August 2022

www.ifssh.info

ifssh

VOLUME 12 | ISSUE 3 | NUMBER 47 | AUGUST 2022

ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

FINAL REPORT IFSSH/IFSHT CONGRESSHAND THERAPY

THE RELATIVE MOTION FLEXIONORTHOSIS IN THE MANAGEMENT OFFINGER FLEXOR TENDON REPAIRS:AN UPDATELEASONS FROM:REPLANTATION SURGERYIFSSH EXCO ANNOUNCEMENT

1www.ifssh.info

August 2022

www.ifssh.info

VOLUME 12 | ISSUE 3 | NUMBER 47 | AUGUST 2022

contents
4

5

EDITORIAL
IFSSH Charter Perspective

Cortical plasticity - what we learn beyond hand

- Ulrich Mennen

surgery - an overview

PRESIDENT'S MESSAGE- Daniel Nagle

628 SCIENTIFIC CONTRIBUTION- Jörg Bahm

32 SHARE SECTION
Lessons learned from 25 years of replantation

SECRETARY-GENERAL REPORT

surgery- David Warwick

10 IFSSH EXCO ANNOUNCEMENT
Upcoming bylaws changes

1118- Olivier Delaere- Patrick Suttor

38 MEMBER SOCIETY NEWS• Korean Society for Surgery of the Hand

FINAL REPORT IFSSH CONGRESS• Belgian Society for Surgery of the Hand
• Peruvian Association of Hand Surgery and

PIONEER PROFILES

Microsurgery• Adalbert Ibrahim Kapandji• Austrian Society for Hand Surgery• Wladyslaw Manikowski• Ecuadorian Society for Surgery of the Hand
• AustralianSociety for Surgery of the Hand

20 HAND THERAPY• Mexican Society for Hand Surgery• The relative motion flexion orthosis in the• Canadian Association for Hand Surgery

management of finger flexor tendon repairs:• Brazilian Society for Surgery of the Hand

		 An update• Association of Chinese-Speaking Hand

		 - Julianne W Howell		 - Melissa J Hirth• IFSHT Newsletter

Surgeons United

51

UPCOMING EVENTS

27 ART"Tre gratier"- Istvan Lisztes

2

3

EDITORIAL

www.ifssh.info

Perspective on the
IFSSH Charter
It may be prudent to remind ourselves from time tothrough organized participation in all areas oftime about the aim of the IFSSH.

specialty

August 2022

President’s
message
My Dear Colleagues,

PRESIDENT’S MESSAGE

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILYIFSSH DISCLAIMER:
The IFSSH ezine is theofficial mouthpiece of theInternational Federation ofSocieties for Surgery of theHand. The IFSSH does not

I am humbled and honoured to stand here before you as the 20th President

endorse the commercial

The Bylaws (Article III, Section 1, Members) state that

We as Hand Surgeons who have a major interest inof the International Federation of Societies for Surgery of the Hand.

advertising in thismembership of the IFSSH is granted to any group of

hand surgery may not always remember that globally

I thank the Member Societies of the Federation for their confidence

publication, nor the content

individuals (Societies or Clubs for surgery of the hand)

the majority of hand conditions are managed byand support. I look forward to working with the Delegates and newlyor views of the contributors

whose members have a major interest in surgery ofgeneral medical practitioners, medical officers, nurses,

expanded Executive Committee, as we continue to refine the Federation’s

to the publication.

the hand.

therapists and other related medical professionals,

governance and expand the opportunities for educational sponsorship.

Subscription to the IFSSH

and not Hand Surgery Specialists.
The main purposes of the IFSSH are:
•
•
•
•

•
•

ezine is free of charge andI must thank Dr. Garcia Elias for his friendship and the kind andthe ezine is distributed on athoughtful leadership he has provided during these tumultuous times.

quarterly basis.

I look forward to seeing you all in Washington DC in 2025.

Should you be interested toto coordinate the activities by maintaining liaison

Our main task as members of the IFSSH in the first

between the various Societies.

place therefore, should be to teach and inform theseto promote the free and full exchange ofprimary health care professionals on the acceptableknowledge among the constituent organizations

and practical ways in dealing with everyday handto improve and widen the opportunities for study

cases. To become a Hand Surgeon is a privilege, and to

Thank you.

please contact the Editor:and observation in the various countries

train Hand Surgeons is rewarding, but we must shareDan.

ezine@ifssh.info

to establish and recommend the adoption of

our knowledge with those who are in the frontline

certain standards of nomenclature, classification

how to do the basic management correctly in orderand standards of evaluation and treatment

to minimise complications and maximise outcomes.

IFSSH EZINEEDITORIAL TEAM:

to promote a bibliography of world literature on

Most people use their hands to earn their living, and

EDITOR:

surgery of the handmost time lost from work injuries is from hand andProfessor Ulrich Mennen

to disseminate knowledge through publications

arm trauma.

Past President: IFSSH

and practice of surgery of the hand

Basic hand surgery should be taught as part of

DEPUTY EDITOR:

to improve the education and research in hand

primary health care.

Professor Michael Tonkin

advertise in this publication,and scientific meetings and to enhance the study•

surgery at all professional levels••

Past President: IFSSH

to take an interest in the socio-economic impact ofdisorders of the hand

Daniel Nagle

GRAPHIC DESIGNER:

to further the availability of hand surgery

President: IFSSH

Tamrin Hansen

throughout the world•

www.foxydesign.co.za

to further the cooperation between hand surgery
and other related professionals•

4

to encourage the cooperation of all members

Sincere regards,

to advance the principles and practice of hand

Ulrich Mennen

surgery of all members throughout the world

EditorTO SUBSCRIBE GO TO:
www.ifssh.info
administration@ifssh.info
5

SECRETARY-GENERAL REPORT

www.ifssh.info

Secretary General
Report

SECRETARY-GENERAL REPORT

August 2022

Abraham Cuperman Donskoy

Allen Van Beek

- Colombian Association for Surgery of the Hand

- American Association for Hand SurgeryJosé Mauricio de Morais Carmo

Catherine Vlastou- Brazilian Society for Surgery of the Hand

- Hellenic Society for Surgery of the Hand

David Elliot

Batia Yaffe- British Society for Surgery of the Hand

- Israeli Society for Surgery of the Hand

Marybeth Ezaki

Fok-Chuan Yong

- American Society for Surgery of the Hand

- Singapore Society for Hand Surgery

Alexandru Georgescu

The IFSSH extends its sincere gratitude to all Pioneers
for their contributions to the field of hand surgery.

Message from the Outgoing Secretary-General:

Without her institutional knowledge, dedication and- Romanian Society for Surgery of the Hand

S. Raja Sabapathy

efficiency, the role of Secretary-General would be

Rolf Habenicht

Performing the role of the Secretary-General in an

impossible.As it would be without the dedication and- German Society for Surgery of the Hand

2022 IFSSH Delegates’ Council Meeting

International organization can be a great experience.  

contribution of the entire Executive Committee. I look

Leiv M. Hove

The annual IFSSH Delegates’ Council Meeting was

For me it was enjoyable as I was working with aforward to working with the Executive Committee -- Norwegian Society for Surgery of the Hand

held on Wednesday 8 June with a number of important

great team led by President Marc Garcia-Elias andour President Dan Nagle, the new Communications

William B. Kleinman

decisions reached. As described in the revised Bylaws,

our administrative secretary, Belinda Smith, who is

Director Jin Bo Tang, President Elect Raja Sabapathy,- American Society for Surgery of the Hand

the Executive and Nominating Committees have been

extraordinarily efficient. It was eventful as we madePast President Marc Garcia-Elias and of course

Simon Kay

expanded to allow for greater participation, regionala good overhaul of the By-laws governing the IFSSH

our expanded pool of Members-at-Large and new- British Society for Surgery of the Hand

representation and increased transparency. We thankto make it more vibrant. It was satisfying as we

Nominating Committee - to maintain and grow the

Bhaskaranand Kumar

all who submitted nominations and congratulate those

introduced the concept of the Mid-term Course in Hand

wonderful role that the IFSSH assumes in the world of- Indian Society for Surgery of the Hand

who were appointed:

Surgery which will also help to make the IFSSH more

hand surgery.

Susan E. Mackinnon

visible. Most importantly, many countries came out of- American Society for Surgery of the Hand

Incoming IFSSH Executive Committee

their travel restrictions of the pandemic, and we had

15th IFSSH Congress, London: June 6-10, 2022

Murray Hugh Matthewson

Past-President (by succession): Marc Garcia-Elias

a wonderful in-person IFSSH congress in London. On

The 15th triennial IFSSH Congress was a spectacular- British Society for Surgery of the Hand

President (by succession): Daniel Nagle

a personal note, it was a pleasure to work with theweek of reconnecting with colleagues in person in

Duncan Angus McGrouther

President-Elect (by succession): Raja Sabapathy

local organizing committee led by David Shewring,

London. Over 3600 hand surgeons and therapists from

- British Society for Surgery of the Hand; Singapore

Secretary-General: David Warwick

Jonathan Hobby and Wee Lam and congress organizers

89 countries participated in the congress, experiencing

Society for Hand Surgery

Communications Director: Jin Bo Tang

Asszisztencia.

a sophisticated scientific programme and enjoying theA. Lee Ostermansocial events.

- American Association for Hand Surgery; American

Members-at-Large:

Society for Surgery of the Hand

- Asia-Pacific: Gregory BainI hand over the baton to David Warwick who I am sure
will help steer the IFSSH to greater heights in its quest

2022 IFSSH Pioneers of Hand Surgery

Timo Raatikainen- North America: Jorge Clifton Correa

to promote Hand Surgery worldwide.

The tradition of inducting IFSSH Pioneers of Hand

- Finnish Society for Surgery of the Hand

- South America: Aida Garcia Gomez

Surgery continued at the Opening Ceremony, with 28

Yolanda Restrepo De Marriaga- Europe and Africa (x2): Francisco del Piñal andsurgeons honoured:- Colombian Association for Surgery of the Hand

Message from the Incoming Secretary-General:			David Shewring

Robert RussellDavid Warwick
It is a privilege to take over the baton of Secretary

Peter Amadio- American Association for Hand Surgery

Incoming IFSSH Nominating Committee

General from Raja Sabapathy. I would like to thank him- American Association for Hand Surgery

Francois Schernberg

Past-President (automatic appointment to committee):for all his contributions so far and for all his future

Ronaldo Jorge Azze

- French Society for Surgery of the Hand

Marc Garcia-Elias (Chair)

involvement as President Elect and then President.

- Brazilian Society for Surgery of the Hand

Beat R. Simmen

President (automatic appointment to committee):

Having worked as the Historian for the past 6 years, I

Jacques Baudet- Swiss Society of Hand Surgery

Daniel Nagle

have seen the remarkable support provided by Belinda- French Society for Surgery of the Hand

Michael A. Tonkin

Members-at-Large: Ilse Degreef and Peter Amadio

Smith, our Administrative Secretary.

Duke Whan Chung- Australian Hand Surgery Society- Korean Society for Surgery of the Hand

6

7

SECRETARY-GENERAL REPORT

www.ifssh.info2024 IFSSH Mid-Term Course

XVIth IFSSH – XIIIth IFSHT Congress

The Delegates’ Council also selected the host Society– Washington D.C., USA

for the inaugural IFSSH Mid-Term Course. Four23- 28 March, 2025

August 2022

SECRETARY-GENERAL REPORT

competitive bids were presented by the Australian
Hand Surgery Society, Bolivian Association of Hand

XVIIth IFSSH – IXth IFSHT Congress

Surgery, Ecuadorian Hand Surgery Society, and Thai

– Singapore

Society for Surgery of the Hand. The Ecuadorian Hand

23– 27 October, 2028 (TBC)

Surgery Societywas successful and will host the course
in February 2024. This is a great achievement for aWith very best wishes

recently established Society and we look forward to
supporting their progress as they plan this course.
2028 IFSSH Triennial Congress
The 2028 IFSSH Triennial Congress Host was also
selected. After informative and entertaining bids,
the Singapore Hand Surgery Society was selected
over the Association of Chinese-Speaking Hand
Surgeons United. Congratulations to all involved in the
preparation of the Singaporean bid.
Further general business matters will be detailed inDavid Warwick

subsequent newsletters.

