Search Our Scientific Publications & Authors

JPRAS Open 2022 Jun 21;32:98-110. Epub 2022 Feb 21.

Department of Plastic, Aesthetic Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover 30625, Germany.

The treatment of traumatic major upper limb amputation is complex and of great urgency. Loss of time often represents a majorrestriction for replantation. Thus, logistical and infrastructural developments, such as the expansion of specialised hand trauma centres, are crucial for optimizing delivery of care. Read More

Ann Med Surg (Lond) 2022 Mar 11;75:103378. Epub 2022 Feb 11.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Bilateral brachial plexus blocks can be an alternative to general anaesthesia in the surgery of arm, forearm, wrist, or hand. This study aims to report a case in which a risky patient underwent amputation surgery under regional anaesthesia.

Case Presentation: A 64-year-old male was admitted to the hospital for an amputation operation. Read More

Injury 2022 Jun 10;53(6):2102-2109. Epub 2022 Feb 10.

Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.

Introduction: This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would differ from a recent study of patients treated in hospital emergency departments (EDs) in Jerusalem.

Methods: Data on all hand injury patients treated at any of the CBECs belonging to a large nationwide chain in 2017 were retrieved from the electronic medical records of the treatment centers, including demographic and clinical characteristics. Read More

IEEE Trans Biomed Eng 2022 Jul 17;69(7):2243-2255. Epub 2022 Jun 17.

Objective: Persons with normal arm function can perform complex wrist and hand movements over a wide range of limb positions. However, for those with transradial amputation who use myoelectric prostheses, control across multiple limb positions can be challenging, frustrating, and can increase the likelihood of device abandonment. In response, the goal of this research was to investigate convolutional neural network (RCNN)-based position-aware myoelectric prosthesis control strategies. Read More

Annu Int Conf IEEE Eng Med Biol Soc 2021 11;2021:4670-4673

Table tennis is a popular sport for forearm amputees. However, forearm amputees with limited pronation and supination movements cannot switch the racket angle properly for forehand and backhand drives. This paper reports a table tennis prosthetic hand controlled based on distance measurement using a ToF Sensor. Read More

Handchir Mikrochir Plast Chir 2021 Oct 18. Epub 2021 Oct 18.

Pomeranian Medical University, Department of General and Hand Surgery.

Replantation of amputated hands is now considered a routine procedure in countries representing high standards of medical care. However, organization of care for patients with hand amputations is not uniform and varies from country to country, even in the European Union. This article presents organization of the Replantation Service for hand amputations in Poland, and ten-year activity report of the Service. Read More

J Hand Surg Asian Pac Vol 2021 Sep;26(3):455-459

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. Read More

Pol Przegl Chir 2021 Mar;93(2):26-32

Department of Traumatology and Hand Surgery, Medical University in Wroclaw, Poland.

This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Read More

J Neuroeng Rehabil 2021 01 6;18(1). Epub 2021 Jan 6.

Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, CNRS and Univ. Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France.

Background: Prosthetic restoration of reach and grasp function after a trans-humeral amputation requires control of multiple distal degrees of freedom in elbow, wrist and fingers. However, such a high level of amputation reduces the amount of available myoelectric and kinematic information from the residual limb.

Methods: To overcome these limits, we added contextual information about the target's location and orientation such as can now be extracted from gaze tracking by computer vision tools. Read More

J Hand Microsurg 2020 Oct 2;12(Suppl 1):S70-S74. Epub 2019 Nov 2.

Department of Orthopaedic and Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, United States.

 We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management.  Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active "place-and-hold" motion protocol was initiated within the first 3 postoperative days. Read More

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:3285-3288

Currently, myoelectric prostheses lack dexterity and ease of control, in part because of inadequate schemes to extract relevant muscle features that can approximate muscle activation patterns that enable individuated dexterous finger motion. This project seeks to apply a novel algorithm pipeline that extracts muscle activation patterns from one limb, as well as from forearm muscles of the opposite limb, to predict muscle activation data of opposite limb intrinsic hand muscles, with the long-range goal of informing dexterous prosthetic control. Read More

Injury 2020 Aug 18;51(8):1828-1833. Epub 2020 Jun 18.

