Scientific Abstract Presentations: Residents Reconstructive and Hand Abstracts Session 3 Friday, October 16 Fri, Oct 16 10:30 a.m.-12:30 p.m. CDT

Background: Major lower extremity amputation (LEA) is often required in life-threatening infection, trauma, or end-stage peripheral vascular disease. Functional recovery following amputation depends on surgical outcomes and engagement with rehabilitation services. Patients in safety-net systems face barriers that often stall this transition. This study aimed to characterize rehabilitation utilization following major LEA, including the role of Plastic Surgery involvement in outpatient rehabilitation referral and prosthesis acquisition.

Methods: This was a retrospective review of adult patients over 18 years of age undergoing LEA at a safety-net hospital from 2018 to 2024. Demographics, comorbidities, operative details, and follow-up were collected. To assess the outpatient care cascade, mortality was treated as a competing risk, and utilization rates were calculated among survivors only. Descriptive statistics characterized the cohort and Fisher's exact tests compared prosthesis acquisition rates by amputation level.

Results: Of the 177 patients undergoing LEA, the cohort was predominantly male (80%) and Hispanic (56%). Most (57%) relied on county-subsidized financial assistance or public/community insurance. High comorbidity rates were observed, including diabetes mellitus (89%) and hypertension (78%), with infection as the primary indication for amputation (87%). Most underwent below-knee amputations (88.7%). Regarding utilization, 132 patients (74.6%) were referred for outpatient evaluation. Twelve patients (6.8%) experienced mortality during the study period, including 7 referred but passed away prior to evaluation. After adjusting for mortality as a competing risk, the attendance rate among referred survivors was 76.0%. Plastic Surgery was involved in 35 cases (19.8%). Within this subgroup, 77.1% were referred to rehabilitation, and 88.9% of referred survivors successfully attended evaluation. Attendance among referred patients trended higher with Plastic Surgery involvement compared to those without (88.9% vs 72.4%, p=0.12). However, only 26.1% of survivors ultimately acquired a prosthesis. Acquisition rates were similar between below- and above-knee amputation survivors (23.0% vs 29.4%, p=0.41).

Discussion: While rates of referral to and attendance at outpatient rehabilitation are high at our safety-net hospital, a significant gap exists in successful prosthesis acquisition. These findings suggest that factors other than clinical may be the drivers of prosthetic attrition in this population and that multidisciplinary surgical involvement may improve transition to outpatient specialty care.

Purpose: Non-melanoma skin cancers (NMSC) are a heterogenous group of neoplasms that include squamous and basal cell carcinoma, the two most common skin cancers worldwide. While surgical excision remains the gold standard for treatment, primary radiation therapy (XRT) can be used for patients who are deemed poor surgical candidates or have tumors in anatomically sensitive areas. However, XRT can lead to the development of chronic wounds that are more challenging to treat than in the initial non-radiated setting. This study seeks to evaluate the prevalence and risk factors for the development of chronic wounds in patients undergoing XRT for NMSCs.

Methods: Using the PearlDiver national data set (2010-2023), patients diagnosed with NMSC and who received treatment within six months of diagnosis were identified. Two cohorts were defined: XRT-only and excision with reconstruction. Within each cohort, mean age, Carlson Comorbidity Index (CCI), and rates of common comorbidities were collected. Using "open wound" ICD-9/10 codes, chronic wounds were defined as wound diagnoses within 1-12 months after NMSC treatment. The rates and anatomical distributions of chronic wounds were collected and compared using Chi-squared and Welch two-sample t-tests.

Results: A total of 53,482 patients received XRT and 144,325 underwent excision and reconstruction. The average age (72.4, 70.3; p<0.0001) and comorbidity burden (CCI: 2.82, 1.96; p<0.0001) were significantly higher in the XRT cohort. Patients most commonly received treatment for NMSCs located to the head/neck (75.8% XRT, 73.3% surgery), followed by treatment to the extremities (17.6% XRT, 26.8% surgery), and to the trunk (5.2% XRT, 15.2% surgery). Chronic wounds occurred in 2,060 (3.8%) XRT patients and 7,530 (5.2%) surgical patients. Among patients with wounds, XRT patients were older (73.3, 70.9; p<0.0001), and had a higher comorbidity burden (CCI: 4.89, 2.89; p<0.0001). Stratifying by NMSC location, patients who received XRT for a NMSC on their extremities or trunk were found to have a significantly higher risk of developing a chronic wound to those locations (Extremities - 13.3% XRT, 8.6% surgery, p<0.0001; Trunk - 11.6% XRT, 4.8% surgery, p<0.0001) Of patients who had extremity wounds, those who underwent XRT more commonly developed wounds to the lower extremities (66.3%, 61.7%; p<0.005) compared to the upper extremities.

Conclusion: XRT remains a viable treatment for many NMSCs; however, its use in older, comorbid patients may confer increased risk for chronic wounds compared to surgical management. This elevated risk can expose patients, initially deemed poor surgical candidates, to the need for advanced reconstructive procedures to address chronic, radiated wounds to the trunk or lower extremities.

