Palmaris Longus Opponensplasty

Composite tissue allograft (CTA): tolerance induction without graft vs host disease (GvHD)

Department of Surgery; Division of Plastic and Reconstructive Surgery; University of Louisville; Louisville, KY

Clinical OtolaryngologyVolume 35, Issue 4 p. 332-336 CORRESPONDENCE: HOW WE DO IT: The internal mammary artery perforator pedicled island flap for reconstruction of the lower head and neck and supraclavicular region: how we do it P.P.A. Schellekens, P.P.A. Schellekens Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this authorJ.J. Hage, J.J. Hage Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The NetherlandsSearch for more papers by this authorE.C. Paes, E.C. Paes Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this authorM. Kon, M. Kon Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this author P.P.A. Schellekens, P.P.A. Schellekens Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this authorJ.J. Hage, J.J. Hage Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The NetherlandsSearch for more papers by this authorE.C. Paes, E.C. Paes Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this authorM. Kon, M. Kon Departments of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, UtrechtSearch for more papers by this author First published: 25 August 2010 https://doi.org/10.1111/j.1749-4486.2010.02171.xCitations: 11 J.J. Hage, MD, PhD, Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Tel.: +31 20 512 2979; fax: +31 20 512 2554; e-mail: j.jorishage@inter.nl.net Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume35, Issue4August 2010Pages 332-336 RelatedInformation

Sir:FigureLymphatic malformations located on the extremities can cause severe functional impairment and disfigurement. Large lymphatic malformations that fail conservative management have traditionally been treated with surgical debulking through large incisions that are prone to complicated wound-healing and extensive scarring. We report our experience with a limited-incision surgical option using ultrasound-assisted liposuction with pull-through technique. This study was approved by the Committee on Clinical Investigations at Children's Hospital Los Angeles on September 20, 2010, as study CCI-10-00161. Ultrasound-assisted liposuction has been effective in debulking involuted hemangiomas by liquefying low-density tissues such as fat while sparing neurovascular structures and connective tissue.1 Ultrasound-assisted liposuction demonstrates decreased blood loss and fluid shift, improved contour, and decreased surgeon fatigue compared with standard liposuction.2,3 Ultrasound-assisted liposuction also provides advantage in areas of significant fibrous tissue such as the male breast and back.3 Eight patients with large microcystic lymphatic malformations of the lower extremity underwent ultrasound-assisted liposuction with pull-through technique. Under general anesthesia, tumescent solution was injected into the lymphatic malformation and surrounding subcutaneous tissues. Liposuction ports were triangulated around the lymphatic malformation. Using a LySonix 3000 (Byron Medical, Inc., Tucson, Ariz.), the ultrasound-assisted liposuction probe was introduced subcutaneously through each port and passed through multiple planes. Standard liposuction was performed using 3.7- to 10-mm cannulae until desired debulking was achieved. To create a smoother contour, the ultrasound-assisted liposuction probe was reintroduced for feathering the transition zone between lymphatic malformation and normal tissue. Remaining fibrous septa and connective tissue were stripped and extracted through the ports using an alligator clamp (Fig. 1). The incisions were closed loosely with a single deep dermal suture to promote drainage. Postoperatively, the limb was placed in a pressure dressing for 4 weeks.Fig. 1: Six-year-old patient with a microcystic lymphatic malformation of the right lower extremity shown preoperatively (left) and 18 months postoperatively (right) following limited-incision debulking using ultrasound-assisted liposuction with pull-through technique.All eight patients demonstrated stable improvement in limb girth and contour, with postoperative follow-up ranging from 3 months to 2 years (Fig. 2). There were no postoperative infections, seromas, or other complications. Mild residual contour irregularities were noted in all patients, with one patient experiencing undercorrection requiring traditional debulking.Fig. 2: Four-year-old boy with recurrent symptomatic microcystic lymphatic malformation of the right leg and foot shown following excisional debulking with subsequent recurrence (left) and 12 months postoperatively after undergoing limited-incision debulking of the leg using ultrasound-assisted liposuction with the pull-through technique (right).Both medical and surgical approaches to treatment of lymphatic malformations have been successful in achieving symptomatic relief. Choice of treatment is guided by size, anatomical location, the nature of lymphatic malformation (i.e., microcystic versus macrocystic), and surgeon experience. Lasers, irradiation, and interferon/octreotide medical therapy can be useful; however, each is associated with considerable side effects.4,5 In addition, sclerotherapy is useful for macrocystic variants of lymphatic malformations. Likewise, surgical debulking is helpful for the treatment of large lymphatic malformations but is often associated with extensive scarring and other complications including perioperative infection and poor or delayed wound healing. We demonstrate successful treatment of lower extremity lymphatic malformations using ultrasound-assisted liposuction with pull-through technique resulting in smaller scars, reduced complications, and improved contour. Our technique is inherently limited as to the extent of debulking compared with an open excisional approach; however, in our experience, the retained tissue was stable over time, resulting in minor contour irregularities. Furthermore, conversion to an open surgical approach can always be undertaken at a later date should limited-incision debulking prove inadequate or if the lymphatic malformation recurs. Further studies will examine use of this technique in the upper extremity and trunk. Cameron S. Francis, M.D. Division of Plastic and Reconstructive Surgery, University of Southern California, Keck School of Medicine Elizabeth A. Rommer, B.S. Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles Justin T. Kane, M.D. Division of Plastic and Reconstructive Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif. Kathryn Iwata, B.S. New York University School of Medicine, New York, N.Y. Andre Panossian, M.D. Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, Calif. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication.

