wire) obscuring a larger medullary infection, which required extensive bone and overlying soft tissue debridement, leaving a soft tissue defect to be reconstructed of size ranging from 2 x 4 cm to 5 x 7 cm. The soft tissue defects were due to concomitant superficial infection and consequent debridement. All patients were treated with bone debridement and a chimeric posterior interosseous flap, which included part of the extensor digiti minimi and/or extensor carpi ulnaris to fill the intramedullary canal of the bones. No fixation of bone was necessary. Results The skin paddle of the flaps ranged from 2 x 5 cm to 5 x 6 cm, replicating the defect area, plus a teardrop tail of skin circa 1.5 cm wide and as long as the pedicle of the flap. The muscular components of the flaps used to fill the intramedullary canals ranged from 1 x 1 x 1.5 cm to 1.5 x 1.5 x 4 cm. All flaps survived and osteomyelitis resolved in all cases without major complications. At the final follow-up at 16 months (range 12-26 months), assessment of the hands using TAM, Power Grip and Key Pinch Strength measurements and, where appropriate, Kapandji scores, demonstrated satisfactory hand function. Conclusion The chimeric posterior interosseous flap including part of the muscles of the forearm may be a robust solution for augmenting the flap bulk and may be used in cases of severe osteomyelitis of the hand.

Since microsurgical finger replantations started to be successfully performed at the beginning of the 1960 s, there has been an evolution in the techniques for restoring blood flow to the amputated fingers. Initially, end-to-end anastomoses were performed. Later on, vascular grafts - predominantly vein interpositional grafts - were successfully used for difficult avulsion injuries. These vascular grafts were extended by microvascular flaps in the form of flow-through flaps in cases with simultaneous soft tissue loss. A further development of these techniques has been achieved by the replantation of amputated fingers with the help of fabricated chimeric flaps. The amputated finger is anastomosed microsurgically with a flap "in tabula" before the actual replantation. Only then is the fabricated chimera replanted as a construct. The latest development so far is heterotopic replantation with secondary replantation in the form a fabricated chimeric flap. By way of introduction, we describe three cases in which we have successfully applied this concept of fabricated chimeric flap surgery for orthotopic thumb replantations.Seit Beginn erfolgreicher mikrochirurgischer Fingerreplantationen Anfang der 60er Jahre des letzten Jahrhunderts zeigt sich eine Evolution in den Techniken zur Wiederherstellung der Durchblutung der amputierten Finger. Initial wurden bei den ersten Fingerreplantationen End-zu-End-Anastomosen der Arterien und Venen durchgeführt. Später wurden bei schwierigen Avulsionsverletzungen Gefäßinterponate – in erster Linie Veneninterponate –mit Erfolg eingesetzt. Diese Gefäßinterponate wurden bei gleichzeitigen Weichteilverlusten durch Lappenplastiken im Sinne von Durchflusslappen erweitert. Eine Weiterentwicklung der Techniken stellt die Replantation von amputierten Fingern mit Hilfe von fabrizierten chimären Lappenplastiken dar. Dabei wird der amputierte Finger noch vor der eigentlichen Replantation in Tabula, auf dem Operationstisch, mit den Gefäßen einer Lappenplastik mikrochirurgisch anastomosiert und erst dann diese Chimera fabricata als Konstrukt replantiert. Die bisher letzte Entwicklung ist die heterotope Replantation mit sekundärer Replantation als fabrizierte chimäre Lappenplastik. Wir beschreiben im Sinne einer Einführung 3 Fälle, bei welchen wir dieses Konzept der fabrizierten chimären Lappenplastik bei orthotopen Replantationen erfolgreich angewendet haben.