Introduction: Raynaud's phenomenon (RP) is a vasospastic disorder that can cause significant pain, functional impairment, and digital ischemia [1]. Botulinum toxin type A (BTX-A) has emerged as a potential treatment, but high-quality evidence remains limited [2]. This double-blind, randomized controlled trial evaluated the efficacy of BTX-A injections in improving pain, function, and physiologic perfusion measures in patients with refractory RP. Methods: Adults with RP and persistent symptoms despite medical therapy were equally randomized to receive peri-arterial injections of placebo, 50 units of BTX-A, or 100 units of BTX-A per hand. Participants were assessed at baseline and at four, 12, and 24 weeks post-injection. The primary outcome was change in visual analog scale (VAS) pain. Secondary outcomes included PROMIS Upper Extremity function, QuickDASH, Raynaud's Condition Score, subjective hand value, fingertip temperature, and fingertip oxygen saturation. Results: Twenty-four subjects were enrolled, with 20 completing 24-week follow-up. There were no significant differences between BTX-A and placebo groups for change in VAS pain at any time point, although a nonsignificant reduction in pain was observed at four weeks post-injection in the pooled BTX-A group (−0.94 ± 0.60; p=0.13). By-arm analyses showed similar trends without dose–response effects. Secondary outcomes, including functional scores and physiologic parameters, showed no between-group differences through 24 weeks. Conclusion: BTX-A did not demonstrate statistically significant improvements in pain, function, or digital perfusion compared with placebo among patients with refractory RP. Larger, adequately-powered studies with standardized injection techniques and stratified patient groups are needed to clarify the role of BTX-A in Raynaud's management.

Reference 1: Cooke JP, Marshall JM. Mechanisms of Raynaud's disease. Vascular Medicine. 2005;10(4):293-307. doi:10.1191/1358863x05vm639ra Reference 2: O'Donohoe P, McDonnell J, Wormald J, Aljohmani L, Cronin K, Durcan L, Kennedy O, Dolan R. Botulinum Toxin for the Treatment of Raynaud's Conditions of the Hand: Clinical Practice Updates and Future Directions. Toxins. 2024; 16(11):472. https://doi.org/10.3390/toxins16110472

Background Groin and genital defects often arise from oncologic resections, inflammatory processes, or infections. Reconstruction here is particularly challenging due to constant moisture, a high bacterial load, significant pressure, and shear forces. These wound qualities require durable, well-vascularized soft-tissue coverage. The gracilis flap is traditionally considered the workhorse thigh-based option for this region, but it has a short pedicle, an unreliable distal third, and is expected to result in loss of muscle bulk over time. The profunda artery perforator (PAP) flap is a muscle-sparing alternative based on consistent posterior medial thigh perforators offering adequate volume, reliable pedicle length, and minimal donor-site morbidity. We present a case series of 8 patients undergoing PAP flap reconstruction for perineal defects to better define its role, technical considerations, and outcomes in this complex population.

Methods This was a retrospective review of 8 patients who underwent pedicled PAP flap reconstruction for perineal defects at our institution from November 2024 to February 2026 (10 flaps total). Demographics, comorbidities, wound information, complications, and hospital course data were collected. Flap details included flap size, number of perforators, perforator location, pedicle length, and pedicle location.

Results The median age at surgery was 56 years, and 50% of patients were female. One patient (13%) required coverage for Fournier's Gangrene, five patients (63%) required reconstruction after oncologic resection (n=1 sarcoma, n=2 colorectal cancer, n=1 cervical cancer, n=1 perianal squamous cell carcinoma), and two patients (25%) required coverage after hidradenitis suppurativa resection. Two patients required bilateral PAP reconstruction. Preoperative CT angiogram was obtained in all patients. All flaps were designed longitudinally along the thigh. Average flap length was 17.3 cm, and width was 6.2 cm (total area 107 cm2). Half of the flaps (50%) were tunneled to the defect. An average of 2 perforators were used per flap, with the A perforator being the most common. The average distance from the most proximal perforator to the most proximal edge of the flap was 8 cm, and from the most distal perforator to the most distal edge of the flap was 7.3 cm. The average pedicle length was 11.3 cm. The average distance of the entry of the PAP pedicle into the profunda (pivot point) was 7.7cm from the groin crease. There were no instances of partial or total flap loss or OR takebacks.

Conclusion The pedicled PAP is a reliable choice for perineal reconstruction. It provides long-lasting bulk to obliterate dead space, its perforators are highly predictable, and the skin paddle is highly reliable. The flap's long pedicle and generous arc of rotation allow wide reach with minimal donor-site morbidity. We recommend taking a single perforator when possible to maximize pedicle length and to consider the pedicle's entry point into the profunda artery to ensure sufficient reach.

Purpose: Reconstruction of complex lower extremity defects in vessel-depleted limbs remains a major microsurgical challenge. When ipsilateral recipient vessels are unavailable, conventional free flap reconstruction, vein grafts, or arteriovenous loops increase operative complexity and risk (1,5). This study presents a staged reconstructive strategy using a cross-leg free anterolateral thigh (ALT) flap assisted by 3D exoscopic visualization as a limb salvage alternative.

Methods: A 28-year-old male presented with high-energy lower limb trauma resulting in a 14 cm tibial diaphyseal defect and extensive soft tissue loss. Six months after injury, angiographic evaluation confirmed absence of suitable ipsilateral recipient vessels. A three-stage reconstructive approach was performed: (1) external fixation for skeletal stabilization, (2) contralateral posterior tibial vessel identification and preparation using Doppler guidance, and (3) transfer of a free ALT flap (14 × 10 cm) with microvascular end-to-end anastomosis of the descending branch of the lateral circumflex femoral vessels to the contralateral posterior tibial vessels in a cross-leg configuration. All microsurgical anastomoses were performed using a high-definition 3D exoscope, a technology shown to provide comparable outcomes with improved ergonomics (4). Pedicle division was completed at 21 days after confirmation of independent flap perfusion.