Secretary-General, IFSSH
Email: secretary@ifssh.info

Future Meetings

Web: www.ifssh.info

A detailed list of national and regional hand surgery

Twitter/Instagram: @IFSSHandmeetings is available on the IFSSH website. The
triennial IFSSH Congresses are as follows:
1st IFSSH Mid-Term Course in Hand Surgery– Ecuador
14– 17 February, 2024

8

9

IFSSH EXCO ANNOUNCEMENT

www.ifssh.info

FINAL REPORT IFSSH CONGRESS

August 2022

Upcoming
bylawschanges
The combined IFSSH, IFSHT and FESSH conference took place at the ExCeL Conference Centre in London
during the second week of June 2022. Despite several significant obstacles during the years leading up to the
The International Federation of Societies for Surgery

Embedded in the 2020 bylaws were provisions for anof the Hand revised its bylaws in 2020 to address theeventual move to a biennial IFSSH Congress. However,preservation of institutional memory, the excessive

the Delegates’ Council elected to preserve the triennial

Linked to the congress was a new feature for IFSSH: a programme of observational fellowships. During the twotime spent on the Executive Committee, to improve

congress. The proposed 2022 bylaw changes you will

weeks prior to the congress thirty-two fellows appointed in open competition from thirty countries visited 18

opportunities for Societies to participate in the

be asked to ratify are housekeeping changes needed tocentres around the UK. At the end of the two weeks the fellows travelled to London for the Jubilee weekend. A

governance of the IFSSH, to improve the transparency

restore the Executive Committee terms to three years

teaching programme was organised at the newly refurbished Royal College of Surgeons and there was a tour ofof the Executive Committee nomination process

to be consistent with a triennial congress.

the sights of London, prior to the start of the Congress.

In addition to this, the amended 2022 bylaws will

The “Elizabeth Line” was finished just in time for the congress and opened to the public just a few days before.

contain more detailed description of the Federation

This provided a high-speed connection from London Heathrow airport, via Paddington station, to a station at theThe 2020 bylaws have been successful in achieving

membership requirements previously included in theentrance of ExCeL, making traveling across London significantly easier. Stencils of the logo on the pavement led

these goals. Indeed, the global representation on the

Policies and Procedures.

delegates from the station to the entrance of ExCeL……

conference, we consider that it was a success.

and improve global representation on the Executive
Committee.

Executive Committee has expanded from one Memberat-large to five Members-at-large including one

It is the Executive Committee’s hope to have these

After an “Educational afternoon”, organised by FESSH at the ExCel

Member-at-large each from the North America/Central

bylaw changes in your hands for review and voting

on Monday, we had the opening ceremony. There were addresses

America/Caribbean region, the South America region

by early September. The ElectionBuddy system usedfrom Marc Garcia-Elias (IFSSH), Nicola Goldsmith (IFSHT), Daniel

and the Asia-Pacific region. Two Members-at-large

in 2020 will once again be used for the bylaws change

Herren (FESSH) and Jonathan Hobby (BSSH), before Raja Sabapathy

now sit on the Executive Committee from the Europe/

process.

introduced the Pioneers of Hand Surgery, with twenty-eight pioneers

Africa region given the large number of Societies

being honoured. Marc Garcia-Elias, IFSSH President, then gave ain that region.The nomination process is now more

The Executive Committee sincerely appreciates yourmoving tribute to the “Unknown Surgeon”, with an accompanying

transparent thanks to the addition of two Members-at-

support and participation in the IFSSH.

book. Following the closure of the ceremony we were entertainedlarge selected by the Delegates’ Council.

by the “Evolve Shadow Show”, a stylised history of the earth inDaniel J Nagle MD, FAAOS, FACS

silhouettes, with a bespoke hand surgery theme.

The Secretary General-elect position has been

President: International Federation of Societies for

At the after-party in the exhibition area, we were entertained byeliminated and eventually the President-elect position

Surgery of the Hand.

the Ben Harker jazz trio. There was a tangible aura of joy aroundwill be eliminated to decrease from fifteen years to

the venue, with many people meeting for the first time since thenine years the time spent in the Presidential line.

disruption of COVID.

10

11

FINAL REPORT IFSSH CONGRESS

www.ifssh.info

FINAL REPORT IFSSH CONGRESS

August 2022

Asszisztencia, assisted by the BSSH office team delivered a fantastic event. The conference was attended by 3,073

At the IFSSH delegates meeting, the right to hoston site and a further 632 online, with a total of 3,765 registrations from 89 countries around the globe. We ran

the IFSSH congress in 2028 was won by a verya hybrid programme for those in countries unable to attend, mainly for Asian countries where on-going travel

well organised bid from Singapore, led by Mark

restrictions prevented many from attending. There was a broadcast of a selection of the content followed by an

Puhaingran. Congratulations to the Singapore

online discussion, starting at 06.00 each day. On site there were over 1,700 presentations with 960 free papers, allteam and we look forward very much to that.

of which are now available as on-line videos on the congress website.
The well attended closing ceremony took place
The theme of the core series of instructional course lectures was “Tendon Disorders of the Hand and Wrist”. A

on Friday lunchtime, with a handover from theseries of plenary lectures was accompanied by a book edited by me, Dean Boyce and Grey Giddins, published byoutgoing IFSSH president Marc Garcia-Elias toThieme and included in the full registration fee. This book represents the current “state of the art” thinking andthe incoming president Dan Nagle. We wish himpractice in discipline of tendon surgery and we were privileged to have chapter contributions from leaders in theluck for his tenure.

field, from all corners of the globe. Although practice inevitably evolves, we hope that this volume will serve as a
useful guide and definitive reference for years to come.

We are very much looking to the next meeting in Washington, which we are sure will be a great event.

There was a fantastic program team led by Jonathan Hobby and Wee Lam with a comprehensive programme of

Meanwhile, here are some memories from London…..https://youtu.be/zJUA7P13rks

instructional sessions and symposia. The Swanson lecture was given by Professor Tim Davis from Nottingham
and featured his work on scaphoid fractures.

We are pleased that it seemed to go well. It was certainly worth every scrap of all the effort through the years.

The Presidential Lecture was given by Professor Gus McGrouther from Singapore with a discussion of current

We certainly enjoyed it.

concepts on hand infection. Professor David Ring from the USA gave the BSSH Douglas Lamb Lecture on theinfluence of psychological factors on outcomes in hand surgery. The British Association of Hand Therapists, led

We hope you did too….

by Christy Fowler, Helen Buchanan, Fiona Sandford, Lisa Newington and Donna Kennedy organised a fantastic
Best wishes

therapy programme.
The Presidential dinner was held at the Barber SurgeonsDavid Shewring

on Tuesday evening with transport to and from theConsultant Hand Surgeon, University Hospital of Wales, Cardiff

venue in traditional London Buses, which had been

Chair, Organising Committee IFSSH/IFSHT/FESSH London 2022

requisitioned. On Wednesday there was a lively “PubNight” organised by the therapists at the Revolution
Bar which was very well attended. On Thursday, we had
the Gala dinner at the Old Billingsgate. Guests arrived
by water taxi from the ExCeL and disembarked near
the Tower of London, for a champagne reception on theterrace overlooking the Thames and Tower Bridge. Afterdinner the “MIB Band” filled the dance floor, with a freebar until the early hours of the morning. The dinner wasattended by 900 people.
The logo proved to be a surprise hit, with a large wooden
version of it at the entrance to the exhibition area. Eachtime I walked past it there were groups of people having
photos taken with it, which was very gratifying.

1213

www.ifssh.info

August 2022

IFSSH/IFSHT Congress
in London, June 2022”(Photos by Simon Callaghan)

14

15

www.ifssh.info

16

August 2022

17

PIONEER PROFILES

www.ifssh.info

PIONEER PROFILES

August 2022

Adalbert Ibrahim Kapandji

Wladyslaw Manikowski

17/04/1928 - 07/01/2019b. 28/09/1937

Adalbert Ibrahim Kapandji

Amongs many other publications, Kapandji is especially

Wladyslaw Manikowski

University of Poznan from 1996 to 2002 and thereafter

was born on 17 April

known for his major work on functional anatomy.

was born on 28 September

Dean for two terms. During his tenure as Chief of Hand

1928 in Paris, France. He“The Physiology of the Joints” Volume 1 (Upper Limb)

1937 in Vilnius, Poland.

Surgery, he established the Laboratory of Experimental

descended from a Turkish-and Volume 2 (Lower Limb) (English translation,

After completing secondary

Microsurgery and introduced microsurgery as part ofGreek family who settled

Churchill Livingstone , New York, 1970), first appeared

school education in 1955

the hand surgery curriculum.

in Paris. After completingin French in 1963. These books have been translated

in Poznan, he began his

his basic medical studies

into 11 languages. The illustrations are done by him.

medical studies at theProf. Manikowski supervised 18 doctoral and 9 post-at the Faculty of Medicine

His exceptional drawing talent is well represented in

University of Poznan anddoctoral theses, published over 200 papers and 18 bookin Paris (1951-1956), he

yet another of his books: “Dessins de Mains” (Maloine,

graduated as a doctor

chapters, organised numerous courses and meetings,

worked in various surgical

Paris 1988). In 1936 his father Mehmet and Louis Sauvé

in 1962. Following his

was Editor-in-Chief of the Polish edition of “Current

departments in Paris specialising as a general andseparately popularised the so called Kapandji-Sauvéinternship, he worked

Orthopaedics” from 1992-1997, as well as Deputy Editor

orthopaedic surgeon from 1956 to 1960.

procedure on the distal end of the ulna. Adalbertanother year in theof the Polish Journal of Orthopaedics. Manikowski

Kapandji earned his ‘Doctor of Medicine’ in 1960. He

modified the procedure in 1986 by adding a second

Rehabilitation Clinic of the Medical Faculty, before

was co-founder of the Polish Society for Surgery of thescrew to fix the ulnar head to the radius.

starting his training in Orthopaedics and Traumatology

Hand and its President for two terms (1997-2001). He

in 1964. In 1967 Manikowski started a further

was also a two term President of the Polish Society of
Orthopaedics and served on various medical boards.

then worked as an Assistant Surgeon at the Hospital
La Pitié-Salpétriere and the Hospital Broussais until

Kapandji was President of the French Society for

qualification in Rehabilitation of the Musculo-skeletal

1964. During this time he was also Chief of Clinics of theSurgery of the Hand (1987-1988), and was Honorary

System. He then became an academic teacher in 1970 inFaculty of Medicine in Paris. His interest in anatomy

Member of numerous international Hand Surgery

the newly created Hand Surgery Clinic of the InstituteFor his pioneering research and academic contribution

and function was kindled by his Surgeon father Mehmet

Societies.

of Orthopaedics and Rehabilitation of the Medical

Manikowski was honoured with numerous awards,

University in Poznan. He successfully defended his PhD

amongst others the Knight’s Cross of the Order ofIbrahim Kapandji and his maternal grandfather Adalbert
Chevalier, a marine engineer. His mother Robert Jeanne

Adalbert was married to Lydie Richard, one of histheses in 1975 based on his research into disorders of

Polonia Restituta, the Golden Cross of Merit, thewas a painter from whom he must have inherited

erstwhile surgical assistants, and they have a daughter

the blood and nerve supply in patients with Dupuytren’s

Honorary Badge of the City of Poznan, the Badge of Merithis drawing skills. Kapandji was also Professor ofMartine and a son Thierry, both medical doctors. His

Contracture, and then became Assistant Professor

for the Development of the Poznan Province, the Badge

Anatomy at the Nurses School of Paris Hospitals andhobbies included photography, poem writing, travel andin the same year. In 1981 he was appointed Head offor Exemplary Work in Health Service, and the Golden

the Physiotherapy School in Necker Hospital from

diving. He died aged 90 on 7 January 2019.

the Hand Clinic, followed with additional duties as

Badge of Merit for the Development of Polish Fencing.

Deputy Director of the Institute of Orthopaedics andEven after his retirement, he stayed on as teacher

Rehabilitation in 1983.

and consultant in the Departments of Orthopaedics

1959-1965, and from 1968-1970 at the Physiotherapy Staff
School at Bois-Larris.