From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA. Address reprint requests to Dr. Kaplan, Division of Plastic Surgery, R-213, Stanford University Medical Ctr, Stanford, CA 94305.

A technique for iliac crest bone grafting has been described which allows rapid harvesting of bone with a significant reduction in the pain, scarring, and distortion traditionally associated with this technique.

E DITORIAL Sixth Dedicated CSPS Annals—In Memory of Michael F. McGuire and Janet K. Salomonson Michael S. Wong, MD, FACS FIGURE 1. Michael F. McGuire, MD, Past President of the ASPS and the CSPS, and Past Director of the ABPS, pictured at CSPS reception. This picture was shared by James H. Wells, MD. FIGURE 2. Janet K. Salomonson, MD, had a passion for helping children with clefts. She provided this picture for an article published in Saint John’s T his Annals of Plastic Surgery supplement marks the 6th California Society of Plastic Surgeons (CSPS) publication of select manuscripts of abstracts presented at the 66th Annual Meeting of the CSPS held May 27 to 30, 2016, at the Santa Monica Fairmont Miramar Hotel & Bungalows. This meeting was the last time many of us were able to see Michael McGuire. Despite the many accolades he received as a leader in organized plastic surgery—Past President of the ASPS, Past Director of the ABPS, and Past President of CSPS, he always made time for me. I will miss my mentor and supporter, Dr. Michael F. McGuire (Fig. 1). He passed away on November 14, 2016, in his Santa Monica home. Not only home to our last CSPS meeting, Santa Monica is also where Michael and Dr. Janet Salomonson (Fig. 2) both practiced. They had a special relationship, with Janet being one of Michael’s residents at University of California, Los Angeles. Michael delivered Janet’s eulogy after she passed away on September 25, 2013, and shared at her memorial mass, “All physicians care for their patients, but Dr. Salomonson truly loved them.” 1 Janet and I met through the 2008 Pathways to Leadership Program, a brainchild of Michael’s. Quickly drawn to each other as Myers-Briggs introverts, sensing, feeling, and judging, Janet and I always enjoyed catching up at CSPS meetings. Janet was always supportive and encouraging; the last time I saw her was at our San Francisco meeting at the St. Francis Hotel May 2013 where she was complimentary on our third dedicated CSPS-Annals. Both Michael and Janet loved plastic surgery, the CSPS, and our Annual Scientific Meeting. Just before her passing, Janet demonstrated her generosity and affection for the CSPS by bequeathing a portion of her estate to the CSPS. In loving memory and in honor of Janet K. Salomonson and her mentor and friend Michael F. McGuire, this CSPS-Annals Supplement is dedicated to them. In recognition of her role as Medical Director of the Cleft Palate Service at St. John’s Health Center and her love for children, a greater proportion of manuscripts included in this supplement are related to cleft lip, cleft palate, and pediatric plastic surgery, including Tringale’s on sustained overcorrection after facial fat grafting in the pediatric population. As always, published supplement manuscripts are all peer review by way of initial selection for presentation by the Scientific Program Committee and scrutiny by a minimum of 2 reviewers from the CSPS-Annals Review Commit- tee before final editorial acceptance and copyediting by the Annals team. Special thanks to the Review Committee for our Sixth CSPS-Annals (David Boudreault, Joseph Carey, James Chao, Keith Denkler, Susan Downey, Jesus Garcia, Received January 27, 2017, and accepted for publication, after revision January 31, 2017. From the Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA. Conflicts of interest and sources of funding: none declared. Reprints: Michael S. Wong, MD, FACS, Division of Plastic Surgery, University of California Davis Medical Center, 2221 Stockton Boulevard, Suite 2123, Sacramento, CA 95817. E-mail: mswong@ucdavis.edu. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/17/7805–S173 DOI: 10.1097/SAP.0000000000001082 Annals of Plastic Surgery • Volume 78, Supplement 4, May 2017 www.annalsplasticsurgery.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. S173

Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability. In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%). Orthopaedic and plastic hand surgery fellowships afford disparate operative experiences. Understanding these differences may help to align prospective trainees with future career goals and to guide discussions to better standardize hand surgery training.

Sir:FigureWe sincerely appreciate Dr. Gradinger's comments and astute observations regarding our study, “The Five Step Lower Blepharoplasty: Blending the Eyelid-Cheek Junction.”1 Dr. Gradinger has raised some interesting points that further underscore the need for enhancing our ability to truly grade our results objectively using evidence-based medicine, and the challenges plastic surgeons face in effective and predictable lower eyelid rejuvenation. Directly correlating quantitative outcomes with clinical improvements in aesthetic surgery continues to be a daunting task. The crux of Dr. Gradinger's comments centers around our computer-generated outcomes. It is important not to distract our readers from the key points of our study with computer-generated data, which only served to confirm the safety of our study. Dr. Gradinger's queries are valid and require clarification. Overall, we saw a cumulative improvement in the aesthetic outcomes and had no complications that required reoperation. This is quite rare in performing lower eyelid rejuvenation surgery. The goal of our study was to delineate a safe and effective method of blending the eyelid-cheek junction without disrupting the orbicularis oculi muscle or performing operative techniques that have excessively high morbidity. The high complication and reoperation rates seen in lower eyelid surgery served as the impetus for the five-step combination and research design. Although our maneuvers may not have had 100 percent desired change in each of the individual data points measured, overall aesthetics were improved. Does a slight increase in pupil-to–eyelid margin distance in 36 of 100 eyelids mean that the technique is ineffective? Is it possible that in many of the same patients who demonstrated an increase in pupil-to–eyelid margin distance there was also a decrease in tear trough width and pupil-to–tear trough distance? If so, then the sum of effects was effective and safe, because the overall improvements did not require further surgical correction. It is the sum of the five steps and the overall combined effect of these individual techniques and their direct morphologic changes that lead to improved eyelid-cheek junction blending. Just as the individual steps should not be isolated, so should the results not be judged on each isolated data point. Rather, these data points were measured to evaluate the spectrum of changes that can be observed, whether it decreased in some respects and increased in others. The orbicularis retaining ligament is a key structure in bringing together the cumulative changes. With that said, we will address all the points raised by Dr. Gradinger. Selective release of the orbicularis retaining ligament is as effective as arcus release because the major significance assigned to the arcus is its translated effects by means of the orbicularis retaining ligament to the overlying skin and soft tissue. Full release is not always necessary. Lateral retinacular support served as prophylaxis against lid malposition during the healing/edema phase and is not meant to be permanent. All eyelids undergo slight to minimal lower lid fat removal, sometimes purely for contour and “smoothing,” not just for debulking purposes. We have not witnessed any posterior and/or middle lamellae contracture with the five-step method. All patients in our study required at least slight skin pinch excision, and no patients demonstrated exophthalmos, which is a contraindication to this technique. The conservative degree of skin removal and avoidance of injury to the septum/orbicularis muscle anteriorly all help to eliminate tension and resultant anterior lamella shortening. Concern regarding exacerbation of tear trough as a result of adjacent augmentation of the deep malar fat pad is valid and is a common source of trepidation. Selective orbicularis retaining ligament release allows migration of native lower lid fat to coalesce with the superficial and deep malar fat compartments. Molding is performed intraoperatively to further blend this region. Reducing skin laxity with pinch removal also helps reduce tear trough appearance. Deep malar fat augmentation also acts to elevate the superficial fat compartments cephalically to meet the now released lower lid fat. We thank Dr. Gradinger for his clear and directed comments on the numerous challenges inherent in lower eyelid rejuvenation. We hope that our five-step technique helps to shed more light on the key principles and techniques in safe and effective lower eyelid-cheek rejuvenation.2–5 Ashkan Ghavami, M.D. Department of Surgery, Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif. Rod J. Rohrich, M.D. Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Very few microsurgical courses have been offered for medical students in Germany to date. To raise early interest in this technique, which is essential for plastic and reconstructive surgery, and to guide eligible medical students to choose plastic surgery as their specialist field, the Department of Plastic and Hand Surgery, supported by the Faculty of Medicine of the Friedrich-Alexander-University of Erlangen-Nuremberg, implemented a microsurgical course for students in 2011. This study describes the implementation of that course and evaluates its impact on the subsequent choice of the participants' specialist fields. Since the summer of 2011, the microsurgery course for medical students has taken place regularly 3 times per term. It is free of charge for participants and is guided by senior physicians of the Department of Plastic and Hand Surgery together with student tutors from the Faculty of Medicine. The arterial end-to-end anastomosis in the fresh chicken leg is used as a training model. Based on a questionnaire survey the participants were evaluated and statistically analysed regarding their course satisfaction, self-assessment of their own eligibility before and after the course, the anticipated future choice of their medical specialist field and how their choice was influenced by this course. After the successful implementation of the microsurgical course in 2011, a significant number of students were interested in microsurgery. According to the questionnaire, the level of enthusiasm was high among all participants. The self-assessment of microsurgical skills improved significantly after the course compared with the pre-course assessment. In 82% of the participants, the course had a strong positive influence on the future choice of their specialist field. The regular implementation of a microsurgical course for students in the form described here is practicable and possible without undue personnel and cost of materials. The ongoing interest among students in such an offer is enormous and the satisfaction of the participants is very high. This might be a way to recruit future plastic surgeons by raising early enthusiasm for microsurgery. These future plastic surgeons, in turn, would be given the chance to experience a very fascinating aspect of plastic surgery, which might help them to decide on their specialisation within that field at a later point in their career.