Results: The flap survived completely without major complications. Stable soft tissue coverage was achieved, protecting the osseous defect and preserving limb function. No vein grafts or arteriovenous loops were required. Donor site morbidity was minimal, consistent with evidence supporting ALT flap reliability and low morbidity (2). The use of cross-leg free flap techniques in vessel-depleted limbs has demonstrated high success rates and acceptable complication profiles in recent literature (1,3).

Conclusions: The cross-leg free ALT flap represents a reliable and reproducible salvage strategy for lower limb reconstruction in vessel-depleted extremities. This approach avoids complex vascular constructs such as long vein grafts or AV loops while providing robust soft tissue coverage. The incorporation of 3D exoscopic technology enhances microsurgical precision and ergonomics, particularly in challenging configurations such as cross-leg positioning (4). This technique expands the reconstructive armamentarium and may represent a paradigm shift in the management of complex lower extremity defects with absent recipient vessels.

REFERENCES 1. Celie KB, Guo S, Raya J, Fahradyan A, Carey J, Salibian AA. The cross-leg free flap: A systematic review of the literature. Microsurgery. 2024;44(2):e31144. 2. Duan A, Xiang Z, Fan Y, Duan W, Wei Q, Duan X. Evaluating the clinical efficacy of the anterolateral thigh flap in lower limb reconstruction surgeries: A systematic review and meta-analysis. Am J Transl Res. 2024;16(7):3326-37. 3. Sonika SS, Sharma MK, Babu VS, Samraj C, Boyidi BB. Cross-leg microvascular free ALT flap as a safe, viable option in vessel-depleted limbs. Indian J Plast Surg. 2024;57(Suppl 1):S118-S122. 4. De Virgilio A, Costantino A, Russo E, Festa BM, Pirola F, Spriano G. Comparison between the high-definition 3D exoscope and the operating microscope in reconstructive surgery. Int J Oral Maxillofac Surg. 2024;53(6):475-81. 5. Haumer A, Speck NE, Kurlander DE, et al. Free flaps in patients with advanced arteriosclerosis of tibial vessels: mini vein graft strategies. Plast Reconstr Surg Glob Open. 2024;12(5):e5814.

Background

Negative pressure wound therapy (NPWT) is a well-established wound management modality that improves perfusion, reduces edema, promotes granulation tissue formation, and may decrease infection risk, with demonstrated benefits across multiple reconstructive applications.(1,2) In lower extremity free flap reconstruction, postoperative edema can impair wound healing and flap outcomes, and while prior studies suggest NPWT may help mitigate these challenges, the safety of immediate application over a newly inset free flap remains unclear.(3)This study evaluates the safety of immediate NPWT over lower extremity free flaps, hypothesizing that NPWT at the time of flap inset would be non-inferior to standard dressings with respect to flap-related complications, salvage, and failure.

Methods

A retrospective review was conducted of lower extremity free flaps at a single institution from January 2021 to December 2025. Vascularized bone flaps and those using arteriovenous loops were excluded. Characteristics such as indication for index procedure, salvage procedure, type of free flap, recipient location, surgical technique, and 30-day complications were collected. Statistical analyses with Fishers exact test and multivariate logistic regression were performed using JASP.

Results

In total, 75 flaps were included following the application of exclusion criteria. NPWT was utilized in 29 flaps (38.7%). 30-day complications were noted in 21 flaps (28%). NPWT had 6 (20.7%) complications and non-NPWT had 15 (32.6%) complications; however, these results were not significant (p=0.26). Other variables such as specific complications, return to OR within 7 days, flap salvage and flap failure rates, were not significant between the two groups except venous complications, which were significantly higher in the non-NPWT group (p=0.40). When controlling for patient characteristics, the NPWT group showed an odds ratio of 0.507, while not significant (p=.29), does show 49% lower odds of complications and a potential protective trend.

Conclusion

The use of immediate NPWT over lower extremity free flaps is a reliable adjunct therapy to microvascular reconstruction. This technique had lower rates of complications compared to the non-NPWT group and a high flap salvage rate. Other potentially quantifiable benefits of this therapy in the future include decreased healthcare costs, and improved patient comfort. Large, multi-institutional studies would be required to further determine if NPWT is superior for flap perfusion following lower extremity free flap.

References:

1. Iheozor‐Ejiofor Z, Newton K, Dumville JC, Costa ML, Norman G, Bruce J. Negative pressure wound therapy for open traumatic wounds. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD012522. DOI: 10.1002/14651858.CD012522.pub2

2. Norman G, Shi C, Goh EL, Murphy EMA, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD009261. DOI: 10.1002/14651858.CD009261.pub7.

3. Qiu SS, Hsu CC, Hanna SA, et al. Negative pressure wound therapy for the management of flaps with venous congestion. Microsurgery. 2016;36(6):467-473. doi:10.1002/micr.30027

Intro: Targeted Muscle Reinnervation (TMR) following limb amputation has been shown to reduce neuroma and phantom limb pain and improve prosthesis use and physical function in the adult population. More recently, studies have begun to suggest similar benefits in the pediatric population. Although complications and costs of amputation with versus without TMR have been examined in adults, there remains limited data regarding the use and safety of TMR in pediatric patients. The aim of this study is to compare patient and facility factors, resource utilization, and acute postsurgical complications in pediatric patients undergoing TMR at the time of limb amputation versus traditional amputation.