The title “Pioneer of Hand Surgery” was bestowed on
Adalbert Ibrahim Kapandji at the Tenth Congress of theand Hand Surgery. Wladyslaw is married to his wife,

Adalbert Kapandji then established in 1965 andInternational Federation of Societies in Sydney on 11

Manikowski earned a second doctoral degree (DSc) inmanaged the private orthopaedic and hand surgery

March 2007.

1988 based on his research on the reconstruction of

Magdalena, a pharmacist, and they have two sons.

clinic, named the “Clinique de l’Yvette” in Longjumeau indamaged flexor tendons. In May 1989 he was appointed

At the Tenth Congress of the International Federation

the south of Paris, and worked there until his retirement

Associate Professor. Ten years later in 1996 he alsoof Societies for Surgery of the Hand which was heldin 2001.

became Associate Professor in the Academy of Musicin Sydney, Australia in March 2007, Prof. Wladyslaw

in Poznan! He became full Professor in 1999. Prof.

Manikowski was honoured as a ”Pioneer of Hand

Manikowski was also appointed Vice Dean of theSurgery”

18

19

HAND THERAPY

www.ifssh.info

HAND THERAPY

August 2022

The relative motion
flexion orthosis
IN THE MANAGEMENT OFFINGER FLEXOR TENDON REPAIRS:AN UPDATEThe relative motion extension (RME) approach

Newer to the literature is the application of relative

has become the primary rehabilitation approachmotion flexion (RMF) orthoses to manage zones I-II

implemented by hand therapists following extensor

flexor digitorum profundus (FDP) tendon repairs

tendon repair in zones V-VI.

(Figure 1a,b,c). This article offers anatomical(1, 2)

Safe early active

motion (EAM) makes use of the ‘quadriga effect’

rationale, biomechanical proof of the concept, athat results from positioning the repaired tendon

clinical outcomes summary, and guidelines for use of

metacarpophalangeal joint (MCPJ) in greater

the RMF orthosis/EAM approach.

extension compared to that of the MCPJs of theuninjured digits.

Anatomical rationale / Proof of concept(3)

Figure 1b. Relative motion flexion splint with all

Figure 1c. Relative motion splint with all fingers infingers in extension. Long finger MCP joint in relative

flexion. Long finger MCP joint in relative flexion.

flexion.

For this application of the relative motion concept, the quadriga effect is imposed on the FDP by

A biomechanical ‘proof of concept’ cadaver study

Another study measured the change in finger flexion

positioning the involved digit’s MCPJ(s) in relatively

examined intact and repaired zone III FDP tendons

force and linear finger flexion when a ‘differential

Comparatively, return to function was earlier thanmore flexion (Figure 2). Relying on the fact that

repaired with 6-0 nylon interrupted sutures both in

splint’ (a.k.a. RMF orthosis) and neutral wrist

immobilization

the FDP is a single muscle shared by multiple

and out of the RMF orthosis.

position were used.(24) Within the ‘differential splint’

tendons which serve as the primary motor fororthosis, a dorsal-based forearm orthosis positioned

the involved MCPJ was put in 15, 30, or 45° moreinterphalangeal joint (IPJ) finger flexion.

the wrist in 30° extension and MCPJs in 50° flexion

flexion than the uninvolved MCPJs, which wereduring full finger motion loading.

kept in 30° greater MCPJ flexion. The flexion forces

Safety of the RME/EAM approach has beenvalidated biomechanically
(8)

(4)

and clinically.

(20)(3, 5-11)

or palmar blocking orthoses

improved patient satisfaction (7).

(7)

and

(21)

(22)

In addition to a RMF(22)

For tendons

protected with the RMF orthosis, elongation was lessmeasured at the imposed differential MCPJ angles ofthan 2mm, whereas repaired tendons not protected

30 and 45° (actually, 60 and 75° MCPJ flexion) of theby the RMF orthosis gapped.

long, ring and small finger decreased the most, and(22)

with index flexion force affected the least.(24)The safest wrist position and relative angle of MCPJThe greatest loss of linear finger flexion or tendon

flexion is unknown. Experimentally, in normal

excursion was at the differential MCPJ angle ofhands passive tension imposed by the long extensor

45°(actually 75° MCPJ flexion) with loss of flexion

tendons during finger flexion is the least when thegreatest to least being, ring, long, small, and index

wrist is in 45° extension with the MCPJs flexedfinger.(24)compared to a neutral or flexed wrist, implying that

Figure 1a. Relative motion flexion splint for left long finger.

20

in these positions, less force is needed for active

The “work of flexion (WOF)” or “energy needed to flex

finger flexion.

the digits” (25, p18) is an important consideration(23)

after flexor tendon repair.

21

HAND THERAPY

www.ifssh.info

HAND THERAPY

August 2022

Published outcomes summary

When the RMF approach is selected, thoughtful

orthosis. As functional activities can vary between

A 10-patient case series provides the first (and only

prescription of exercises both in and out of thecultures, it is helpful to describe activities you preferto-date) published data on RMF orthoses for FDP

orthosis, and proper advisement on functional hand

your patient avoid for different postoperative phases.

zones I-II flexor tendon 4-strand repairs.

(20)

The

use, especially during the initial 3-4 weeks post

initial three cases wore a dorsal wrist-hand-finger

repair is needed. Our experience is that the orthosis

As an example, for the first 3 postoperative weeks

blocking orthosis (wrist in 0-20 flexion) with theimposed quadriga effect may overprotect the repair,while both the RMF and the wrist orthoses are being

RMF orthosis, whilst the remaining seven wore ai.e., limit FDP excursion. As a result, implementation

worn is to ‘avoid lifting objects heavier than a tub of

0-20 wrist extension orthosis with the RMF orthosis.

of EAM exercises with the RMF orthosis removed isbutter’. Equally as important is to advise patients onessential.

what they can do while wearing both orthoses, such

(20)

For all the RMF orthosis MCPJ flexion differential

was 30-40. For the first three weeks post-surgery

as ‘use your hand to brush your teeth’. Keeping inboth orthoses were worn full time (exception hand

mind that weaning from the RMF orthosis will vary

hygiene), with advice given to avoid strenuous

depending on the demands patients placed on theiroperated hand lifting/squeezing. Patients werehands. One way to progress the program after theencouraged to move their fingers actively as allowed

third postoperative week is to decrease flexion ofby the RMF orthosis and undertake light activities.

the involved MCPJ while maintaining the 30° MCPJ

(20)

differential. For example, if the initial flexion of theSpecific exercises were passive composite IPJ

involved digit’s MCPJ was 75°, the next progression

flexion and passive IPJ extension to neutral withwould be to 60°, then later to 30°. While preserving

the MCPJ flexed.

At 3 weeks post-surgery thethe flexion differential with the non-involved MCP

Figure 2. Chariot analogy for concept of relative

RMF orthosis was continued full time whilst thejoints, initially at 60°, progressing to 30° and finallymotion flexion. The dark horse is the injured

dorsal block or wrist orthosis was worn only forto neutral. Remember that index FDP repairs may

digit positioned in relative MCP joint flexion. In

sleep or ‘at risk’ activities until week 6 when it wasneed to be managed more conservatively (Figure 3).

this illustration the chariot reins that are on slack

discontinued; full time wear of the RMF orthosis

represent the FDP tendon on which the ‘quadriga

continued until 8-10 weeks post-surgery at which

Points to consider when implementing a RMF

effect’ has been imposed. (©2018 KW Design.

time all restrictions on hand use were lifted.

orthosis and therapy program:

For permission to use, contact Katie Wright ofThere were no tendon ruptures, secondary surgeries,

Design:Wright.design.illustration.com)

or PIPJ contractures with similar mobility andorthosis. When deemed safe (patient-dependent),

functional outcomes as other EAM studies.

removing the orthosis for PROM is an option

(20)

(20)

•

(20)

Include PROM (all digits) within the RMF

The two previous studies were included as a

Practical advantages mentioned included the RMF

Figure 3. Relative motion flexion splint long finger

reminder to clinicians contemplating use of the RMF

orthosis/EAM approach simplicity, and the ability toin the final position as suggested by the authors

initiation of finger flexion with the DIPJ firstorthosis to be mindful of the WOF when considering

permit active finger motion and functional hand use.

for splint weaning. Note the minimum (15-20°)

to maximize FDS/FDP differential glide (26)wrist and MCPJ position as each influence passive(20)

difference in relative flexion between the MCP joint

and focus on recovering full active PIPJ flexion•

tension of long extensor and intrinsic muscles,
respectively.

In and out of the RMF orthosis, encourage active(especially for zone I repairs and after FDS slip
Clinical insights

If the Wide-awake Local Anaesthesia No Tourniquet

Advancement in surgical procedures (eg. multi-(WALANT) technique is used by the surgeon,

Secondly, generalising from the last abovementioned

strand core repair, excision of FDS slip and pulleyknowing the MCPJ flexion differential that allowed

RMF orthosis. If by 3 weeks postoperatively fullstudy, the soundest initial RMF orthosis position

venting) coupled with stronger low resistance suture

safe excursion of the repair is useful information

active PIPJ extension is limited, consider adding

for the involved finger may be somewhere between

materials have permitted hand surgeons to betterfor planning the postoperative program. If WALANT

passive stretching, or add a night IPJ extension

60° and 75° of MCPJ flexion while maintaining 30°

tailor FDP tendon repairs. Similarly, therapists haveis not used, observation and patient feedback areorthosis in combination with the RMF orthosis

MCPJ flexion differential in the non-involved digits;

many postoperative orthotic options for delivering

the therapist’s best tools. Just as with other EAM

and when the involved finger is the index, 75° MCPJEAM to best suit each patient’s needs. The RMF

flexor repair postoperative approaches, emphasis onsurgeon/therapist dependent, the cohort in theflexion may be best.

orthosis/EAM approach appears to be another tool in

passive IPJ motion and oedema control support safe

Henry and Howell study was discharged from all

Additional research is needed to determine this.

the therapist’s toolbox.

advancement into active exercises in/out of the RMF

protection between 8-10 weeks postoperatively (20)22

excision)(20)••

Promote active PIPJ extension exercises in the

Discharge of the RMF orthosis is patient/23

HAND THERAPY

Future directions and summary

www.ifssh.info

article. Hand. 2013;8(1):17-22.

HAND THERAPY

August 2022

15. Merritt WH, Howell JW. Relative Motion Concepts:

23. Savage R. The influence of wrist position on the

The use of the RMF orthosis/EAM approach after

7. Collocott SJF, Kelly E, Foster M, Myhr H, Wang A,

Applied to Hand Therapy Management of Finger

minimum force required for active movement

FDP zones I-II repair has been newly introduced as

Ellis RF. A randomized clinical trial comparing

Extensor Tendon Zones III-VII Repairs, Acute andof the interphalangeal joints. Journal of handa postoperative rehabilitation management choice

early active motion programs: Earlier hand

Chronic Boutonniere Deformity and Sagittal Bandsurgery.1988;13(3):262-8.

and compares favourably to other EAM approaches.

function, TAM, and orthotic satisfaction with a

Injury. In: Skirven TM, Osterman AL, Fedorczky

To determine the efficacy of the RMF approach

relative motion extension program for zones V

J, Amadio P, Feldscher SB, Shin EK, editors.

RG. Differential splintage for flexor tendon

in the management of finger flexor tendons, larger

and VI extensor tendon repairs. Journal of hand

Rehabilitation of the Hand and Upper Extremity:

rehabilitation: an experimental study of its

prospective cohorts or RCTs are required.

therapy : official journal of the American Society

Elsevier; 2020. p. 1496-510.

effect on finger flexion strength. Journal of hand(20)of Hand Therapists. 2020.
References:1.

8. Hirth MJ, Bennett K, Mah E, Farrow HC, Cavallo

16. Howell JW. Therapist's Corner - Relative motion
flexion. American Association for Hand Surgery,

25. Amadio PC. Tendon nutrition and healing. In:

AV, Ritz M, et al. Early return to work andmotion extension management of zones V andimproved range of motion with modified relative

VI extensor tendon repairs: Does internationalmotion splinting: a retrospective comparison

Managing Acute and Chronic Boutonnierepractice align with the current evidence? Journal

with immobilization splinting for zones V andDeformity: Anatomic Rationale and Earlyof hand therapy : official journal of the American

VI extensor tendon repairs. Hand Therapy.