Degenerative changes of the distal interphalangeal (DIP) joints can be painful, disabling, and disfiguring. Swanson spacers can be used for DIP arthroplasty. The standard approach for Swanson spacer implantation at the DIP joint involves transecting the extensor tendon close to its insertion, which necessitates a 6-week period of postoperative immobilization. Another DIP approach involves sparing the extensor tendons, as already published. Both techniques lead to a similar range of motion of the replaced DIP joints. We present a novel approach for DIP joint arthroplasty with division of the extensor tendon in zone 2 with only 2 weeks of postoperative immobilization. Optimizing the motion-preserving operative approaches is of value to our high-demand patients. Postoperative results do not differ from the postoperative range of motion published in the literature for both tendon-sparing and standard approaches. But our approach is technically easy and requires a significantly shorter time of immobilization.

Arthroplasty of the distal radioulnar joint (DRUJ) using a semiconstrained DRUJ implant yields good outcomes according to the literature. The aim of this study was to investigate the subjective, clinical and radiographic outcomes with a special focus on complications in nine patients with a mean follow-up of 6years and to compare them with our previously published 3-year follow-up results. No subjective or objective changes were seen between the 3-year and the 6-year follow-up. In the previous study, one implant loosening and two irritations of the superficial branch of the radial nerve occurred. We saw three complications that needed surgery in addition to the three complications already found 3years after surgery. One patient with a large ulna had loosening of the cemented ulnar stem and therefore the prosthesis was explanted. One patient had an allergic reaction to the metal alloy of the prosthesis, which also led to removal. One patient had an ulnar impaction syndrome caused by too-distal placement of the implant that needed revision. Prior studies reported low complication rates. In our study, six complications occurred in four out of nine patients, requiring reoperation including two revisions and two implant removals. A precise surgical technique is mandatory to avoid the otherwise frequent complications and potential implant failures. LEVEL OF EVIDENCE: IV.

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half. When the flexor digitorum profundus tendon would not glide under the A2 pulley, we excised the remaining slip of the flexor digitorum superficialis tendon. The wrist was splinted in mild extension post-surgery with early commencement of tenodesis exercises. No tendon repair ruptured. By the Strickland criteria, out of 27 fingers, 18 had excellent, six had good, two had fair, and one had poor results. We conclude that a strong core suture (such as the M-Tang repair) without peripheral sutures, and with division of pulleys as necessary is safe for early active motion and yields good outcomes. Level of evidence: IV

The protocol for primary flexor tendon repair in zones 1 and 2 of the hand is changing. This article discusses recent changes. Immediate repair within 48 hours is performed whenever possible. A 6-strand core suture is performed using the M modification of Tang's technique. The pulleys are divided to allow free excursion of the repaired tendon within the tendon sheath. To avoid repaired structures within the sheath being too bulky, the authors generally repair only half of the flexor digitorum superficialis. In some cases, the flexor digitorum superficialis is excised completely. Rehabilitation remains based on controlled active motion.

Zusammenfassung. Das Extremitätentrauma mit Weichteilschaden ist eine Herausforderung für die behandelnden Chirurgen. Für das Outcome entscheidend ist ein effizienter interdisziplinärer Behandlungsansatz durch Unfallchirurgen/Orthopäden und Plastische Chirurgen, die so früh wie möglich eine gemeinsame Strategie festlegen. Das Ziel dieses orthoplastischen Vorgehens ist die frühe definitive Frakturstabilisation kombiniert mit Weichteildeckung (fix and flap). Die Weichteilrekonstruktion erfolgt heute nach einem modularen Prinzip und nicht mehr linear gemäss der rekonstruktiven Leiter. Die Vielzahl unterschiedlicher Verletzungsmuster bedingt sehr variable Vorgehensweisen in der Rekonstruktion der Weichteildefekte. Dies erschwert eine standardisierte Behandlung und erfordert massgeschneiderte Lösungen, häufig unter Zuhilfenahme mikrochirurgischer Techniken. Eine funktionelle Wiederherstellung verlangt vielfach eine Kombination von Hauttransplantaten, lokoregionalen und freien Lappenplastiken. Die Vakuumtherapie hat sich als nützliches Werkzeug in der Behandlung komplexer Extremitätenverletzungen erwiesen.

