Recent Publications

This study examined how different causes of traumatic lower extremity injuries — such as car crashes, motorcycle collisions, blast injuries, falls, and pedestrian accidents — affect surgical reconstruction outcomes. Researchers reviewed 251 patients treated at a Level I trauma center over 30 years, using statistical models to identify which injury causes independently predicted complications, additional surgeries, or longer hospital stays. Motor vehicle collisions (MVCs) were linked to significantly longer hospitalizations, averaging nearly 17 additional days, regardless of injury severity or the type of reconstructive procedure performed. Surprisingly, high-energy injuries did not universally lead to worse outcomes, and crush injuries did not increase the risk of tissue death when reconstruction was appropriately timed. These findings suggest that the cause of injury provides clinically meaningful information beyond general injury severity scores, which can help surgeons and care teams better anticipate resource needs and tailor treatment planning for trauma patients.

This study investigated how patients with upper extremity peripheral nerve injuries perceive the value of rehabilitation psychology (RP) as part of their multidisciplinary care. Fifty consecutive patients attending a specialized peripheral nerve clinic completed surveys rating their views on RP before and after meeting with a rehabilitation psychologist, who provided mental health screening and referral recommendations; clinic providers also completed a related survey. The researchers examined whether factors like injury type, duration, or surgical decisions influenced changes in patients' perceptions. Results showed that 74% of patients either improved their view of RP or already held the highest possible opinion of it before their visit, suggesting broad acceptance of psychological support within this care setting. Although no specific clinical factors were found to significantly predict perception changes, the findings support routinely incorporating rehabilitation psychologists into peripheral nerve injury care teams and call for future research on long-term outcomes across other injury types.

Pyogenic flexor tenosynovitis (PFT) is a serious bacterial infection occurring within the closed tendon sheath spaces of the hand that can lead to significant long-term stiffness and disability if not properly managed. The study reviewed the recognition, diagnosis, and treatment of PFT, emphasizing that early identification through physical examination findings—when assessed together rather than individually—is key to distinguishing it from other finger infections. Notably, standard laboratory markers of inflammation are often normal in early-stage PFT, making them less reliable for diagnosis, while imaging tools like X-ray, ultrasound, and CT scans have not yet been established as routine diagnostic methods. When the condition is caught early, antibiotic treatment alone can be sufficient to resolve the infection without the need for surgery. The findings highlight that prompt diagnosis and early rehabilitation, including hand therapy and movement exercises, are critical to minimizing lasting complications such as joint contracture and reduced finger mobility.

This study examined how the demographic makeup of plastic surgery trainees has changed between 2017 and 2023, with comparisons to five other medical specialties. Researchers used national medical education databases to track application and residency trends by gender, race, and ethnicity, applying statistical tests to identify meaningful changes over time. The proportion of female applicants to plastic surgery nearly reached parity with male applicants, rising from 32% to 48%, and women now make up the majority of plastic surgery residents — a faster rate of increase than most peer specialties. While Hispanic applicants increased substantially, their representation among actual residents declined, and Black applicants and residents both remained well below their share of the U.S. population across all specialties studied. These findings suggest that while gender equity in plastic surgery has made notable progress, persistent structural barriers — such as bias in selection processes or lack of mentorship — continue to prevent racial and ethnic diversity from translating from the applicant pool into residency programs.

Peripheral nerve injuries affecting the brachial plexus and upper and lower extremities remain some of the most difficult conditions to treat in reconstructive surgery, with unpredictable outcomes and limited high-quality research to guide care. Currently, surgeons rely on patient history, physical exams, electrodiagnostic tests, imaging, and sometimes surgical exploration to assess these injuries, but accurately determining injury severity and predicting recovery remains a significant challenge. Treatment options range from nerve repair and grafting to nerve and tendon transfers, yet outcome measures like muscle grading and range of motion assessments are inconsistent and subjective across different clinicians and institutions. The authors identify critical gaps in diagnosis, intraoperative assessment, and outcome measurement, calling for standardized tools that can be reliably used across multiple medical centers. To move the field forward, they recommend large-scale multicenter collaborations, advances in imaging and biomaterials, and a stronger focus on patient-reported outcomes to better connect surgical innovation with meaningful functional recovery for patients.