Clinical Results for the Relative Motion Concept

Lees VC. The Manchester short splint: A change

Society of Hand Therapists. Available online 9th

2011;16(4):86-94.

Permitting Immediate Active Motion and Hand

to splinting practice in the rehabilitation ofUse. Annals of plastic surgery. 2020;84(3S Suppl

zone II flexor tendon repairs. Hand Therapy.

2):S141-S50.

2014;9(2):47-53.

2. Hirth MJ, Howell JW, Feehan LM, Brown

9. Svens B, Ames E, Burford K, Caplash Y. Relative
active motion programs following extensor

Hand Association News, December. 2016.
17. Merritt WH, Jarrell K. A Paradigm Shift inT, O'Brien L. Postoperative hand therapy

tendon repair: A pilot study using a prospective

management of zones V and VI extensor tendon

cohort and evaluating outcomes following

Use of relative motion orthoses to manage

repairs of the fingers: An international inquiry

orthotic interventions. Journal of Hand Therapy.

extensor tendon zones III and IV and sagittalof current practice. Journal of hand therapy :2015;1(28):11-9.

band injuries in adjacent fingers. Journal of handofficial journal of the American Society of Hand

10. Cesim OB, Ayhan E, Bas CE, Oksuz C. Use of

Therapists. Available online 9th March 2020.

relative motion splint in extensor mechanism

3. Howell JW, Merritt WH, Robinson SJ. Immediate

repairs: a retrospective case series. Hand Surg

controlled active motion following zone 4-7
extensor tendon repair. Journal of Hand Therapy.
2005;18(2):182-90.

Rehabil. 2020.
11. Mottay N, Govender P, Mpanza D. The use of

Tang JB, Amadio PC, Guimberteau JC, Chang J,
editors. Tendon surgery of the hand. Philadelphia,
PA: Elsiever Saunders; 2012. p. 16-23.
26. Peck FH, Roe AE, Ng CY, Duff C, McGrouther DA,

18. Hirth MJ, Howell JW, O'Brien L. Two case reports-

therapy : official journal of the American Societyof Hand Therapists. 2017;30(4):546-57.
19. Johnson C, Swanson M, Manolopoulos K. A casereport: Treatment of a zone III extensor tendon
injury using a single relative motion with dorsal

the ICAM Splint Programme in Zone IV to VII

hood orthosis and a modified short arc motion

4. Sharma JV, Liang NJ, Owen JR, Wayne JS, Isaacs

Extensor Tendon Repairs: Patient outcomes andprotocol. Journal of hand therapy : official journal

JE. Analysis of relative motion splint in theclinician experiences in a specialised hand unitof the American Society of Hand Therapists. 2019.

treatment of zone VI extensor tendon injuries.

in SA. South African Journal of Occupational

The Journal of hand surgery. 2006;31(7):1118-22.

Therapy 2020;50(2):23-34.

20. Henry SL, Howell JW. Use of a relative motion
flexion orthosis for postoperative management

JULIANNE W HOWELL,

Altobelli GG, Conneely S, Haufler C, Walsh M,

12. Merritt WH. Surgical Demonstration: Extensor

of zone I/II flexor digitorum profundus repair: A

Self-employed consultant, 1715 River Ridge, Saint

Ruchelsman DE. Outcomes of digital zone IV

Mechanism with Anatomical Concept of a Ring

retrospective consecutive case series. Journal of

Joseph, MI USA 49085

and V and thumb zone TI to TIV extensor tendon

Splint for Zone VI Extensor Tendon Repairs.  26th

hand therapy : official journal of the American

julianne0525@gmail.com

repairs using a running interlocking horizontal

Annual American Society of Hand Therapists

Society of Hand Therapists. 2020;33(3):296-304.

mattress technique. The Journal of hand surgery.

(ASHT) meeting; Hollywood, CA2003.

2013;38(6):1079-83.
6. Burns MC, Derby B, Neumeister MW. Wyndell
merritt immediate controlled active motion

24

surgery. 2005;30(2):168-74.

Hirth MJ, Howell JW, Brown T, O'Brien L. Relative

March 2020.

5.

24. Savage R, Pritchard MG, Thomas M, Newcombe

21. Brand PW. Mechanics of individual muscles at

MELISSA J HIRTH,

13. Howell JW, Peck F. Rehabilitation of flexor andindividual joints. In: Klein EA, editor. Clinical

Senior Occupational Therapist, Austin Health,extensor tendon injuries in the hand: current

Mechanics of the Hand. St Louis, Missouri: CV

Studley Road, Heidelberg, VIC, Australia 3084

updates. Injury. 2013;44(3):397-402.

Mosby Company; 1985. p. 192-309.

& Malvern Hand Therapy, 253 Wattletree Road,(ICAM) protocol following extensor tendon

14. Merritt WH. Relative motion splint: active motion

repairs in zone IV-VII: review of literature,

after extensor tendon injury and repair. The

Flexion Splinting for Flexor Tendon Lacerations:melissa.hirth@austin.org.au

orthosis design, and case study-a multimedia

Journal of hand surgery. 2014;39(6):1187-94.

Proof of Concept. Hand. 2019;14(2):193-6.

(left is Julianne Howell and right is Melissa Hirth)

22. Chung B, Chiu DTW, Thanik V. Relative Motion

Malvern, VIC, Australia 3144

25

HAND THERAPY

www.ifssh.info

ART

August 2022

IFSHT August 2022
IFSHT NEWSLETTER
We proudly reveal our new logo for REACH!
The winner of the REACH logo competition wasannounced at the IFSHT Executive Committee
meeting at Congress in London in June.
Well done to Michele Yuen from Australia.
We are now preparing a special edition of the next issue of REACH which will exclusively report on
highlights from the IFSSH-IFSHT joint Congress in June.
If you missed the last issue, you can read it here:  https://ifsht.org/publications/reach-newsletter-issue-1-2/
The publication aims to collate Research, Education, Achievement and Clinicians in Hand and upper
limb therapy around the world. All previous issues are archived on the IFSHT website.
We call on hand and upper limb therapy clinicians and researchers to submit any contributions forconsideration to informationofficer@ifsht.org.

IFSSH, IFSHT & FESSH

It was also announced at the Closing Ceremony

Combined Congress – London,

that the the 2028 joint IFSSH-IFSHT Congress will

6-10 June 2022 and the

be in Singapore. Next, in 2025, our host will beannouncement of our next host

Washington, USA, with Aviva Wolff taking on therole as the host country Scientific Committee Co-

The IFSSH, IFSHT & FESSH Combined Congress

Chair.

was a tremendous success with peers connecting
once again face to face and also virtuallyfor the first time. Outgoing IFSHT President,
Nicola Goldsmith, closed the IFSHT ceremony

Art Exibit #17

by thanking all and welcoming in the 2022-25
Executive Committee: Peggy Boineau (new IFSHT“Tre gratier”

President) and Stacey Doyon, Susan de Klerk,
Marie Eason Klatt and Liz Ward.

Identical triplets expressing kindness, care and love with their rotated arms and hands.

The Silent Auction was yet again a success raising

26

Sculptor: Istvan Lisztes$8,326. Money raised will support therapists to

Look out for the link to the London Congress

Cast bronz. 185 cm high. 1997.

attend the congress in 2025.

special edition of REACH in the next IFSSH ezine!

Rikshospitalet, Oslo, Norway

27

SCIENTIFIC CONTRIBUTION

www.ifssh.info

Cortical plasticity
WHAT WE LEARN BEYOND HAND SURGERY- AN OVERVIEWSCIENTIFIC CONTRIBUTION

August 2022

Non-human primate experiments on the Chacma

The more extended use of contralateral nerve transfers

baboon (Papio ursinus) have shown that nerve(mostly the ‘dispensable’ C7 root) teaches us thatregeneration and new growth does indeed take place

the cortical re-organization may overcome laterality

in the higher animal (Mennen 1998). This was followed

concerns. Furthermore, proximal upper limb tasks,

by a large clinical end-to-side nerve suture series on

which is a frequent parallel and simultaneous bilateral

peripheral radial, median and ulnar nerves (Mennen

activation eg. lifting of heavy objects, involves bilateral1998). One of the first and most used motor nerve

shoulder and biceps activation. Muscles like thetransfers (end-to-end) today is the “Oberlin transfer”

intercostals or diaphragm not directly involved in

Cortical plasticity is a fascinating concept, describing

His books are a fascinating life story and arewhich re-neurotises the biceps and / or brachialis

these bilateral movements muscles may successfully

our brain cortex’s capacity to learn and adapt

recommended for every interested scientist andmuscle by redundant motor fascicles coming frombe used to reanimate elbow flexion power using acontinuously. We all know of Penfield´s homunculus

physician.

the unaffected median and /or ulnar nerve (Teboul etnerve transfer onto the motor nerves to brachialis andal. 2004). After the nerve transfer, the new relevant

biceps muscle (Malessy et al. 2003).

and its imaged cortical representation of the various
body parts in the sensory and motor cortex and theirYears before, the American neurologist Frank Wilson

motor area in the cortex related to the motor donor isrelative importance by their topography, size andwrote an amazing comparative study about the hand

re-wired for the new function (Anastakis et al. 2008,

These surgical techniques, based on a growing

density.

in human evolution: “How Its Use Shapes the Brain,

Socolovsky et al. 2017).

knowledge of the brain cortical reorganization,

Language, and Human Culture” (Wilson 1999).
Göran Lundborg´s interesting explanations andMeanwhile, their use is

exquisite illustrations about the processes which

Cortical plasticity thus may be understood on

progressively extended

happen when sensory or motor nerves get injured ora molecular, cellular and structural tissue level,from peripheral nerve injury

transected help us to understand how the brain copes

involving physiological and pathological processes

cases to medullar trauma

with peripheral nerve damage. The represented area

directed by brain activity and peripheral input.

(para- and tetraplegia) oris “shattered” or lost, but some suboptimal restitution

Motor and sensory controls are more complex thaninfection (acute myelitis

does happen as nerve regeneration takes place

merely efferent and afferent signals or impulses. It

transversa) and even central(Lundborg 2005). Body parts (like the fingers) haveis a dynamic process to optimize integrated bodily

nerve conditions like stroke

adjacent topographic representative areas (like thefunctions.

(spastic hemiplegia) andface) and we explain changes in sensation and motor

spasticity (contralateral root

control referring to and using this relationship in our

As we as surgeons understand more and more of theC7 transfer which decreases

endeavor to restore function.

neurological processes and how to gain more function

the hypertonia by theafter nerve injury, and deal with neuropathic pain,

ipsilateral C7 de-connection

nerve transfers of all sorts are being developed.

and adds controllable new

These adaptive processes based on neurophysiologicallearning and memory processes have been discovered

motor input by the other“Cortical plasticity
may be understoodon a molecular,
cellular andstructural tissue
level

”

has already extended tototally different fields ofreconstructive surgery,like urology (neurogenic
bladder, Agarwal et al. 2020)
or ophthalmology (corneal
resensibilisation, Catopano
et al. 2019).
We successfully started totreat children with upper
limb arthrogryposis using
nerve transfers to reanimate
elbow flexion and shoulder
lateral rotation (Bahm et al.
2013).

and described so well by Nobel Prize winner

Nerve transfers bring healthy donor fascicles onto

healthy C7, Zheng et al.

neuroscientist Eric Kandel. He did most of his

sensory or motor targets which were denervated by

2018). It is interesting tostudies on the neurophysiology of memory in marine

previous peripheral or central nerve injury, illness orimagine that in cases ofmollusks (Aplysia californica) which only have twenty

tumors. This technique was described over a hundred

upper limb spasticity, the surgical reduction of motororganization, not only for motor rehabilitation, but also

thousand neurons, some of them as large as 1 mm.

years ago in 1913, by Alfred Stoffel , but only started

input known as hyponeurotisation or hyperselective

in regaining the sensory and nociceptive pathways.

in diameter. In his textbook on neuroscience, firstto be popularized in the 1990s. It was also realizedneurotomy initially described by Georgio Brunelli,

The well-established mirror therapy and graded motor

published in 1981, and in an extended autobiographythat healthy nerves do not only regenerate into otherand  refined by Leclercq et al. (2021) may be extended

imagery (Moseley 2004, Strauss et al. 2021) are very

telling of his life and scientific career, he describes

disconnected nerves (end-to-end and end-to-side

to motor nerve transfers from adjacent but healthy,

useful in the treatment of neuropathic pain and CRPS.

the molecular and genetic changes associated withaugmentation), but that intact axons also have thenon spastic donors, which are regulated by voluntarily

Motor rehabilitation in adults mostly needs time andshort and long term memory and more specifically theability to ‘sprout’ laterally into recipient nerves (end-to

controllable cortical areas.

an exercise program.

different learning forms of habituation, sensitizationside connection).

