Recent Publications

This study examined how pain interferes with daily life in patients with traumatic brachial plexus injury (BPI)—a serious nerve injury affecting arm and shoulder function—both before and one year after surgery. Researchers followed 37 patients from a multicenter study, collecting standardized questionnaires measuring pain interference, depression, anxiety, physical limitations, and emotional well-being, alongside surgeon assessments of muscle function and injury severity. Before surgery, patients reported notably high levels of pain interference, which showed meaningful links to depression and functional limitations; however, one year after surgery, pain interference scores remained essentially unchanged, with strong associations emerging between pain interference and pain symptoms, physical limitations, and emotional recovery. Muscle strength testing did not meaningfully predict pain interference at either time point, suggesting that physical recovery alone does not drive improvements in how pain affects patients' lives. These findings highlight that pain remains a persistent and significant burden for BPI patients even after surgical intervention, emphasizing the need to prioritize pain management and psychological support alongside efforts to restore physical function.

This study examined how common it is for medical trainees, faculty, and staff in plastic surgery and urology residency programs to refuse participation in gender-affirming surgeries based on personal, moral, or religious beliefs—a practice known as conscientious objection. Researchers surveyed leadership from 239 accredited U.S. residency programs between February and October 2023, achieving a 52% response rate of 124 programs. Most programs offered both classroom instruction and hands-on clinical exposure to gender-affirming surgery, yet only 19% had formal policies addressing conscientious objection. Objections were reported by 13% of programs, primarily from trainees, and were not significantly linked to geographic location, surgical exposure, or the presence of objection policies—though programs with formal policies felt more confident handling future objection situations. The findings suggest that while conscientious objection to gender-affirming surgery is relatively rare, residency programs should proactively develop clear policies to protect patient access to care while reasonably accommodating objecting providers.

Flexor tendon injuries in the hand require surgical repair, and this article outlines the key principles that surgeons should follow to achieve reliable results. The study focuses particularly on Zone II injuries — located in the finger between the first and second pulleys — which are the most challenging to treat due to the complex anatomy in that region. Surgical techniques have advanced significantly over recent decades, with current best practices emphasizing a core strand repair using at least four strands of suture, an additional epitendinous suture to improve both strength and smooth gliding of the tendon, and strategic venting of the fibrous pulleys to reduce friction. A critical component of successful recovery is initiating active movement of the fingers within three to five days after surgery, as early mobilization helps prevent scar tissue from restricting tendon movement. These guidelines are significant because following them consistently gives patients the best chance of regaining functional hand movement after what can otherwise be a difficult injury to treat.

This case report describes a surgical reconstruction approach for a young patient with tetraplegia who lost the ability to flex their thumb and fingers after a nerve transfer procedure did not work as intended. The original surgery attempted to restore hand function by redirecting a nerve that controls the extensor carpi radialis brevis (ECRB) muscle to stimulate finger-flexing muscles, but it was unsuccessful. As a follow-up, surgeons performed a tendon transfer — physically rerouting the ECRB tendon itself to restore thumb and finger bending motion. One year after the tendon transfer, the patient regained functional grip and pinch strength and was able to use both hands for everyday tasks. This case is significant because it demonstrates that tendon transfer can serve as an effective backup strategy when nerve transfer fails, offering patients with tetraplegia a second opportunity to regain meaningful hand function.

Ulnar-sided wrist pain is difficult to diagnose because several anatomical structures overlap in that region and can cause similar symptoms. This article provides surgeons with a practical guide for using magnetic resonance imaging (MRI) as a diagnostic tool to better identify the source of pain on the inner side of the wrist. The authors outline the key anatomical structures involved and explain how they appear on MRI scans, helping clinicians distinguish between different potential causes. A step-by-step, systematic approach to reviewing wrist MRI images is presented to reduce the chance of missing important findings. This guide is significant because it helps surgeons more accurately interpret advanced imaging, which can lead to better diagnosis and more targeted treatment for patients with ulnar wrist pain.

Researchers reviewed how artificial intelligence (AI) technologies, particularly natural language processing and machine learning, are being used in plastic surgery for both patient care and administrative tasks. The study examined AI applications across several areas, including monitoring patients after complex reconstructive surgeries, assessing preoperative risks, and analyzing clinical notes and records. A key focus was on AI's ability to automatically interpret billing codes from clinical documentation, which has traditionally required significant time and manual effort from healthcare staff. Medical billing companies have already begun deploying these tools to improve hospital revenue cycles, and insurance companies are using AI to speed up the prior authorization process. These findings suggest that AI has strong potential to reduce administrative burdens, improve billing accuracy, and increase financial efficiency for plastic surgeons and healthcare systems more broadly.

This study investigated the causes of ulnar-sided wrist pain in patients under 18 years old and evaluated how accurately MRI detects these injuries compared to direct visualization through arthroscopy. Researchers conducted a retrospective review of 40 pediatric and adolescent patients who received both an MRI and a diagnostic arthroscopy within one year of each other between 2004 and 2021. The most common diagnosis was a type of cartilage tear called a Palmer 1B triangular fibrocartilage complex (TFCC) tear, found in 68% of patients, followed by ulnotriquetral ligament tears in 28%. MRI showed high specificity (meaning it was reliable when it identified no injury) but low sensitivity (meaning it frequently missed real injuries), with accuracy ranging from 70% to 83% depending on the condition. These findings suggest that a negative MRI result should not rule out significant wrist pathology in young patients, and surgeons should consider proceeding to arthroscopy when clinical examination still points to a TFCC injury.