Methods: Data from the 2016, 2019, and 2022 nationwide Kids' Inpatient Database (KID), the largest all-payer pediatric inpatient care database in the United States, was gathered for all patients who underwent limb amputation during the recorded hospitalization. Patients were sorted into cohorts based on whether or not TMR was performed at the time of amputation. Patient and facility factors, acute postoperative complications, and hospital costs were compared between the two groups.

Results: A total of 1576 patients were included in the study, 1521 in the traditional amputation cohort and 55 in the TMR cohort. Patients who underwent TMR at the time of amputation tended to be older (p=0.010) with an upper extremity amputation (<0.001) and at a large volume hospital (p=0.023). There were no statistically significant differences in length of stay, hospitalization costs, surgical site infection, hematoma or seroma, or stump dehiscence between the two cohorts.

Conclusion: TMR can safely be performed at the time of amputation in pediatric patients, without increasing initial hospital costs or length of stay. Adoption of this technique appears to be more widespread in high volume centers and in the management of patients requiring upper extremity amputations. The study is limited by the lack of follow-up inherent in the database, which prevents the evaluation of longer-term complications and functional outcomes between the two cohorts.

References: 1. ElAbd R, Dow T, Jabori S, Alhalabi B, Lin SJ, Dowlatshahi S. Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic Review. Plast Reconstr Surg. 2024;153(2):494-508. 2. Bjorklund KA, Alexander J, Tulchin-Francis K, et al. Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital. Plast Reconstr Surg Glob Open. 2023;11(4):e4944. Published 2023 Apr 13

Background/purpose:

Free tissue transfer to the lower extremity is an essential reconstructive option for significant, acute traumatic injuries – however, it is fraught with complications. Success requires multidisciplinary management of numerous and complex patient, medical, orthopedic, wound care, peri-operative, and rehabilitative factors. This study reviews a level 1 trauma center experience, examining factors impacting reconstructive outcomes.

Methods:

Retrospective review of all lower extremity free flap reconstructions at the University of Chicago within 30 days of traumatic injury was performed (from May 2018 to April 2024). Patient factors, injury characteristics, peri-operative management, reconstructive and operative details, complications, and functional outcomes were analyzed.

Results:

27 free flaps were performed in 26 patients (92% male, mean age 38). 42% of patients were healthy and 15% had psychiatric illness. 15% of injuries were gunshot wounds. Essentially all injuries were Gustilo 3B. 46% were debrided by plastic surgery prior to flap, and limited to more complex wounds. Plastic surgery was consulted on average 4 days after injury; day-of-injury consult occurred in 27% of cases. Flap coverage was performed on average 15 days after injury. ALT fasciocutaneous flaps were most common (63%), followed by latissimus dorsi muscle flaps (19%). One or two venous anastomoses were equally likely, and most cases utilized couplers 2.5 mm or larger. Major flap-related complication(s) occurred in 15 (56%) cases. Cases without complications had more formal debridements and earlier plastic surgery involvement than those with complications. LD muscle flaps had fewer complications (21%) than ALT fasciocutaneous flaps (71%). A 2.0 mm coupler was used in most cases that developed acute venous congestion (83%). 5 of the 7 flaps (72%) with total or partial loss were ALTs, and there were no cases of LD flap loss. Limb salvage rate was 92%, and 81% of patients achieved independent ambulation, on average 330 days after injury. Those achieving independent ambulation in <1 year were younger (mean age 33) and most had ALT flaps (80%). Those who continue using an assistive device were older (mean age 46) and all had muscle flaps. All patients with psychiatric co-morbidities had successful limb salvage and expediently achieved independent ambulation (mean of 191 days after injury).

Conclusions:

While free flap reconstruction has expanded limb salvage for severe lower extremity injuries, complications are considerable. Our results highlight the need for timely and anticipatory plastic surgery consultation, and earlier involvement in wound preparation. Our data corroborate previous findings that pre-operative thrombocytosis may be associated with acute flap thrombosis, and that even a single 2.5 mm or larger venous anastomosis may be protective against developing acute congestion. Furthermore, while fasciocutaneous flaps may have more acute complications, they may be more favorable for independent ambulation. Finally, psychiatric illness did not portend poor outcomes. Our study is limited by small sample size, but prospective analyses will be higher powered as we perform more lower extremity flaps at our trauma center.

Introduction

Medial canthal defects account for approximately 33% of periocular malignant tumors (1), and their reconstruction represents a key area within Plastic and Reconstructive Surgery. Operating on the medial canthus of the eye can damage important structures, such as canaliculi, lacrimal sac, medial canthus tendon, and orbicularis oculi fibers, which are part of the lacrimal system. Complications such as ectropion and canthal webbing are exclusive to this periocular area and can be a challenge to deal with. This reinforces the importance of strategic surgical planning from the outset. Size, depth and location of the defect, involvement of anatomical subunits and local skin laxity should be carefully asessed. For small defects, healing by second intention is more often successful.(2,3) However, larger defects often require tissue redistribution to control tension vectors and prevent eyelid distortion. In this study, cases of medial canthal defects were analyzed, and a management protocol based on defect size and bilaterality was proposed, supported by the outcomes obtained and relevant literature.