Introduction None of the existing treatments in the management of painful end-neuromas of the superficial branch of the radial nerve (SBRN) has been proven superior due to high levels of pain relapse. Fat grafts enriched with the stromal vascular fraction (SVF) could act as a mechanic barrier with biological effects decreasing the resorption rate and boosting the graft's regenerative potential. This study describes the novel surgical treatment technique of SVF-enriched fat grafting. Patients and Methods In this clinical study, five consecutive patients treated for painful end-neuromas of the SBRN between 2012 and 2013 were analyzed retrospectively. Microsurgical resection of end-neuromas followed by SVF-enriched fat grafting around the nerve stump was performed in all patients. Five different pain modalities and various predictors were compared pre- and up to 36 months postoperatively. Results Pain reduction observed at 2 months after surgery was constant over time, though not statistically significant compared to preoperative levels. Spontaneous pain could be reduced from 1.6 ± 0.55 to 1.2 ± 1.1 (p = 0.414), spikes from 2.2 ± 1.3 to 1.4 ± 1.34 (p = 0.180), hyperaesthesia from 1.6 ± 1.14 to 1.2 ± 1.64 (p = 0.713), tap pain from 2.8 ± 0.45 to 1.8 ± 1.3 (p = 0.197) and motion pain from 2.8 ± 0.45 to 1.4 ± 1.34 (p = 0.066). An improvement in overall pain reduction could be observed from 2.2 ± 0.97 to 1.4 ± 1.26 3 years after the surgery (p = 0.104). Conclusion SVF-enriched fat grafting represents another alternative to numerous available treatments of painful end-neuromas of the SBRN. Our preliminary results could not show any significant difference in pain reduction following SVF-enriched fat grafting. Further larger trials are required in order to evaluate the therapeutic potential of SVF-enriched fat grafting.

Fifteen consecutive patients with severely comminuted Rolando fractures were treated by closed reduction and fixation with a modified Suzuki frame without rubber bands, followed by immediate mobilization. All the fractures healed within 5 weeks. At 3 months, no rotational deformity was observed. The Kapandji score was equal that of the contralateral thumb in eight cases. No residual pain was recorded. Grip strength was 78% and pinch strength was 78% of the contralateral hand. One patient needed the frame tension modified. One patient developed a sensory deficit in the area of the superficial branch of the radial nerve that resolved spontaneously in 3 months. One patient healed with a 2-mm articular step-off, but the clinical outcome was good. Our retrospective study suggests that the small modification we made to the Suzuki frame provides a relatively simple and minimally invasive technique for the treatment of comminuted Rolando fractures.

Summary Background Population aging strongly affects the demographic development of industrialized countries. While microsurgical procedures were initially believed to be only feasible in patients of younger age because of the duration of the surgical procedure and the higher risk of vascular insufficiency due to age-related comorbidities, it has become evident that these procedures are beneficial even for patients at an advanced age. Methods We retrospectively investigated microsurgical procedures in a patient cohort ( n = 25 with 27 free flaps) with a minimum age of 78 years with regard to patients' characteristics, flap survival, and postoperative surgical and medical complications. Results Median age was 81 years (IQR 6). Most defects were located in the head and neck region. The mean operation time was 384 min (standard deviation (SD) 131). Flap failure was observed in three cases (11%). The median length of hospital stay was 17 days (interquartile range (IQR) 8). The mean ASA score was 2.48. Patients' age and ASA group did not correlate. The mortality rate was 4%. Postoperative surgical complications were observed in 11 cases (41%), while 19 patients (70%) showed one or more medical complications. Higher ASA classes tended to show more postoperative complications. However, neither age nor operating time nor ASA status showed significant influence on the occurrence of postoperative medical or surgical complications. Conclusion There is growing demand for structural and functional restoration using free tissue transfer in an aging population. If there are no alternative treatment options available promising similar structural and functional preservation, free tissue transfer is justifiably in very old patients despite a potentially increased flap failure. As such, free tissue transfer is used as a curative treatment concept aiming at a maximum of patients' independence and early ambulation. Occurrence of complications can be diminished by adequate patient selection and thorough perioperative care.