Rehabilitation usuallyforms a very important andessential part in cortical re-and conditioning.

28

29

SCIENTIFIC CONTRIBUTION

www.ifssh.info

The motor function of the donor area (like finger

References

Reconstruction And Cortical Remodeling.

flexion in an Oberlin transfer, breathing or coughing•

Churchill Livingstone 2005

Agarwal P, Parihar V, Kukrele RR, Kumar A,

when the intercostal nerves have been transferred)

Sharma D. Anatomical feasibility of anastomosing

must be specifically addressed to start biceps activity,

SCIENTIFIC CONTRIBUTION

August 2022•

Teboul F, Kakkar R, Ameur N, Beaulieu JY, Oberlin

Malessy MJ, Bakker D, Dekker AJ, Van Duk JG,

C. Transfer of fascicles from the ulnar nerve tointercostal nerves (D10&D11) and subcostal nerve

Thomeer RT. Functional magnetic resonancethe nerve to the biceps in the treatment of upper

which will need a parallel trigger training for months,(D12) to S2 ventral root and lumbar plexus forimaging and control over the biceps muscle after

brachial plexus palsy. J Bone Joint Surg Am.

before the targeted movement may be addressedmanagement of bladder function after spinal

intercostal-musculocutaneous nerve transfer.

2004 Jul;86(7):1485-90. doi: 10.2106/00004623-

separately (active elbow flexion becoming addressable

cord injury. J Clin Orthop Trauma. 2020 Sep-

J Neurosurg. 2003 Feb;98(2):261-8. doi: 10.3171/

200407000-00018. PMID: 15252097.

even with extended fingers). Motor nerve transfers

Oct;11(5):900-904. doi: 10.1016/j.jcot.2019.12.018. Epubjns.2003.98.2.0261. PMID: 12593609.

in children however, seldom need specific targeted2020 Jan 2. PMID: 32879578; PMCID: PMC7452297.

therapy, as children are able with some months’••

Mennen U. “End-to-side Nerve Suture in the

Wilson FR The Hand: How Its Use Shapes theBrain, Language, and Human Culture 1999

Anastakis DJ, Malessy MJ, Chen R, Davis KD,

Primate (Chacma Baboon)”. Hand Surgery, Vol.3,

delay to self-learn the newly gained function. This

Mikulis D. Cortical plasticity following nerve

No. 1, June 1998, p1-6.

Cao XH, Zhao NQ, Lyu JY, Xu JG, Gu YD, Xu WD. Trial

applies for classic motor nerve transfers in the uppertransfer in the upper extremity. Hand Clin.

Mennen U. “End-to-side Nerve Suture in theof Contralateral Seventh Cervical Nerve Transfer

limb, like the Oberlin or Somsak transfer. Intercostal

2008 Nov;24(4):425-44, vi-vii. doi: 10.1016/j.

Human Patient”. Hand Surgery, Vol 3, No. 1, June

for Spastic Arm Paralysis. N Engl J Med. 2018 Jan

nerve transfers aimed to reanimate elbow flexion andhcl.2008.04.005. PMID: 18928891.

1998 p7-15.

4;378(1):22-34. doi: 10.1056/NEJMoa1615208. Epub

Moucha R, Kilgard MP. Cortical plasticity and2017 Dec 20. PMID: 29262271.

extension often work well with little therapy.

••

PMID: 34661105; PMCID: PMC8514858.

•

Bahm J. Arguments for a neuroorthopaedic

•

•

•

Zheng MX, Hua XY, Feng JT, Li T, Lu YC, Shen YD,

strategy in upper limb arthrogryposis. J Brachialrehabilitation. Prog Brain Res. 2006;157:111-122. doi:

Although much basic knowledge is available (Moucha

Plex Peripher Nerve Inj. 2013 Oct 17;8(1):9. doi:

10.1016/s0079-6123(06)57007-4. PMID: 17167905.

et al. 2006), rehabilitation techniques need to be

10.1186/1749-7221-8-9. PMID: 24135288; PMCID:

better integrated in training programs after functional

PMC3953705.

long-standing complex regional pain syndrome: aCatapano J, Fung SSM, Halliday W, Jobst C, Cheyne

randomised controlled trial. Pain. 2004 Mar;108(1-D, Ho ES, Zuker RM, Borschel GH, Ali A. Treatment2):192-8. doi: 10.1016/j.pain.2004.01.006. PMID:

Brain cortical plasticity may explain why some of ourof neurotrophic keratopathy with minimally

15109523.

nerve surgery techniques work, but much researchinvasive corneal neurotisation: long-term clinicalis still needed to understand how this process can beoutcomes and evidence of corneal reinnervation.

Flores L. Current concepts in plasticity andJörg Bahm MD PhD

improved. The challenging concept of brain plasticity

Br J Ophthalmol. 2019 Dec;103(12):1724-1731. doi:

nerve transfers: relationship between surgical

Chief: Brachial Plexus Surgery Unit,

can also be applied to all higher cerebral functions,10.1136/bjophthalmol-2018-313042. Epub 2019 Feb

techniques and outcomes. Neurosurg Focus. 2017

Plastic-, Hand- and Burn Surgery Clinic,

including the specific mental states like coma or near-

15. PMID: 30770356.

Mar;42(3):E13. doi: 10.3171/2016.12.FOCUS16431.

University of Aachen,

Kandel ER, Schwartz JH, Jessell TM. Principles of

PMID: 28245665.

Aachen, Germany.

Strauss S, Barby S, Härtner J, Pfannmöller JP,

tel.: +49 (0) 241 8089702

Kandel ER. In Search of Memory- The Emergence

Neumann N, Moseley GL, Lotze M. Graded motor

email: jbahm@ukaachen.deof a New Science of Mind. 2007

imagery modifies movement pain, cortical

Lane R. Steven Laureys: a clinical focus

excitability and sensorimotor function in complex

otherwise left untreated or neglected. It is therefore

on consciousness research. Lancet. 2020

regional pain syndrome. Brain Commun. 2021 Sep

not only important to refine our microsurgical andNov 28;396(10264):1719. doi: 10.1016/S0140-

25;3(4):fcab216. doi: 10.1093/braincomms/fcab216.

rehabilitation techniques, but also to participate in6736(20)32477-6. PMID: 33248489.

reconstructive surgery.

death-experiences, which would lead to more insights.

••(Lane and Laureys 2020).

Neural Science. Elsevier 1981•

Understanding these concepts better will provide
more indications and surgical solutions to conditions

frequent discussions with colleagues internationally.

••

Leclercq C, Perruisseau-Carrier A, Gras M, Panciera
P, Fulchignoni C, Fulchignoni M. Hyperselective

These discussions and new ideas should involve

neurectomy for the treatment of upper limb

colleagues of other disciplines which would be to

spasticity in adults and children: a prospective

the benefit of all to understand this exciting andstudy. J Hand Surg Eur Vol. 2021 Sep;46(7):708-716.

mysterious medical phenomenon.

doi: 10.1177/17531934211027499. Epub 2021 Jul 13.

It is an ongoing process which reveals new discoveries

PMID: 34256619.      and makes this a fascinating journey!

30•

Lundborg G Nerve Injury And Repair: Regeneration,

•

•

•

Moseley GL. Graded motor imagery is effective forSocolovsky M, Malessy M, Lopez D, Guedes F,

EDITOR: I HAVE ALWAYS WONDERED HOW THE BRAIN KNOWS WHAT TO DO WHEN WE SWITCH NERVES AROUND OR ATTACH THEM TO OTHERS.
IS IT THAT THE PERIPHERAL SENSORY ORGANS SEND AREA SPECIFIC SIGNALS (LIKE MOBILE PHONES) BACK TO THE BRAIN, REGARDLESS HOW
THE IMPULSES AND BY WHAT ROUTE THEY TRAVEL? THE BRAIN WILL ONLY RECOGNIZE (LIKE A MOBILE PHONE) THE PREDETERMINED SIGNALAND RECOGNIZE ITS ORIGIN. SIMILARLY WITH MOTOR ACTIVATION. THE BRAIN SENDS AN INTENDED SIGNAL FOR A SPECIFIC MOVEMENT, AND
THE NECESSARY INNERVATED AND/OR AVAILABLE MUSCLES WILL RESPOND. THIS COULD EXPLAIN HOW EG. ELBOW FLEXION WORKS WHEN
INTERCOSTAL NERVES ARE USED TO MOTORIZE THE BICEPS. IT IS ALL ABOUT “THE ABILITY TO DO”, RATHER THE FUNCTION OF THE NAMEDMUSCLE OR NERVE! ULRICH MENNEN

31

SHARE SECTION

www.ifssh.info

Lessons learned
from 25 years of
replantation surgery

SHARE SECTION

August 2022

which failed as well, a second one a bit longer without

The following case we would like to share is a

success and finally a very long one from the snuffbox

very peculiar one. lt was a blast injury of the rightto the IP joint and only at that stage the thumb washand in a right handed manual worker, with loss ofrevascularized (Fig.1), with a very good cosmetic andthenar muscles and distal thumb, but also a subtotal

functional resut at the end.

amputation of the index finger, the only structure
in continuity being the ulnar digital nerve… So that
was a perfect case for an heterotopic replantation of
the index finger on the thumb, with a long vein graft(remember lesson 2). In the same time, the flexor
digitorum profundus tendon of the index finger was
sutured to the flexor pollicis longus, an oppositiontransfer was done with the extensor indicis proprius

Since the first successful repair of an amputated arm

Even if it won’t replace microsurgical training, sharing

and the first web was covered with a pedicle chinese

in a 12-year old boy by Malt and McKhann in 1962 ,this experience might be helpful for any hand surgeon

flap (Fig.2). The early functional result was quite

replantation surgery has become a common procedure

eager to improve his skills in replantation surgery. The

encouraging. The patient seemed as happy as we were.

for every hand surgeon and remains one of the most

following paper is primarily intended for them.

(1)

Fig.1

publicized parts of his discipline. Limb replantation

Nonetheless, he disappeard from sight for months andthe next time we heard from him was in the T.V. news.

has been the subject of more than 2500 scientific

My colleague Patrick Suttor and I have been working

publications, with a current annual rate of more than

together in the same Hand Unit in Belgium since 1997.

So the first lesson we would like to share is

to to bomb his house and to kill his family. Fortunately

80. Nevertheless, a downward trend concerning both

Within 25 years, the volume of replantation cases weperseverance. And this lesson is already written inwithin a few hours he was overpowered by the police.

prevalence and success rates has been noticed within

had to treat might not reach half of the cases reported

the history books of microvascular surgery by a man

And I felt quite uncomfortable with that story. I felt arecent years by a lot of Authors, mainly in North

by Alicia Billington’s center. Nevertheless, we mightnamed Harry Buncke, who was the first one to report

bit guilty, guilty of something I always wanted to avoid,

Americabe considered as experienced microsurgeons, I mean

a successful replantation of a rabbit ear in 1964. It wasand this thing is counter-Darwinism (7).

out for this downward trend ; decentralization of

the ones Hustedt (3) calls « high volume surgeons », and,the first report of a successful repair of blood vessels

replants from high-volume hospitals, paucity of on-callnot least, all our replantation cases were exclusivelyof 1 mm in size, something that everybody thought tohand specialists, rising health care costs, decreasing

managed by ourselves. The area covered by our Hand

be technically impossible at that time. As interesting

reimbursement for replants, waning surgeon

center might not be the largest but within 25 years of

were the conditions under which his experiments

experience, increased selectivity of patients or fewer

time it has been busy enough for us to treat any kind of

were done ; they were done in his garage with his wife

amputations.

indications.