Material and methods

A retrospective study (December 2024–December 2025) was conducted including patients who underwent medial canthus tumor excision with histopathological confirmation of malignancy. Demographic variables, histologic type, defect size, and reconstructive technique were analyzed. Tumor excision was performed under local anesthesia with intraoperative frozen-section biopsy. Reconstruction was determined according to defect size and bilaterality: primary closure (≥0.5 cm) or secondary intention healing (<0.5 cm), using simple closure, local flaps, or skin grafts.

Results

Four patients (six defects) were included; 75% were female, with a mean age of 77 years. All cases corresponded to basal cell carcinoma. Only 2 cases were bilateral. The mean defect size was 1.6 cm. All procedures were performed under local anesthesia. The mean follow-up was 1 year, with 75% patient follow-up completion. No major complications were reported, only one case of minor complication (haematoma).

Conclusion

Reconstruction of defects of the medial canthus can be achieved in most cases using local techniques, in a single surgical procedure, and under local anesthesia. The medial canthus of the eye is one of the most challenging facial sites to reconstruct due to its unique contour and the convergence of skin with varying thickness and texture. Resource optimization is feasible without increasing the complication rate, allowing for safe outpatient procedures in selected patients. We conclude that apart from a personalized dynamic analysis of each patient, guidance based on the size of the defect is key to surgical planning for achieving satisfactory functional and aesthetic results. Despite this encouraging pathway, a randomized controlled trial will be needed to prove the efficacy of the protocol. We are currently testing it in more patients with results to be published

(1) Inkster C, Ashworth J, Murdoch JR, Montgomery P, Telfer NR, Leatherbarrow B. Oculoplastic reconstruction following Mohs surgery. Eye (Lond). 1998;12 ( Pt 2):214-218. doi:10.1038/eye.1998.51 (2) Shankar J, Nair RG, Sullivan SC. Management of peri-ocular skin tumours by laissez-faire technique: analysis of functional and cosmetic results. Eye (Lond). 2002;16(1):50-53. doi:10.1038/sj.eye.6700057 (3) Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol.1979;97:2192.

Introduction: Mandibular defects can cause unsightly disfigurement, leading to unfavorable outcomes and a low quality of life. In this study, we aim to evaluate the aesthetic outcome in patients following mandibular reconstruction using a single-barrel (SB) or double-barrel (DB) Free Fibula Flap (FFF). Methods: A retrospective analysis of patients who underwent mandibular reconstruction between 2010-2024. Patient demographics, defect class, follow-up duration, and complication rate were recorded. Mandibular defects were stratified according to the Brown classification for mandibular defects [1]. A comparative aesthetic evaluation of pre-and postoperative clinic photographs graded by two independent surgeons blinded to patients' data, using a standardized scoring scales [2-4]. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) for continuous aesthetic scores (symmetry, jaw deviation, lip deformity, scar) and Cohen's Kappa for categorical parameters (sagging, bulkiness, contour defects, hair growth, color mismatch). Results: In this study, 34 patients were identified. Mandibular defects ranged from Brown Class I to IVc (Class I in 17%, Ic in 15%, II in 11%, IIc in 16%, III in 15%, IV in 15%, and IVc in 11%). Ameloblastoma was the most common cause of mandibular defect (57%). 57% of patients were reconstructed with SB, while 42% with DB. Agreement between raters was good across continuous domains (ICC = 0.82 for symmetry, 0.79 for jaw deviation, 0.81 for lip deformity, 0.77 for scar quality). Categorical parameters demonstrated substantial agreement (k=0.72 for sagging, 0.68 for bulkiness, 0.70 for contour defects, 0.74 for hair growth, 0.69 for color mismatch). Median follow-up duration is 3 months (range: 2-60 months). Postoperative aesthetic scores improved across all domains. Mean symmetry scores increased from 2.3 to 3.5, jaw deviation from 2.5 to 3.7, lip deformity from 2.4 to 3.3, and scar quality from 2.8 to 3.2. Class I and III defects achieved the highest postoperative scores, while Class IV showed moderate improvements. Importantly, double-barrel reconstruction yielded superior outcomes in Class IIc and IVc defects, with postoperative symmetry and contour scores consistently ≥3.8 compared to 3.2-3.4 in single-barrel cases. Evaluation of additional parameters revealed lower sagging (69%), contour defects (76%), and flap bulkiness (65%), while color mismatch and hair growth remained infrequent. Complications included one flap failure due to congestion and one wound dehiscence. Conclusion: Free fibula flap achieved improved aesthetics across mandibular defect classes. DB provided superior vertical height restoration and contour balance in Class IIc and IVc defects, whereas single-barrel techniques were effective for lower defects but more often associated with minor contour irregularities. Scar score demonstrated moderate improvement, though variability remained depending on defect class and bulkiness. These findings underscore the value of defect-specific planning and reconstruction in optimizing aesthetic outcomes for mandibular defects.

References: 1. Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016 Jan;17(1):e23-30. doi: 10.1016/S1470-2045(15)00310-1. Epub 2015 Dec 23. PMID: 26758757. 2. Petrovic I, Baser R, Blackwell T, et al. Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible. Head & Neck. 2019;41:2123–2132. https:// doi.org/10.1002/hed.25666 3. Chen J, Yin P, Li N, Wu L, Jian X, Jiang C, Functional mandibular reconstruction with double-barrel fibular flap and primary osseointegrated dental implants improve facial aesthetic outcome, Journal of Oral and Maxillofacial Surgery (2018), doi: 10.1016/j.joms.2018.08.008. 4. Posch NA, Mureau MA, Dumans AG, Hofer SO. Functional and aesthetic outcome and survival after double free flap reconstruction in advanced head and neck cancer patients. Plast Reconstr Surg. 2007;120:124-129.