We present the results of 26 patients with 31 consecutive displaced or unstable extra-articular fractures of the base and shaft of the proximal and middle phalanges of the digits of the hand, treated over a period of 12 months with an intramedullary headless compression screw and early mobilization with no splinting. All fractures healed with no major complications. Only one patient, who had a pathological fracture through an enchondroma, required a tenolysis to improve the mobility of the finger. This technique seems to be technically simple, effective and with few drawbacks. Level of evidence: IV

The aim of this study was to quantify the articular cartilage defect created with two different antegrade techniques of intramedullary osteosynthesis with a headless compression screw inserted through the metacarpophalangeal joint. In 12 out of 24 fingers from six cadaveric hands, a trans-articular technique with cannulated headless compression screws (2.2 and 3.0 mm diameter) was used; whereas in the other 12 fingers, an intra-articular fixation technique was used. The areas of the articular surface and the defects created were measured with a digital image software program. All measurements were made twice by two observers. In the intra-articular technique, the average defect in the base of the articular surface of the proximal phalanx was 4.6% with the 2.2 mm headless compression screw and 8.5% with the 3.0 mm screw. In the trans-articular technique, the defect size was slightly smaller; 4.2% with the 2.2 mm screw and 8% with the 3.0 mm screw, but the differences were not statistically significant. The main advantage of the intra-articular technique was that it avoided damage to the articular surface of the metacarpal head.

In this report a case of closed mallet thumb injury is described, which was diagnosed clinically and indication for surgical treatment was confirmed with ultrasound examination. The EPL-tendon was successfully reconstructed with an excellent result. We propose a mandatory ultrasound examination of all closed mallet thumb injuries.

We aimed to examine if joint procedures in hands and wrists of patients with scleroderma could be performed without major morbidity and conducted a systematic review of the literature to assess this hypothesis. Studies were identified in four different databases; soft tissue procedures in scleroderma patients were excluded, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven studies out of an initial total of 203 articles were included. One-hundred and twelve scleroderma patients with a total of 402 joint procedures in the hand and wrist were identified. A low complication incidence, comparable with that of non-sclerodermic population, in terms of infection, wound healing problems, and nonunion was reported in all studies. The application of joint procedures in scleroderma hands and wrists seems to be associated with low morbidity.

We analyzed the results of 20 unstable metacarpal fractures in 15 patients treated with a cannulated compression screw and no immobilization. All fractures healed within 6 weeks. One patient with multiple fractures and a flexion deficit required arthrolysis of two metacarpophalangeal joints. Another patient had an extension lag. There were no other complications. This fast and easy technique results in good outcomes for unstable metacarpal fractures. The advantages are early active motion without immobilization and stable fixation. Surgical removal of the screw is rarely needed. Level of evidence IV (therapeutic).

Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone. One case presented a multiple metacarpal and phalangeal facture associated. The authors used wide-awake anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter). No open reduction was needed. Early active mobilization started with a buddy strapping soon after surgery (0–3 days). The authors followed all patients until satisfactory function was achieved (4–6 weeks) and recorded the time till return to work. All fracture healed with less than 5 degrees of rotational or axial deformities. All patients return to work within 2.38 weeks after surgery (0.5–6 weeks). No cases of complex regional pain syndrome (CRPS), tendon lesions, nerve injuries, infection, hardware protruding, or mobilization were reported. Intramedullary screw fixation with wide-awake anesthesia for transverse, oblique, and select comminuted fractures treatment metacarpal fractures represent a reliable option to early active mobilization recovery and a quick return to the work and ordinary activities.