Constance as assistant because he had no access to(2,3,4). A number of reasons have been pointed(2)

He went completely crazy and one day he threatened

any lab in his hospital. And even more revealing is that
Accordind to Billington et al. , a contributing factor to

Hereunder we’ll report the story of a few selected cases

this experiment was attempted 51 times before it was

lower replantation success rate could be the relatively

we had to treat and the lessons we learned from eachsuccessful (5).

high resident/fellow involvement in a surgicalof them.

(4)

procedure with a notably high time requirement

The second lesson we learned from that case is also

for proficiency. According to Hustedt et al. , an

The first case we wanted to report was a young malesomething written a long time ago by some pioneers

amputation injury presenting to a high-volume surgeon

patient referred to us with a typical case of thumbof microvascular surgery like Bernard O’Brien (6) : in

(5 cases/year) at a high-volume center (20 cases/

avulsion. We were working together on that day andavulsion cases, the operating microscope already letsyear) has a 2.5 times greater likelihood of obtaining

thank goodness, because it was one of our longest

see a nice vessel wall about 8 mm from the rupture

a successful replantation than an amputation injury

operating times, nearly 8 hours of surgery, mainlysite, but the electron microscope can still show some

So lesson 3 : beware of the patient's psychologicalpresenting to a low-volume surgeon at a low-volume

because of arterial problems. According to the aspect ofsignificant lesions up to 4 cm. So except in very

background. These kind of bad injuries do not happen

hospital. In other words, experience remains one of thethe ulnar artery and despite the avulsion, we first triedcleancut amputations, always resect a bit « more » ofrandomly. These patients might be mentally unstable

main keys of successful replantation surgery.

a resection and direct suture, but it failed quickly so weartery before anastomosis.

before the accident, and this instability can contribute(3)

switched to vein grafts, a short one first,

32

Fig.2

to those kinds of injuries.

33

SHARE SECTION

www.ifssh.info

SHARE SECTION

August 2022

And on the other hand those kinds of injuries can

In another case of multiple finger injury, a carpenter

Single and proximal amputations of fingers are

the success is in the head, but also, and it will becontribute to mental problems. In this respect, alost more than half of his thumb and nearly the wholeconsidered as contraindications for replantation, butlesson 7 : replantation in children can pay off beyond

good functional result might become a psycho-social

index and middle fingers, but with a spindle moulder,

there are some exceptions to that rule, especially in

expectations. . .

disaster.

which is far worse than a circular saw, because thechildren. We also had to treat a rather rare case of

amputated fragments are usually so badly damaged

complete avulsion of the fifth finger in a three years

Lets move now to distal and very distal replantations,Anyway I haven’t finished yet with this case. A few

that they are not suitable for replantation. The mainold child above the PIP joint level (Fig.5). The finger

which have become the most frequent now, but whichmonths later, his wife came to my clinic and said toproblem here was to restore the full length of thewas trapped between two steps of a staircaise and thecan be also very difficult and technically demanding.

me : « You know what Doctor ? My husband hanged

thumb to regain a functional pollicidigital pinch withrescuers had to dismantle the staircase to retrieve theSome years ago (13), I had the opportunity to share ourhimself, ank I have to thank you because youd did a

the ulnar fingers. In this case the emergency doctor

amputated finger.

own experience of a dorsal approach for fingertip

good job : the knot was very tight ! » The only answer

came to us and said : « No hurry ! The amputatedwhich came to me was : « My pleasure ! ». But lesson

fragments are unsuitable for replantation. They

The replantation included the harvesting of a 15 mm

patients admitted to our emergency unit during a

4 came to me as a relief just afterwards : Darwin was

are already in the trashbin. ». As soon as he turnedvein graft to repair the ulnar digital artery (remember

two year period with 11 fingertip amputations (thumbobviously right .

his back, I went to the emergency unit, opened thelesson 2). But what is quite interesting here is that we

excepted) with a mean follow-up of of 18 months andtrashbin, and I found exactly what I needed for an

had the opportunity to see the patient about ten years

a survival rate of 72.7 %. The main advantages of thisThe next case was another bad lesion in a young

heterotopic replantation (Fig.4). The pollicidigitallater for another reason, and the patient was kindapproach is to avoid additional incisions, to have a

independent right handed carpenter. Four fingers ofpinch was excellent at three months. From there,

enough to let us check her fifth finger. Even if the PIP

mirror view of the section and find vessels and nerves

the right hand were removed by a circular saw, withlesson 6 would be a reminder of a well-known principle

joint was stiff, she had good active flexion of the DIP

more easily during dissection and to reduce thendonly three available for reconstruction and with 2

in replantation surgery ; really all the means are good

joint, but the most surprising was the assessment ofneed of interpositional arterial or vein grafts without

and 3 MP joints destroyed. What we did here is an

to preserve thumb length, and check the trashbin firstsensitivity. Two-point discrimination was near normal,

compromise on the survival rate. But beyond that, weheterotopic replantation from the third finger on the

before the patient's toes !

Semmes-Weinstein was normal, wrinkle test was

would like to share two more lessons or two advices forfourth ray and from the index finger on the fifth. And

normal, and even sensibility treshhold to vibrations

those who are not used to distal replantations.

what still amazes me now about this patient was hisor electrical stimulation were found to be normal.

speed of recovery. At about 9 weeks, he had alreadyThat is quite interesting because at the time of injury,

recovered a good grasp, a good pinch and even a good

the avulsion was so bad that both digital nerves were

handwriting (Fig.3). This patient went back to work as

unable to be repaired. Spontaneous neurotization anda carpenter one week later, while at the same time, ansensory recovery in denervated flaps is something welladministrative worker would still ask to be out of work

reported, specially in oropharyngeal reconstruction,

because of pillar pain after carpal tunnel release. So

where 2pd can reach up to 6 mm (8).

(7)

rd

remember lesson 4 and move to the next one : part ofFig.4

the success is clearly in the patient’s head.

replantations (Fig. 6) with a series of 9 consecutive

In the field of hand surgery, fingertip replantation
without nerve repair can lead to even better results, andspecially in children (9), but there is no data available
in the scientific literature for proximal lesions above
the PIP joint like here (10). Spontaneous neurotization issomething not well explained and not fully understood.
But what is clear is that the Meissner’s Corpuscules are

Fig.6

the main receptors responsible for fine discriminative
touch and they do not disappear when the skin is

Fig.3

34

Fig.5

denervated, so reconnection of these receptors is one

The first advice is about tremors, I mean theof the keys

physiological tremors when you hold a position against(11). But most probably the main key, able

to explain these good results in children, is the brain

gravity. You barely see it when you are suturing big

synaptic plasticity. Lundborg himself says that thevessels, but at high or very high magnification it mightoutcome of nerve repair depends mainly on central

be a nightmare. So one of the most important phases

nervous systemof fingertip replantation is not during the anastomosis,(12). So remember lesson 5 : part of35

SHARE SECTION

www.ifssh.info

SHARE SECTION

August 2022

but before the anastomosis. And it is stabilization ;synchronize every step of the procedure without

Bibliography

Adjacent and spontaneous neurotization after

stabilisation of the surgeon, straight position with thefighting against each other. Postop was uneventful.

1.

Malt R, McKhann C. Replantation of severed arms.

distal digital replantation in children. Plast

center of gravity in the middle of the stool, eyes andRevision surgery was done after 7 months on the right

JAMA 1964 ; 189 : 114–20.

Reconstr Surg. 2003 ;111(1) :159-65.

ocular at same level , and most of all support of theside, mainly tenolysis of extensor and flexor tendons

hands and forearms as distal as possible, stabilization

2.

Solaja O, Retrouvey H, Baltzer H. 2020. Trends in

10. Gilbert A. Discussion : Adjacent and spontaneous

and TM and CMC joint arthrodesis to open the first web

Digital Replantation : 10 Years of experience at aneurotization after distal digital replantation inof the patient’s hand, mainly with fingertraps or leadspace. Tenolysis of flexor tendons was done on the leftlarge canadian tertiary care center. Plastic Surgery.

children. Plast Reconstr Surg. 2003 ;111(1) :166.

hand, and stabilization of the fingertip itself, and that isside a few months afterwards, with a final extrinsic

2021 ; 29(1) : 21-29.

another advantage of the dorsal approach because youfunction quite honourable on both sides.

3.

11. Wilson P, Snow PJ. Plasticity in the somatosensory

Hustedt JW, Bohl DD, Champagne L. The

system of developing and mature mammals - The

will first stitch the volar skin, and you can even use thedetrimental effect of decentralization in digitaleffects of Injury to the central and peripheral

K-wires to support the distal fragment.

replantation in the United States : 15 years of

nervous system. Springer Berlin/Heidelberg, 2011.

evidence fom the National Inpatient Sample. J
So lesson 8 would be that installation might be time-

Hand Surg (Am). 2016 ; 41(5) : 593-601.

consuming but it is definitely time well spent...

4. Billington, AR, Ogden BW, Le NK, King KS., Rotatori

12. Lundborg G. Brain plasticity and hand surgery : anoverview. J Hand Surg (Br&Eur Vol). 2000 ; 25(3) :242-252.

Vasospasm is also typical of fingertip replacements.

RM, Kim RL., Nydick J. A 17-Year experience in

It is very common and it can last for a very long time.

hand and digit replantation at an academic center.

replantation. Congress presentation. Les

In some of our cases, recolouration time was beyond

Plast Reconstr Surg. 2021 ; 148 (4) : 816-824.

amputations traumatiques des membres, Lille,

Chase RA. In Memoriam : Harry J. Buncke, MD July

France, may 2004.

10 minutes. So lesson 9 : be patient ! do not go back too

5.

quickly to your sutures ; vasospasm remains the first

16, 1922–May 18, 2008. J Hand Surg (Am). 2008 ;reason for the absence of recolouration, and for a long33(7) : 1245.

time.

6.

14. Kipling R. The Jungle Book & The Second Jungle
Book. Macmillan and Co, London, 1894.

Mitchell GM, Morrison WA, Papadopoulos O, O'Brien
BMcC. A study of the extent and pathology of

Fig.7
And finally let's share a few comments about a very

experimental avulsion injury in rabbit arteries andrare case of double amputation at the forearm level weveins. Br J Plast Surg. 1985 ; 38(2) : 278-287.

had to treat in 2019 (Fig.7). Very rare indeed because

13. Delaere O. Dorsal approach for fingertip

7.

Darwin C. The origin of species by means of natural

there are only about 7 successful cases reported in

At the end, what did we learn from that case ? I would

selection, or the preservation of favoured races in

the world, including one in Brussels by Louis Kinnen

say from a technical point of view : nothing special.

the struggle for life. Sixth edition, with additional

and Jean Pierre Moermans. So rare that when we were

The key to success is to be found somewhere else

corrections, John Murray Ed., Albemarle Street,called by the emergency unit, we really thought it was

and it is very simple. It is team working. From theLondon, 1872.

a bad joke... 68 years old man, suicide attempt with amobile emergency care unit which preserved andcircular saw…Do you remember lesson 3 ?

cooled the amputated parts in a perfect way, but

Sensory recovery of innervated and non-innervatedO. DELAERE M.D. AND P. SUTTOR M.D.

The amputation level was just above the wrist on thealso chose the closest and most adapted hospitalradial forearm free flaps : functional implications. J

Hand and Microsurgery Unit, Centre hospitalierright side and on the distal quarter of the forearm on

available, experienced nurses and anesthesiologist

Reconstr Microsurg. 2000 ; 16(3) : 179-185.

Tubize-Nivelles, Rue Samiette, 1, 1400 Nivelles,

the left. Replantation was done simultaneously: Patrick

able to put the patient on the operating table to be

9. Faivre S, Lim A, Dautel G, Duteille F, Merle M.

on one side and me on the other. Osteosynthesis wasoperated so quickly, complicity between surgeons,made with plate and screws on both sides, with anaccurate monitoring in the ICU and last but not least a

additional Darrach procedure on the right. Both radial

really devoted physiotherapist. So the last lesson weand ulnar arteries were sutured and revascularization

would like to share here is a quotation borrowed fromof both hands was reached between 3 and 4 hours andRudyard Kipling’s Jungle book : « For the strength ofafter the injury.

the Pack is the Wolf and the strength of the Wolf is the
Pack ».