The Center for Surgical Health (CSH) works to improve surgical access for under-resourced communities in Philadelphia via patient navigation services. This study defined the social profiles, clinical needs, and satisfaction of patients engaging with the Plastic and Hand Surgery (PHS) division of CSH. Patients referred from June 2019 to October 2024 were included. Eligible patients received NE2AR support: navigation, education, empowerment, access to payers and providers, and screening for legal and social referrals. Patient demographic, insurance, and clinical data were collected and summarized using descriptive statistics. After completion of CSH services, all patients were surveyed to assess satisfaction with navigators and seven domains of the surgical care accessed through CSH using items from the National Cancer Institute Patient Satisfaction Navigator Interpersonal Survey and the RAND Patient Satisfaction Questionnaire-18, two validated patient satisfaction surveys. PHS satisfaction scores were compared to non-PHS patients using two-sided t tests. Of 1146 referrals to CSH, 128 (11.2%) were for PHS. The procedures sought included post-traumatic upper extremity (27.3%) and facial reconstruction (7.0%), gender-affirming surgery (25.0%), and lesion excision (22.7%). Most patients identified as Hispanic/Latinx (35.9%) or Black (36.2%), and 33.6% were primarily Spanish-speaking. A majority of referred patients (74.6%) did not have insurance at the time of referral. Sixty-three patients (49.2%) were eligible for CSH services. Navigators predominantly applied for state-based insurance, including Emergency Medical Assistance (70.1%) and Medicaid (17.7%). PHS patients were highly satisfied with navigators (mean, 38.3; SD, 6.3; max, 45) but were dissatisfied with the Financial Aspects (mean, 2.5; SD, 1.1; max, 5) and Accessibility/Convenience (mean, 3.4; SD, 0.8; max, 5) care domains. PHS patients were less satisfied with Financial Aspects relative to non-PHS patients (mean, 3.27; SD, 0.1; P = 0.02). CSH navigators provided NE2AR surgical navigation for primarily uninsured and historically marginalized PHS patients and increased access to a variety of surgeries that would be otherwise difficult or impossible to obtain. Although PHS patients were generally satisfied, the results highlight persistent barriers for underresourced groups.