Digital replantation is a well-established and increasingly common procedure in specialized hand surgery units worldwide. Replantation after complex trauma is often challenging due to severely injured, small-diameter vessels, especially at the distal level. Digit salvage by arteriovenous anastomosis has been inadequately described in the literature for such cases. The objective of this study was to evaluate the outcomes and complications of arteriovenous digital replantation in complex amputations. We reviewed five cases of digital replantation using a single palmar afferent arteriovenous anastomosis and drainage via a dorsal vein. The postoperative protocol followed our standard replantation protocol. All digits survived with no revision procedures. No major complications were observed. One digit developed partial epidermolysis and one thumb developed marginal skin necrosis, both treated conservatively. The color of the replanted digits was not a reliable monitoring parameter but capillary refill was consistently visible. Microangiography performed four months after surgery demonstrated good digit perfusion. Our results support palmar arteriovenous anastomosis as a reliable alternative in digital replantation if distal arteries are unavailable for anastomosis. The results also suggest that this digit salvage procedure can be carried out at a more proximal level than previously reported.

Summary Peripheral neuromas can result in an unbearable neuropathic pain and functional impairment. Their treatment is still challenging, and their optimal management is to be defined. Experimental research still plays a major role, but - although numerous neuroma models have been proposed on different animals - there is still no single model recognised as being the reference. Several models show advantages over the others in specific aspects of neuroma physiopathology, prevention or treatment, making it unlikely that a single model could be of reference. A reproducible and standardised model of peripheral neuroma would allow better comparison of results from different studies. We present a systematic review of the literature on experimental in vivo models, analysing advantages and disadvantages, specific features and indications, with the goal of providing suggestions to help their standardisation. Published models greatly differ in the animal and the nerve employed, the mechanisms of nerve injury and the evaluation methods. Specific experimental models exist for terminal neuromas and neuromas in continuity (NIC). The rat is the most widely employed animal, the rabbit being the second most popular model. NIC models are more actively researched, but it is more difficult to generate such studies in a reproducible manner. Nerve transection is considered the best method to cause terminal neuromas, whereas partial transection is the best method to cause NIC. Traditional histomorphology is the historical gold-standard evaluation method, but immunolabelling, reverse transcriptase-polymerase chain reaction (RT-PCR) and proteomics are gaining increasing popularity. Computerised gait analysis is the gold standard for motor-recovery evaluation, whereas mechanical testing of allodynia and hyperalgesia reproducibly assesses sensory recovery. This review summarises current knowledge on experimental neuroma models, and it provides a useful tool for defining experimental protocols. Furthermore, it could help future research to define standard experimental model(s) of peripheral neuromas, allowing better comparison of results and improvement of our understanding of such a complex disease.

The purpose of this study was to methodically illustrate and highlight the crucial steps of stromal vascular fraction (SVF)-enriched fat grafting as a novel treatment of symptomatic end-neuromata of peripheral sensory nerves, and in this study, specifically of the superficial branch of the radial nerve (SBRN). Despite a multitude of existing treatments, persistent postoperative pain and common pain relapse are still very common, independent of the procedure assessed. The neuroma is microsurgically excised accordingly to standardized protocol. Instead of the relocation of the regenerating nerve stump in neighboring anatomical structures, such as muscle or bone, a fat graft is applied perifocally and acts as a mechanical barrier. In order to reduce the fat resorption rate and boost the regenerative potential of the graft, the highly concentrated SVF is integrated in the grafting. The SVF is isolated from subcutaneous fat by enzymatic and mechanic separation of the lipoaspirate by a specific commercial isolation system. The SVF-enriched fat graft provides both a mechanical barrier and various biological effects at the cellular level, including improving angiogenesis, inflammation, and fibrosis. Both mechanical and biologic effects help to reduce the disorganized axonal outgrowth of the nerve stump during nerve regeneration and hence prevent the recurrence of painful end-neuromata.

Common hand problems are treated differently in different countries. This article attempts to bring together the views of surgeons from different countries on some of the most common hand problems that hand surgeons encounter in daily practice. In practice, the correct treatment of these problems may be the most important and influential to patients.