The whole procedure took us between 7 and 8 hours,
the main problem being the fact that there was only

8.

Netscher D, Armenta AH, Meade RA, Alford EL.

COMMENTS FROM DEPUTY EDITOR:

Belgium

THIS IS A DELIGHTFUL ARTICLE. IT IS FULL OF PRACTICAL DIRECTIONS AND WRITTEN WITH A EUROPEANFLAIR. IN SHORT, IT IS FULL OF COMMON SENSE. MAY I COMPLIMENT THE SURGEONS/AUTHORS AND THANK THEM FOR BRINGING A SMILE TO
MY FACE IN MEMORY OF PAST PROBLEMS ENCOUNTERED IN MANAGING THESE DIFFICULT CASES. SPECIFICALLY, I REMEMBER REPLANTING A
LIMB AT FOREARM LEVEL AFTER THE PATIENT PLACED IT ON A RAILWAY TRACK IN FRONT OF AN ONCOMING TRAIN, AS THE PART(HAND) HAD
OFFENDED HIM AND GOD. POST-OPERATIVELY, HE TOLD ME THAT HE MAY DO IT AGAIN. “AND I WILL REPLANT IT AGAIN”, I RESPONDED, “WE
WILL SEE WHO WINS”. HE WAS QUITE MAD, OF COURSE, SIMILAR TO THE AUTHORS’ PATIENT, BUT ALSO QUITE APPRECIATIVE OF MY WORDS.
I PROBABLY SHOULDN’T HAVE SPOKEN THEM BUT HE SAID THAT HE WOULD GIVE THEM CONSIDERATION. MICHAEL TONKIN

one microscope available and we had to share it and36

37

MEMBER SOCIETY NEWSwww.ifssh.info

Member Society
KOREAN SOCIETY FOR SURGERY
OF THE HAND

MEMBER SOCIETY NEWS

August 2022

BELGIAN SOCIETY FOR SURGERY
OF THE HAND

which is exactly the intention of the BHSC course. We
are pleased to contribute to a higher level of quality ofthese future hand surgeons and hope that most of theSecond cycle of the Belgian Hand Surgery Certificate

candidates will further their hand surgery careers withThe Belgian Hand Group (BHG) proudly announces thata successful European Diploma in Hand Surgery. The

20 young hand surgeons obtained the Belgian Hand

BHSC continues to implement the positive feedback

many young members who appreciate family life andSurgery Certificate (BHSC) on 18 June 2022. This 2-year

to improve the quality and the interactive teaching.

want to save the time and energy required for in-inter-university training jointly organized by 7 Belgian

We are grateful for all the participants who made thisperson meetings.

universities teaches selected students the basics ofcourse successful for their voluntary and dedicatedhand surgery with theoretic and cadaver courses in 8

work.

During the last 2 years, members of the Korean Society
for Surgery of the Hand (KSSH) have also suffered

Like other academic societies, we also held the 2021

separate 2-day modules. Besides broadening their handfrom the impact of COVID 19, and many local in-annual congress of the Korean Society for Surgery ofsurgery knowledge, this education helps to prepare the50 year anniversary of the Belgian Hand Group

person meetings were cancelled. As we wanted to see

the Hand (KSSH) in online and offline hybrid form on

students for the European Diploma in Hand Surgery

We are proud to celebrate the 50th anniversary of oureach other at least online, we held six small webinar

5-6 November 2021. At this meeting, we launched a new

examination later in their careers. The BHSC is open toscientific and professional hand surgery organisation,case symposiums bimonthly, each with a few caseprogram called “Young Investigator’s Camp”, in which

orthopedic, plastic and general surgeons or residents

the BHG, and look forward to the Celebration Congresspresenters and panelists. The topics were: “TFCC

junior hand surgeons pursuing academic degrees have(preferably in their last 2 years of training) or during

on 3 September 2022.

injury: controversies and challenges”, “Treatment ofa chance to present their theses and get feedbacks

their hand surgery fellowship training.

contractures: principles and strategy”, “Up-to-datefrom senior researchers.

Next cycle of the BHSC: 2022-2024

to improve functional recovery of the extremity”,

We also had the honour to hear from two of our pastMore information at https://www.bhsc.be/“Hand and wrist arthritis”, and “Geriatric hand”. To ourpresidents: Dr. Seok-Whan Song spoke about his path

https://belgianhandgroup.be

surprise, the attendees were more than we expected,

as a hand surgeon and scientist under the title “Handwhich reflected our members’ desire to learn new

Surgeon”, and Dr. Jong-Ik Hwang talked about theknowledge and share their experience in hand surgery,role of hand surgeons and their patients in modern

as well as being eager to see the faces of their friends.

Korea, focusing on young workers who had theirknowledge of treatment of crush injuries”, “My choicehands injured in factories during the time of rapid
We found this platform was welcomed very much byindustrialization.

The 20 students fulfilled all requirements (attendance,
examination and paper presentation). Due to COVID 19,
some modules needed to be organized online or hybrid
and cadaveric trainings had to be rearranged. However,the dual jury exam was live on the hottest day of theyear! With the support of our research and education
center (IORT), we managed to assess 26 candidates
with 19 examiners in 6 juries. After the examination,
the successful candidates were announced followed bya celebration in the blissful sun at Leuven University.
Bram Van Hove achieved the highest grade on the oral
exam and was offered the registration fee of the next
FESSH meeting. He also received the best paper award
and was invited to present his work at the 50th year
Celebration Congress of the BHG on 3 September 2022.
We were pleased that the majority of the students

Photograph of the 1st KSSH Webinar symposium in 2021.

38

demonstrated a profound knowledge of hand surgery,39

MEMBER SOCIETY NEWSwww.ifssh.info

MEMBER SOCIETY NEWS

August 2022

PERUVIAN ASSOCIATION OF HAND
SURGERY AND MICROSURGERY

The Congress program includes in addition to the(Asociación Peruana de Cirugía de Mano yosteosynthesis workshops for the training of theMicrocirugía)(APCMM)

participants. It also includes a theoretical-practical

The Austrian Society for Surgery of the Hand held its

course on hand rehabilitation for Occupational

Annual Meeting from 6-8 May 2022 in Graz, Styria,

In 2018 the Forum of Young Surgeons was founded

Therapists.

Austria. It was our second in-person Annual Congresswith the aim to establish an international network

since the start of the Corona pandemic. More than 200

of young surgeons and to organize further education

The Peruvian Association of Hand Surgery andpresentations, a significant number of practical

Microsurgery was founded on 3 January 2014. It

AUSTRIAN SOCIETY FOR SURGERY
OF THE HAND

should be established for the respective medical
specialties (these findings were published in: Journalof Orthopaedic Surgery and Research (2022) 17:306)

currently has almost 30 medical specialists dedicatedWe are proud to be part of the IFSSH family byhand surgeons and therapists participated sharing

and training. The forum has their own session at theto the exciting specialty devoted to the hand. Ourcontributing and promoting to the science andtheir knowledge. The main topic of the Congress was

Annual Meetings and is about to organise a scientificcurrent president is Mirko Tello Vinces M.D.

knowledge of the hand, and in fostering friendship and“Complex Regional Pain Syndrome – CRPS“, and wasmeeting in the upcoming autumn to deepen personalcollaboration with colleagues from other countries.

divided into 5 key-notes presentations and six well-contacts, knowledge, and experience.

After many national and international activities, we

moderated sessions.

are organising the "First National Congress of Hand

We are welcoming you to join us in our  first Congress

Surgery in Peru", which will be held from 13-15 Octoberin Peru!

2022. More than 15 foreign exhibitors and 10 national
exhibitors will participate in this event. A large turnout

Mirko Tello Vinces M.D.

of doctors is expected.

Since 2020 the so called LEO Award is offered to the
The aim and mission of the Austria Society is to staymost innovative scientific publications in the field of

abreast with the rapid scientific development andhand surgery, and up to 2022, 8 young surgeons wereinternational standards in hand surgery. Therefore

awarded this prize for their scientific work.

it is necessary to give high priority to education andAt the highly successful 2022 IFSSH Congress intraining in the field of hand injuries and disorders to

London, the Austrian Society was represented by 26

ensure an adequate quality of practice.

oral presentations and 4 e-posters covering a broad
spectrum of scientific topics.

The Innsbruck University Hospital for Orthopaedic

The next Annual Austrian Meeting will be hosted inSurgery and Traumatology investigated the variation

Spring 2023 in Bad Ischl, a health resort near Salzburg

in patterns and volumes of injuries admitted to a leveland famous place of former Austrian royalties andone trauma centre during lockdown for COVID-19.

composers.

Due to the global COVID-19 pandemic, a ban on sports
outside one’s home and a prohibition on travel between

Prim. Dr. Walpurga Lick-SchifferProf. - President

communities were imposed in spring 2020 in Tyrol,

Dr. Rohit Arora - Austrian Delegate

Austria. The aim of this study was to evaluate theimpact of these restrictions on a level one trauma
Members of APCMM

Mirko Tello Vinces, Pedro J. Delgado, Jeffrey Yao

centre.The objective was to identify the most common
injury patterns to ensure optimal targeted preventionin
the future incase of an ongoing pandemic. Amongthe injuries treated during the lockdown the largest
increase in relative numbers was in home injuries
to the head and face, and superficial or penetrating
injuries. There was a decrease of serious injuries
as well as patients who needed surgery during the
lockdown compared to previous years. Since the study

Second Hand Surgery Course

40

revealed a significant change in the pattern during the"Prim. Dr. Walpurga Lick-Schiffer, President of the

lockdown, intervention programs to reduce the risk

Austrian Society, with the LEO Award winners.

of home injuries should be introduced. Furthermore,

The LEO Award is a prize which is awarded toin order to save resources during a pandemic, specificyoung surgeons for innovative publications in theguidelines on patient management and treatment

field of hand surgery."41

MEMBER SOCIETY NEWSECUADORIAN SOCIETY FORSURGERY OF THE HAND
(ECUMANO)

www.ifssh.info

Another important achievement for Latin America wasthat the Ecuadorian Society for Surgery of the Hand,

MEMBER SOCIETY NEWS

August 2022

AUSTRALIAN SOCIETY FORSURGERY OF THE HANDECUMANO, won the opportunity to organise theFirst Mid Term Course, a newly established

The Australian Hand Surgery Society (AHSS) is“Hand Surgery United” in Latin-

educational initiative by the IFSSH. It will take placecelebrating its 50th year in 2022. The AHSS was

Americain the city of Guayaquil, Ecuador in February 2024,

formed initially in 1972 as the Australian Hand Club,and will be jointly organised by representatives

with this group of enthusiasts growing to become theAt the last IFSSH Congress infrom all over our Continent. This effort will not only

AHSS in 1990. The AHSS has grown to a membership

London in June 2022, the large

further unite hand surgery in South America, but willof over 200 surgeons and now is responsible for thenumber of participants from thesignificantly help in growing our beautiful speciality.  

education programme for qualified orthopaedic, plastic

whole of Latin America have produced and presented

and reconstructive, and general surgeons who wish tonumerous papers and presentations which indicates

The members of “Hand Surgery United” in Latin

specialise further in hand surgery in Australia and New

the increasing hand surgery activities in this region.

America extends a warm welcome to all our

Zealand. The AHSS also supports research and further

international colleagues to join us for this first IFSSH

professional development with grants and travelling

Professor Michael Tonkin, (Past President AHSS and

A total of 176 Hand Surgeons from 9 Latin American

Mid Term Course in the very centre of our planet,

fellowships, and sponsors hand surgery outreach

IFSSH), was honoured as a Pioneer of Hand Surgery

countries went to London to be part of this world

Ecuador!

programmes to South-East Asia and the South Pacific.

at the recent IFSSH meeting in London, 2022.

meeting.