This pilot randomized clinical trial investigated whether polyethylene glycol (PEG), a chemical that helps fuse severed nerve fibers together and slow nerve degeneration, could improve recovery after serious median and ulnar nerve injuries in the arm. Thirteen patients with complete nerve transections were randomly assigned to receive either PEG-assisted nerve repair or standard nerve repair surgery, and their sensory function, motor function, pain, and quality of life were tracked for over a year. Within the first 22 days after surgery, patients in the PEG group had already achieved measurably better sensory and motor recovery scores, while the non-PEG patients showed little to no improvement during that same period. Across all follow-up visits, PEG-treated patients scored significantly higher on standardized measures of sensation, muscle function, and self-reported hand function, and also reported less pain early in recovery. Although the sample size was small, these findings suggest that PEG-mediated axonal fusion may meaningfully accelerate nerve recovery and improve patient outcomes, supporting the need for larger clinical trials to confirm these results.

This study examined an alternative surgical technique for correcting spastic wrist flexion deformity in children with cerebral palsy (CP), a condition where overactive muscles pull the wrist into a bent position that weakens grip and signals neurological impairment. Researchers retrospectively reviewed outcomes for 24 pediatric CP patients (26 wrists) who underwent a tendon transfer procedure in which the extensor carpi ulnaris (ECU) tendon was rerouted to connect to the extensor carpi radialis brevis (ECRB), shifting muscle force to improve wrist straightening. After surgery, 85% of wrists achieved extension beyond a neutral position, averaging 28 degrees of extension, and 81% of patients reported improved grip strength. The procedure had a relatively low complication rate, with five patients requiring revision surgery for recurring wrist flexion and only one for overcorrection into extension — a known risk with the more commonly used alternative technique. These findings suggest that ECU to ECRB tendon transfer is a safe and reliable option for improving wrist function and appearance in children with spastic CP, potentially offering a lower risk of overcorrection than the traditional approach.

Brachial plexus birth injuries occur when the network of nerves controlling arm movement is damaged during delivery, and surgeons have long relied on the Narakas classification system to categorize these injuries — though its accuracy for describing lower nerve root damage has been questioned. This study introduced a new intraoperative classification system based on which specific nerve roots (C5–T1) were injured and how many were completely torn from the spinal cord (avulsed), applied to 162 patients who underwent surgical repair over 19 years. Patients were grouped into four injury types (A through D) based on the extent of nerve involvement, and arm function was measured before and after surgery using the Active Movement Scale. Results showed that functional outcomes declined as injury severity increased from type A to D, and that the number of avulsed roots within each injury type — particularly in the most severe group — significantly affected recovery outcomes. The authors conclude that this new classification system more accurately reflects the range of brachial plexus birth injuries and better predicts functional recovery than the Narakas system, highlighting the value of detailed intraoperative assessment in guiding surgical planning.

Radial-sided wrist pain is a common complaint that can be difficult to diagnose when symptoms overlap or are hard to pinpoint through physical examination alone. This review article was written to help surgeons better understand how to use magnetic resonance imaging (MRI) as a supplementary diagnostic tool when standard evaluation methods are insufficient. The authors outline the key anatomical structures on the radial (thumb) side of the wrist and explain the imaging features that indicate various types of injury or disease. A systematic approach to reading and interpreting MRI scans is provided to guide clinicians through the diagnostic process in a more consistent and thorough way. This guide is clinically significant because improving how surgeons interpret wrist MRI findings can lead to more accurate diagnoses and better treatment decisions for patients with complex or ambiguous wrist pain.

This study examined the total financial burden faced by medical students pursuing a career in plastic and reconstructive surgery (PRS), a highly competitive specialty. Researchers distributed a survey to PRS residency applicants and members of a virtual research group during the 2023–2024 application cycle, collecting data on education costs, research expenses, conference attendance, and application-related spending. The findings revealed that the comprehensive cost of pursuing PRS ranges from approximately $33,400 to $45,479, encompassing research years (during which over 40% of students received no pay), conference attendance, away rotations, and application fees. Nearly all respondents (96.6%) felt these costs were too high, yet 93.3% still believed pursuing PRS was worth the financial sacrifice. The authors conclude that these financial barriers are unsustainable and disproportionately affect students from lower-income backgrounds, and they call for systemic changes such as paid research opportunities, expanded scholarships, and broader use of streamlined application tools to make the field more accessible.