Chondrosarcoma is a rare primary bone tumor that can produce significant local mass effect and neurological deficits depending on location. These tumors are resistant to conventional chemotherapy and radiation, making en bloc resection the mainstay of therapy (1). Chondrosarcoma involving the spine is particularly challenging, often requiring a multidisciplinary approach for both resection and reconstruction (2). Plastic surgery plays a critical role in restoring structural integrity and function through coordinated reconstructive planning (3). We present a 36-year-old male with biopsy-confirmed pelvic/sacral chondrosarcoma who underwent a staged, 3-day multidisciplinary resection and reconstruction in January 2026 involving six surgical services. Day 1, performed in the supine position, included ureteral stent placement, exploratory laparotomy with low anterior resection and end colostomy, L5 corpectomy with anterior tumor resection and osteotomy to the sacroiliac joint. Vascular Surgery was consulted intraoperatively for a right common iliac vein injury. Plastic surgery simultaneously raised bilateral vascularized fibula grafts and a right vertical rectus abdominis muscle (VRAM) flap for delayed inset, preserving vascular supply for staged reconstruction. The patient was subsequently positioned prone for the second and third stages. Radical resection of the sacrum was performed with partial posterior column resection, lumbar decompression, and posterior instrumentation from L2–L4 to achieve oncologic clearance and spinal stability. In the final stage, recipient vessels were identified from the superior gluteal system, and template-guided fibular osteotomies enabled reconstruction. A free vascularized double-barrel fibula construct restored the left iliac defect with fixation to L5 and L4, while a second free vascularized fibula graft stabilized the right iliac osteotomy to the L4 endplate (3). Venous congestion of one flap required supercharging with a vein graft to augment venous outflow. The VRAM flap was inset through the transabdominal tunnel into the retroperitoneal space covering the hardware and obliterating dead space, and wound vacuum-assisted closure devices were placed to manage postoperative fluid output. The patient required thromboelastogram-guided massive transfusion and staged ICU resuscitation. The postoperative course was notable for a wound infection at 1 month requiring incision and drainage, now healing well. Initial postoperative pain control was challenging but has progressively improved. At 3-month follow-up he demonstrates viable reconstruction with stable fixation and no evidence of hardware failure. He demonstrates weak but improving hip flexion and knee extension with preserved quadriceps activation, without return of plantarflexion or dorsiflexion, and continues rehabilitation. Imaging demonstrates preserved spinopelvic alignment with early osseous integration, reflecting restoration of structural continuity and soft tissue coverage following radical oncologic resection. This case demonstrates that complex spinopelvic reconstruction following radical oncologic resection can be successfully achieved through careful multidisciplinary coordination and deliberate staging of surgical interventions, with plastic surgery playing a critical role in restoring structural stability and ensuring durable soft tissue coverage.

1. Gelderblom H, et al. The clinical approach towards chondrosarcoma. Oncologist. 2008;13:320–329.
2. Fourney DR, et al. En bloc resection of primary sacral tumors: classification and surgical considerations. Spine. 2005;30:E617–E626.
3. Moran SL, et al. Free vascularized fibular grafts for skeletal reconstruction. J Am Acad Orthop Surg. 2005;13:159–170.

Purpose: Post burn contractures in paediatric patients is a significant cause of morbidity despite early interventions (1). These can profoundly limit physical function and hinder overall development. This case report details the successful multistage surgical and rehabilitative correction of severe, function-limiting bilateral popliteal contractures in a pediatric patient Methods and Materials: We present experience of a single case involving a 6-year-old Male who underwent flame burn at the age of 4 years and was managed conservatively at home. He presented two years post-injury with an inability to extend both knee joints, and was completely unable to sit upright, stand, or walk. The initial range of motion was 0 to 30 degrees on the right and 0 to 40 degrees on the left. A three-stage management plan was executed for the Total Popliteal Contracture of Bilateral Knee as per Grishkevich Classification(2). Stage 1 involved incisional release using transverse incisions, achieving up to 90 degrees range of motion, and coverage with bilateral turn-over gastrocnemius flaps. Intraoperative challenges included exposed and shortened sciatic nerves and shortened hamstring tendons. Stage 2 comprised tractional lengthening using bilateral Ilizarov external fixators, consisting of a 6-week dynamic phase and a 6-week consolidation phase. During the consolidation phase, bilateral raw areas were covered using split-thickness skin grafts harvested from the back. Stage 3 focused on extensive physiotherapy and rehabilitation, including active and passive range of motion, strengthening exercises, turn buckle splints, and ankle corrective footwear. Results: Following the multistage intervention, the patient regained significant mobility and function. 6 month follow up post removal of Ilizarov Fixator showed significant functional recovery. He was able to perform Activities of Daily Living and he is able to sit in a chair unsupported, stand with support, and walk using a walker. However, as the severe knee contractures were released and corrected, bilateral ankle deformity was unmasked. Conclusion: A carefully planned, multi-staged approach utilizing incisional release, local gastrocnemius flaps, Ilizarov external fixation for tractional lengthening, and rigorous physiotherapy is an effective strategy for correcting severe, neglected pediatric popliteal post-burn contractures. A combination of flap cover followed by graft placement ensures appropriate joint mobility and also facilitates secondary lengthening procedures. Bibliography: 1. Goverman J, Mathews K, Goldstein R, Holavanahalli R, Kowalske K, Esselman P, et al. Pediatric Contractures in Burn Injury: A Burn Model System National Database Study. J Burn Care Res Off Publ Am Burn Assoc. 2017;38(1):e192–9. doi:10.1097/BCR.0000000000000341 PubMed PMID: 27355656; PubMed Central PMCID: PMC9306192. 2. Grishkevich VM, Av V. Postburn Knee Flexions Contractures: Anatomy and Methods of Their Treatment. Trop Med Surg. 2013;1(6):1–8. doi:10.4172/2329-9088.1000147