While the COVID pandemic restrictions limited the
AHSS to an online meeting in 2021, we were able toDavid McCombe

return to a face-to-face scientific meeting earlier thisClinical Associate Professor, University of Melbourne

year. In 2023, the AHSS will host the British Society for

Plastic and Maxillofacial Surgery Dept, Royal

Surgery of the Hand at its annual meeting in Sydney

Childrens Hospital, Melbourne

and is joining with the American Society for Surgery of
the Hand for a meeting in Hawaii in 2024.
The AHSS continues to be an active member of the
IFSSH. Several AHSS members have been recognised
as IFSSH pioneers of Hand Surgery with the mostrecent being Professor Michael Tonkin who wasawarded this honour at the IFSSH meeting in London.
The AHSS also supports the Asia-Pacific Federationof Societies for Surgery of the Hand (APFSSH) having
hosted the most recent APFSSH meeting on the eve of
the COVID pandemic in 2020 and is represented on the
Latin-America is also proud to have for the first time

APFSSH executive by Anthony Berger, the President-

two elected representatives on the Executive of theelect. We are looking forward to participating in the

IFSSH. Representing North America is Dr. Jorge Clifton

APFSSH meeting in Singapore in 2023.

Correa from Mexico, who is a renowned brachial plexus
and peripheral nerve surgeon, and on behalf of SouthThe AHSS continues to develop and in addition to

America is the President of the Colombian Association

its role in education and advocacy on behalf of itsof Hand Surgery Dr. Aida Garcia Gomez who brings

members, it is seeking to promote diversity within its

much experience to the IFSSH Exco. All of Latin

membership and encourage the engagement of theAmerica congratulates the two representatives fromyounger members of the society with roles within thethis Continent, who have much to contribute.

executive and its other portfolios of responsibility.

42

43

MEMBER SOCIETY NEWSwww.ifssh.info

August 2022

MEMBER SOCIETY NEWSMEXICAN ASSOCIATION FOR SURGERY OF THE HAND
Asociación Mexicana De Cirugía de la Mano A.C. (AMCM)
Celebrating 40 years of Hand Surgery in Mexico

Eventually, in February 2022, we had the celebrationsat our 42nd anniversary in Mexico City. During thisThe Mexican Association for Surgery of the Hand ismeeting a number of our Founders and Past Presidents

celebrating 40 years of existence. When it was founded

were honoured by the current board members.

in 1980 by a small group of plastic and orthopedic
surgeons, the Association now has many Hand

For this meeting we had the honour of having an

Surgeons around the country, and is actively engaged

international faculty from Spain, IFSSH President

in training and continuing medical education. The

Dr. Marc García Elias and Dr Samuel Pajares, and Dr

Dr Samuel Pajares, Dr Joaquin Díaz, Dr Emmanuel

40 year celebration had to be postponed due to the

Alejandro Badia from USA.

Ruiz, Dr Marc García Elias and Dr Juan Ramon Bonfil

Covid-19 pandemic.

Dr Juan Ramon Bonfil, President of AMCM,

during the faculty dinner after the meeting.
Mexican delegation at the Ibero-Latin American (ILA)
Hand Surgery Meeting in Maceió, Brasil.
In March, the biannual Ibero-Latin-American (ILA)
Hand Surgery Meeting took place in Maceió, Brasil andthe organising committee invited Mexican surgeons
as part of the international faculty. Our president Dr
Juan Ramon Bonfil led the Mexican delegation andtheir contributions were outstanding. The AMCM

Dr Salvador Magallon lecturing in Maceió

expresses its appreciation to the Brasilian surgeons
Dr. Raimundo Araujo and Dr Ricardo Kaempf for theinvitation and congratulate them on a successful
The board of the AMCM left to right: Dr. Emmanuel Ruiz, Dr. Raquel Montes, Dr. Juan Ramon Bonfíl

event. Thank you Maceió!

(President) Dr. Jorge Luna, Dr. Victor Azpeitia (actual coordinator of altruistic surgery missions), Dr.
Joaquin Díaz, Dr. García Velazco, Dr. Francisco García Lira, Dr. Juan Manuel Fernández Vázquez, Dr. Alfonso
Vega, Dr. Nicolás Sastré, Dr. Sergio Funes Craviotto, and IFSSH President Dr Marc García-Elias

Board members of ILA, Dr. Raimundo Araujo, Dr.
Ricardo Kaempf, Dr. Pedro Delgado and Dr. Juan
Board members of the Mexican Association with the

Dr Marc García Elias lecturing on the biomechanics

Ramon Bonfíl at the opening ceremony of the XIII

international faculty.

of the forearm.

ILA meeting in Maceió

44

Dr Salvador Magallon lecturing in Maceió

45

MEMBER SOCIETY NEWSwww.ifssh.info

Dr. Erika Ibañez on her talk about anatomy variants

Dr. Carla Orozco from the Mexican Associationin carpal tunnel release.

lecturing at the ILA meeting

August 2022

MEMBER SOCIETY NEWSXII Annual Meeting of the Mexican Association for theSurgery of the Hand, Guadalajara Mexico.
In November 2022 the AMCM will be celebrating its XII
Annual Hand Surgery Meeting which will take place inGuadalajara, Mexico. The faculty will be outstanding!
Some of our international professors are: Dr. Pedro
Delgado, Dr Martin Caloia, Dr René Jorquera, Dr.Andrea
Atzei, Dr. Joaquim Casañas, Dr. Vicente Carratala,Dr. Aida García, Dr. Fidel Cayon, Dr. Jesse Jupiter, Dr.
Michael Haussman, Dr. Matias Sala, Dr. Luis Felipe
Naquira, Dr. Orlando Cruz, Dr Carlos Eduardo Saenz and
Dr. Marc García- Elias.
See you in Guadalajara!

Mexican and Ecuadorian surgeons at the ILA
meeting in Maceió.

46

47

MEMBER SOCIETY NEWSCANADIAN SOCIETY FORSURGERY OF THE HAND(CSSH)

www.ifssh.info

We look forward to seeing everyone at next year’s
meeting in the picturesque Whistler, BC! Information

MEMBER SOCIETY NEWS

August 2022

BRAZILIAN SOCIETY FORSURGERY OF THE HAND

The Brazilian Society for Surgery of the Hand (SBCM)
will have their 42nd annual meeting in Campinas fromon registration will be available on our website: https://

4-6 August 2022 with many confirmed guest speakers

www.csshsccm.com/

from Brazil and other countries.

After a pandemic induced two-year hiatus, theCanadian Society for Surgery of the Hand (CSSH)In November 2022, Brazil will participate as a guest

was back to an in-person annual meeting, taking

nation at the ASSH meeting in Boston, where we will beplace on 14June 2022. Old friends and colleagues

We all had a good time at the 15th IFSSH Congress inwere reunited at the beautiful Fairmount Château

London, enjoying the reunion with old friends and all

Frontenac in the historic old quarter of Québec

the great experiences which London has to offer!    

attending again with a large delegation.

City. A simultaneous virtual platform was alsoavailable for those unable to attend in person. The

More than 60 Hand Surgeons from Brazil were in themeeting involved a series of panel discussions fromdelegation at the IFSSH meeting in London, 6-10 June

Canadian experts sharing tips and tricks, unique2022, with active participation in symposia, lectures

cases, and clinical wisdom. Both plastic surgery

CSSH members getting reacquainted at theand orthopedic surgery trained speakers focused on

conference in Quebec City.

and free papers.

topics including opioid prescribing practices in handsurgery, basal thumb joint osteoarthritis, ulnar-sided
wrist pain, and nerve gap management. The hybrid

Dr. Samuel Ribak

format worked exceptionally well to stimulate many

President

fruitful discussions and personal stories. There wereover 90 attendees in-person, in addition to thoseDr. Milton Bernardo Pignataro

attending virtually. It was wonderful to have so much

Delegate

participation from across the country!
The CSSH would like to congratulate Dr. Jessica Winter,
graduating plastic surgery resident from the Universityof Manitoba, as the recipient of this year’s CSSH

CSSH members enjoying some refreshments andWe had the honour of having two more Brazilians

Hand Surgery Scholarship! Dr. Winter will be goinggood company!

“IFSSH Pioneers of Hand Surgery”: Dr Ronaldo Jorge
Azze and Dr José Mauricio de Morais Carmo.

on to complete fellowship in Hand & Upper Extremity
Surgery at the University of Kentucky before returning
to Canada to pioneer a multidisciplinary hand surgery
outreach program for residents of the northern
territories.
The CSSH would also like to recognize the passing of
the torch from Dr. Avi Islur (University of Manitoba) to
Dr. Heather Baltzer (University of Toronto) as Presidentof the Society. Our sincere appreciation to Dr. Islurfor all the hard work he has done for the CSSH. Many
thanks also to our Executive Committee and CSSH

Outgoing CSSH President Dr. Avi Islur, new CSSH

Board Members for all the hard work they put into

Vice President Dr. Dominique Tremblay and Past

organizing this year’s conference.  

CSSH President Dr. Don Lalonde48

Dr. Ronaldo Jorge Azze

Dr. José Mauricio deMorais Carmo49

MEMBER SOCIETY NEWSASSOCIATION OF CHINESESPEAKING HAND SURGEONSUNITED (ACU)

www.ifssh.info

UPCOMING EVENTS

August 2022

China, Taiwan and other regions in the world.
These events are held annually in early summer. Our
hope is that next year we will be able to return to theprevious format of both on-site (in person) and online

Association of Chinese-speaking Hand Surgeons

streaming.

United (ACU) and 8th Jixia Hand Surgery Forum 2022

ACU also regularly hosts the Nanshan Lecture Series
jointly chaired by Drs Jin Bo Tang and Zeng Tao Wang,

The 4th Congress of the Association of Chinese-

as well as Journal Clubs led by Drs Chao Chen andspeaking Hand Surgeons United (ACU) and the 8th Ji

Yung-Cheng Chiu.

Xia Forum was held on the 25 and 26 June 2022, as an
online event.The ACU Congress was attended by overIn the future ACU will add workshops and local

8674 online attendees (counted by login numbers),

seminars to expand its educational missions towith program chairs Drs Jing Chen and You Mao Zhen

different regions.

under the ACU president Dr Sufeng Wang. The program
consisted of symposiums, keynote lectures (one midcareer and one senior), free paper sections, educationalcourses, and round table discussions. The senior
keynote lecture (30 minutes) was given by Dr Alain
Gilbert entitled “50 years’ experience of microsurgery
TH

PW

FS

Two screenshots from presentations

printing of metacarpal and phalangeal bones. Nerve
graft, evaluating methods of nerve regeneration, and13TH APFSSH, 9TH APFSHT& 8 TH APWA CONGRESS
DIVERSE & INCLUSIVE

the treatment of Kienbock's disease were discussed
in round table discussions. In additional, the meeting

13 T H AP

wrist ligament repair, treatment of comminuted distal

RESS

symposiums. Four instructional courses focused onNG

A variety of wrist conditions were discussed in theradius fracture, congenital hand deformities, and 3D

CO

SH

,

9

FSHT & 8 T H A

Aand hand surgery”.

AP

DI

VER

S E & IN C LU S

IVEof the ACU Therapists’ Society was held together withACU Congress to discuss relevant techniques in hand

ABSTRACT SUBMISSION NOW OPEN

rehabilitation.
The 8th Jixia Forum of Hand Surgery in 2022, wasattended by 7213 online colleagues (login numbers)

SUBMISSION DEADLINE 20TH OCT 2022

(Figures are random screen shots of the presentations).
This Forum was organised by Hand Surgery
departments of four major hospitals from different

Dr Jing Chenparts of mainland China. Similar to the Forums inemail: moshengren1013@163.com

previous years, the discussions were very lively with a
lot of debates on popular topics in hand surgery. This isa very attractive and popular way of interaction among
Chinese-speaking hand surgeons from mainland50

31st May - 3rd June 2023, Singapore
www.apfssh2023.org#APFSSH2023
51

UPCOMING EVENTS

52

www.ifssh.info

August 2022

UPCOMING EVENTS

53

UPCOMING EVENTS

www.ifssh.info

August 2022

UPCOMING EVENTS

or virtally?
ahta.com.au/conference | enquire@ahta.com.au

54

55

UPCOMING EVENTS

www.ifssh.info

August 2022

Join your colleagues in Boston for the2022 in-person Annual Mee ng
We are thrilled to be back to an in-person mee ng in 2022 andwe hope that you will be a part of it.
Our Chairs, R. Glenn Gaston, MD and Peter C. Rhee, DO, MS have an
exci ng program planned that you will not want to miss.

56

57