Department of Orthopaedics Surgery, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, 214000, China. Electronic address:

Background: Major bone defects in forearm caused by severe trauma is a real challenge for orthopedic surgeons. This study aimed to evaluate the role of one-bone forearm (OBF) reconstruction combined with distal radioulnar joint fusion (DRUJF) as a rescue option under this difficult situation.

Methods: In total, 18 patients with major bone defects in forearm caused by severe trauma were selected from 2003 to 2017 and followed up for 2 to 16 years. Read More

SAGE Open Med 2020 27;8:2050312120926351. Epub 2020 May 27.

Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.

Objectives: Our hands play a remarkable role in our activities of daily living and the make-up of our identities. In the United States, an estimated 41,000 individuals live with upper limb loss. Our expanding experience in limb transplantation-including operative techniques, rehabilitation, and expected outcomes-has often been based on our past experience with replantation. Read More

J Hand Microsurg 2022 Jan 13;14(1):31-38. Epub 2020 Apr 13.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago Illinois, United States.

 Our purposes were to (1) characterize the timeline of eight postoperative complications following hand surgery, (2) assess complication timing for the procedures that account for the majority of adverse events, and (3) determine any differences in complication timing between outpatient and inpatient procedures.  Patients undergoing hand, wrist, and forearm procedures from 2005 to 2016 were identified in the National Surgical Quality Improvement Program database. Timing of eight adverse events was characterized. Read More

Ann Plast Surg 2020 12;85(6):612-617

From the Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing.

Background: The hand and wrist are most often in contact with electrical currents and thus most vulnerable to severe electrical burns. The treatment of such severe injury via surgical intervention remains a big challenge because of the vast tissue necrosis and the segmental vascular injury. The flow-through lateral-thigh free flap has been used effectively to resurface these defects and to reconstruct segmental vascular defects. Read More

BMC Musculoskelet Disord 2020 Jan 18;21(1):40. Epub 2020 Jan 18.

Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.

Background: The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.

Methods: Testing was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Read More

Ulus Travma Acil Cerrahi Derg 2020 Jan;26(1):123-129

Department of Emergency and First Aid, European Vocational High School, İstanbul-Turkey.

Background: Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of upper extremity amputation, disfigurements frequently cause psychological and social debilitations.

Methods: Between 2007-2015, fourteen cases were admitted to emergency with total major amputation of the upper extremity. Read More

Zhonghua Shao Shang Za Zhi 2019 Nov;35(11):776-783

Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.

To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. Read More

Cureus 2019 Oct 7;11(10):e5858. Epub 2019 Oct 7.

Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA.

Indications for upper-extremity replantation include wrist-level and wrist-proximal amputations, due to the devastating loss of function incurred from these severe injuries. Decisions regarding replantation must be made expeditiously at these proximal levels in an effort to minimize ischemia time. This decision-making process becomes more complicated when a patient presents following intentional self-amputation of an extremity, especially in the setting of an associated mood disorder, psychiatric illness, and/or frank psychosis. Read More

Plast Reconstr Surg 2019 11;144(5):878e-911e

From the W Institute for Hand and Reconstructive Microsurgery and the Department of Plastic and Reconstructive Surgery, W General Hospital.

Learning Objectives: After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Read More

Anticancer Res 2019 Oct;39(10):5663-5668

Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, U.S.A.

Background/aim: Osteosarcoma of the upper extremities is rare, and characteristics in this location have not been described before. We aimed to analyze the characteristics and survival rate of osteosarcoma of the upper extremities.

Materials And Methods: A retrospective cohort study was performed by querying the National Cancer Database. Read More

Cureus 2019 Jul 17;11(7):e5164. Epub 2019 Jul 17.

Dermatology, Pakistan Air Force Hospital, Islamabad, PAK.

Introduction Traumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons' tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. Read More

Skeletal Radiol 2019 Oct 15;48(10):1643-1649. Epub 2019 Apr 15.