Background: Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma that most commonly affects anatomically complex anogenital regions and frequently requires wide surgical excision for disease control. Resulting defects often involve functionally and aesthetically sensitive areas, necessitating reconstructive intervention to restore form and preserve urinary, bowel, and sexual function. Despite the critical role of reconstruction in EMPD management, reconstructive strategies remain heterogeneous, and outcomes have not been comprehensively synthesized. This systematic review aimed to characterize excisional approaches, reconstructive modalities, margin assessment techniques, and postoperative outcomes following EMPD excision.

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, with protocol registration in the International Prospective Register of Systematic Reviews (PROSPERO; submitted January 28, 2026). A comprehensive search of Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus databases was performed from database inception through May 5, 2025, limited to English and Spanish publications. Studies reporting adult patients undergoing surgical excision of EMPD followed by reconstructive procedures were included. Two independent reviewers performed study screening, eligibility assessment, and standardized data extraction. Extracted variables included patient demographics, disease location, excisional technique, reconstructive modality, specialty involvement, postoperative complications, recurrence, follow-up duration, and functional or patient-reported outcomes. Quantitative meta-analysis was planned a priori; pooling was to be performed only if predefined comparability criteria were met. When criteria for statistical pooling were not satisfied, findings were synthesized using structured descriptive and quantitative summary methods. Unless otherwise specified, reported percentages reflect study-level reporting frequencies.

Results: A total of 117 studies comprising 698 patients were included. Sex was reported for 687 patients, of whom 438 (63.7%) were male and 248 (36.3%) females. The weighted median age was 66 years. Wide local excision represented the predominant oncologic approach (92 studies, 78.6%), whereas Mohs micrographic surgery was reported in six studies (5.1%). Margin assessment techniques, including frozen section analysis and mapping/scouting biopsies, were described in 89 studies (76.1%), although standardized definitions of negative margins were inconsistently reported.

Flap-based reconstruction was the most frequently reported modality, utilized in 89 studies (76.1%) and accounted for 562 reconstructed patients (80.5%). Graft-only reconstruction was reported in 26 studies (22.2%), involving 225 patients (32.2%), while combined graft–flap techniques were described in 19 studies (16.2%), representing 337 patients (48.3%). Flap reconstruction predominated in anatomically complex vulvar, penoscrotal, perianal, and perineal defects requiring durable vascularized coverage and functional preservation.

Postoperative complications were reported in 113 studies (96.6%). Frequently described events included wound dehiscence, surgical-site infection, partial flap or graft necrosis, and anal or urethral stenosis. Recurrence outcomes were reported in 100 studies (85.5%), with documented variability in follow-up duration and recurrence timing. Patient-reported or patient-centered outcomes were described in 101 studies (86.3%); however, validated assessment instruments were infrequently employed.

Conclusions: Reconstruction following EMPD excision demonstrates marked heterogeneity; however, flap-based reconstruction predominates anatomically complex defects requiring functional restoration. Margin assessment strategies and outcome reporting remain inconsistent throughout the literature. Standardized reporting of oncologic and patient-centered outcomes is needed to guide evidence-based reconstructive decision-making in this rare disease population.

Purpose: Microsurgical training is essential but challenging for novice plastic surgery trainees because opportunities for repetitive practice are limited. This prospective study evaluated the E-Da model, a low-cost microvascular anastomosis training device designed to improve confidence and technical performance.

Materials and Methods: The E-Da model was constructed using a plastic cup, latex glove, and intravenous drip system. The latex glove was stretched over the cup to simulate vessel-wall tension, and the drip height was adjusted to maintain an internal pressure of approximately 30-40 mmHg, comparable to peripheral microvascular pressure. Participants completed three tasks: knot tying, suturing a 4-mm linear incision, and suturing a 3 × 3-mm L-shaped incision. Novice trainees attended a 1-day microvascular anastomosis course and completed self-confidence questionnaires before and after training. The training sequence included pigskin, the E-Da model, and chicken vessel practice. Performances were video-recorded in a de-identified manner and assessed independently by 2 experienced microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale. A leakage test was additionally performed for the E-Da L-type task. Statistical analyses included generalized estimating equations, paired Student's t-tests, and Pearson correlation, with p < 0.05 considered significant.