BackgroundThe Hospital das Clínicas - University of Sao Paulo Medical School (HCFMUSP) is the largest university hospital complex in Brazil. HCFMUSP has been converted into a reference center for coronavirus disease 2019. The Division of Plastic Surgery postponed non-essential surgeries and outpatient consultations, accomplishing new guidelines (ANG) of national and international organizations. Even with these challenges arising from the pandemic, alternatives were considered to maintain institutional characteristics. This study aims to analyze this new scenario and the impact on patients’ assistance and Plastic Surgery residents training.MethodsTotal number of surgeries, type of procedures, and outpatient consultations in 2020, before (pre-ANG) and after (post-ANG) ANG, were compared with the same period in 2019 (2019-pre and 2020-post).ResultsA marked reduction in the total number of surgeries and outpatient consultations was observed in the post-ANG period. In the post-ANG period, 267 operations were performed (26.7 ± 20.3/week), while in the 2019-post period, 1036 surgeries were performed (103.6 ± 9.7/week) (p = 0.0002). Similarly, 1571 consultations were conducted in the post-ANG period (157.1 ± 93.6/week), while in the 2019-post period, 3907 were performed (390.7 ± 43.1/week) (p = 0.0003). However, in the post-ANG period, an increase in the proportion of reconstructive compared with aesthetic surgery was observed. The maintenance of highly complex procedures such as microsurgical transplants was also identified.ConclusionsThe predominant profile of reconstructive surgeries at the Division of Plastic Surgery allowed the continuity of procedures at all technical complexity levels, patient care maintenance, and Plastic Surgery residents training.Level of evidence: not ratable

Background: This study aimed to determine the reliability of perforator pedicled propeller flap for coverage of wounds around the ankle. Materials and Methods: This was a prospective study undertaken between September 2017 and November 2018 in the Division of Plastic and Reconstructive Surgery of our institution. Patients with soft-tissue defect of the ankle referred from the Division of Orthopedic Surgery were included. Those with a scarring in the region of calf in the area of proposed flap were excluded. A detailed history and examination were recorded. A complete blood count, kidney and liver function tests, coagulation profile, and hepatitis B and C and human immunodeficiency viral marker testing were performed following informed consent. Anteroposterior and lateral radiographs of the ankle were taken in all cases. Perforator pedicled propeller flaps were raised in all patients for coverage of soft-tissue defects around the ankle. All patients were followed up regularly. Results: Ten patients with soft-tissue defect around the ankle were referred to our division from the Division of Orthopedic Surgery or admitted through the outpatient department of the Division of Plastic and Reconstructive Surgery of our institution. Eight patients were male and two were female, with the age ranging from 10 to 50 years. The mean operation time was 58 min. Size of the flap varied from 21 cm × 8 cm (168 cm2) to 8 cm × 5 cm (40 cm2). Flaps were rotated through 110°–180°. Out of ten flaps, eight flaps survived completely without any complications. Partial flap loss was found in one patient (10%), marginal flap necrosis in one patient (10%), and none of the flap was lost completely. Thus, the overall success rate of perforator pedicled propeller flap in our study observed was 80%. Conclusion: The perforator-based propeller flap is a versatile and reliable flap for the coverage of soft-tissue defects around the ankle because its vascularity is predictable.

Background Hand surgery has become a well-established medical specialty in recent years, with many highly trained hand surgeons practicing in various cities throughout Saudi Arabia. It is crucial to assess the public's knowledge and awareness regarding hand surgery specialists and to identify the existence of bias in the public's perception of plastic and Orthopedic surgeons. Methods A self-administered questionnaire was designed and disseminated to adults in Saudi Arabia via Google Forms. The questionnaire addressed participants' knowledge about which type of surgeon they would consult for various hand-related issues. Results A total of 716 participants were surveyed. Most believed Orthopedic surgeons were more qualified for hand surgeries than plastic surgeons. Furthermore, the public seemed to feel safer with Orthopedic surgeons regarding complications. There was a misconception regarding plastic surgeons' qualifications, with only 24.4% recognizing that all plastic surgeons could perform hand surgery. The majority also held misconceptions regarding Orthopedic surgeons' qualifications for hand surgery. Gender and educational level influenced the responses, with females and those with bachelor's degrees or higher showing slightly more knowledge. Conclusion There is a need for increased public awareness and education regarding the qualifications and capabilities of both plastic and Orthopedic surgeons in hand surgeries. Both specialties are well-trained and competent in this area, and the choice should be based on the specific needs and circumstances of the patient.

James Stanislaus Calnan