Imaging Institute, Cleveland Clinic, 9500 Euclid Ave. A21, Cleveland, OH, 44195, USA.

Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly patients. The neoplasm may be superficial or deep to the muscle fascia and characteristically has an infiltrative growth pattern with a dominant or multinodular mass. We describe an unusual case of high-grade myxofibrosarcoma of the wrist and forearm that infiltrated the muscles, tendons, and wrist joint, causing bone erosions. Read More

Hand Clin 2019 05;35(2):143-154

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA. Electronic address:

Level of injury plays a significant role in decisions to perform replantation, with improved function, nerve regeneration, and decreased rate of reperfusion injury for injuries at the distal forearm or wrist compared with proximal injuries. The principles of a functional and sensate outcome dictate replantable parts, whereas patient comorbidity, expectations, and safety dictate patient candidacy. Vascular grafts are an expected part of the operation, and the contralateral arm or a lower extremity should be prepped into the surgical field. Read More

J Hand Surg Am 2019 Jun 4;44(6):525.e1-525.e8. Epub 2019 Feb 4.

Carolinas Medical Center, Atrium Health, Charlotte, NC; Reconstructive Center for Lost Limbs, OrthoCarolina Hand and Wrist Center, Charlotte, NC. Electronic address:

Targeted muscle reinnervation (TMR) is a surgical technique that improves modern myoelectric prosthesis functionality and plays an important role in the prevention and treatment of painful postamputation neuromas. Originally described for transhumeral amputations and shoulder disarticulations, the technique is being adapted for treatment of transtibial, transfemoral, transradial, and partial hand amputees. We describe a new technique for forearm TMR following transradial amputation with an emphasis on selecting nerve transfer patterns, managing sensory nerves, improving terminal soft tissue coverage, and employing pattern recognition technology. Read More

JBJS Case Connect 2018 Oct-Dec;8(4):e92

Western Orthopaedics, Denver, Colorado.

Case: A 49-year-old right-hand-dominant man sustained an auger-related injury that resulted in open dislocation at the left wrist and palm, with complete amputation of the distal aspect of the forearm and the hand. The injury at the elbow included instability with an ulnar coronoid fracture, posterior dislocation of the ulna, and posterolateral dislocation of the radius. To restore stability of the forearm stump and elbow, we performed a complete resection of the radius, open reduction and internal fixation of the coronoid tip, a repair of the lateral collateral ligament, and transfer of the distal biceps tendon to the coronoid. Read More

IEEE Trans Neural Syst Rehabil Eng 2018 12 13;26(12):2333-2341. Epub 2018 Nov 13.

Osseointegrated transradial prostheses have the potential to preserve the natural range of wrist rotation, which improves the performance of activities of daily living and reduces compensatory movements that potentially lead to secondary health problems over time. This is possible by enabling the radius and the ulna bone to move with respect to each other, restoring the functionality of the original distal-radioulnar joint. In this paper, we report on psychophysics tests performed on an osseointegrated transradial amputee with the aim to understand the extent of mobility of the implants that is required to preserve the natural forearm rotation. Read More

Pol Przegl Chir 2018 May;90(4):1-5

Uniwersytet Medyczny w Gdańsku Katedra i Klinika Ortopedii i Traumatologii Narządu Ruchu.

The paper summarizes 32 months (January 2014 - August 2016) of activity of the Replantation Service for hand amputation in Poland. Over this period a total of 568 cases of total and subtotal amputations as well as other complex injuries to the hand were referred. Of these, 354 referrals (62%) were accepted and 214 (38%) rejected. Read More

Injury 2018 Oct 22;49(10):1805-1809. Epub 2018 Aug 22.

Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC 29425, United States; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC 29425, United States. Electronic address:

Background: All terrain vehicle accidents are a common cause of trauma admission and often associated with extremity injuries. However specifics of injury patterns to the upper extremity has not previously been described. A multicenter, retrospective study was conducted to determine the frequency and distribution of upper extremity injuries sustained from ATV accidents. Read More