Results: Twenty-six participants were included: 15 medical students, 7 postgraduate-year trainees, and 4 residents. Most had minimal prior microsurgical experience, with 23 reporting none and 3 reporting simulation-only experience. General suturing confidence improved significantly from 5.6/10 pre-course to 7.8/10 post-course (p < 0.001), and microvascular anastomosis confidence improved from 3.5/10 to 6.0/10 (p < 0.001). E-Da linear-task SMaRT scores were slightly lower than pigskin scores, without statistical significance (difference = -0.12, p = 0.2). Significant improvement was observed from the E-Da linear task to the E-Da L-type task (difference = 0.58, p < 0.001), and from the E-Da L-type task to chicken vessel suturing (difference = 0.2, p = 0.002). Leakage volume in the E-Da L-type task was significantly negatively correlated with SMaRT score (r = -0.54, p = 0.004).

Conclusions: The E-Da model is a low-cost, accessible, and effective training platform for novice microvascular anastomosis training, with educational value supported by improved trainee confidence, progressive SMaRT score improvement, and inverse correlation between leakage and technical performance.

Background: Identifying the factors associated with unmasking of new sources of neuropathic groin pain after peripheral nerve surgery may help clinicians and patients better understand the pathophysiology and risks, reduce reoperation rates, and improve patient outcomes and satisfaction. Methods: Adult patients following surgery for groin pain localized to any of the lumbar plexus peripheral nerves: iliohypogastric (IHN), ilioinguinal (IIN), genital branch of genitofemoral (GBGFN), and lateral femoral (LFN) between June 2006 and January 2025 were retrospectively evaluated. Patients were stratified into two postoperative cohorts: no reoperation for neuropathic groin pain and reoperation for unmasked neuropathic groin pain in a new/different anatomical distribution. Outcomes were assessed using Numeric Rating Scales (NRS) and functional scores. Multivariate logistic regression was then used to identify independent predictors of the need for reoperation. Minimum follow up was 6 months. Results: 255 (93.4%) patients did not require reoperations and 18 (6.5%) required reoperations for unmasked pain (median onset: 133 days). Preoperative factors conferring lower odds of reoperations were resection of the GBGFN and muscle resection/transposition, while lower BMI, pain, tingling, and/or burning in the scrotum/testicles/labia, higher initial NRS "lowest" pain scores, and pain described as "sharp" were associated with greater odds of reoperation for unmasked groin pain. Conclusion: New locations for neuropathic pain were unmasked following 6.5% of neurectomy operations to treat chronic groin pain in a single-center large patient cohort. Surgeons can utilize this data to double-check for GBGFN pathology in the genitalia preoperatively and to formulate operative plans to potentially include this nerve when findings are less than obvious, to prevent the need for reoperation. This data can also be used for informed consent discussions.

Background: Compressive peripheral neuropathy is an uncommon condition in pediatric populations, with limited literature describing proximal compressive neuropathies of the forearm. PTS is rare, accounting for only 1.1% of upper extremity compressive neuropathies, and pediatric presentations are often under-recognized due to vague descriptions of symptoms and challenges with physical examination reliability.

Purpose: To report a case of proximal median nerve compression in an adolescent caused by an atypical course of the median nerve.

Study Design: Case Report

Clinical Case: A 15-year-old right-hand-dominant female presented with a one year history of activity induced right upper extremity pain, paresthesia, and subjective numbness in the right index, long, and ring fingers. Examination revealed pain with resisted pronation, a positive Tinel's sign at the pronator, and normal two-point discrimination. MRI and ultrasound identified no focal nerve pathology but demonstrated the median nerve coursing superficial to the flexor digitorum superficialis (FDS) and deep to the flexor carpi radialis (FCR). Surgical exploration was performed to decompress the median nerve, anterior interosseous nerve, and the carpal tunnel.

Results: Surgical exploration revealed compression of the median nerve between the superficial (humeral) head of the pronator teres and the flexor carpi radialis, with additional compression at the deep head of the pronator teres affecting the anterior interosseous nerve. Following decompression, the patient reported resolution of symptoms and tolerance of previously aggravating tasks.

Conclusion: This case highlights an atypical course of the median nerve not previously described in the literature and reinforces the importance of tailored clinical evaluation and consideration of anatomical variation in pediatric proximal compressive neuropathies.

Funding – No funding was received for the implementation of this study Conflicts of Interest – The authors have no reported conflicts of interest

Purpose: Trapeziectomy with suture-button suspensionplasty is an increasingly popular surgical treatment for advanced basilar joint osteoarthritis. However, the procedure is not without complications, including fracture of the index metacarpal. Herein, we present a case and review the literature to characterize risk factors, proposed mechanisms, and management strategies. Methods: We present a case of a delayed, atraumatic index metacarpal fracture in a patient who underwent trapeziectomy with suture-button suspensionplasty and performed a literature review of primary research articles describing similar cases by querying the MEDLINE database. Results: Six articles, consisting of ten cases, were included, with publication dates ranging from 2012 to 2022. All previously reported patients were female except for one, with a mean age of 51 years (range: 38–61). On average, patients presented at 13.1 weeks (range: 4–24) following their initial procedure. Patients were treated with immobilization or open reduction and internal fixation, with or without device removal. Our patient was a 56-year-old male who experienced an atraumatic index metacarpal fracture seven weeks postoperatively. He was treated with immobilization and healed uneventfully. Conclusion: Fracture of the index metacarpal following suture-button suspensionplasty is a rare complication that follows a reproducible pattern. Patients present in a delayed fashion with short, oblique fractures oriented along the index metacarpal drill tunnel. Based on available data, minimizing drill diameter, avoiding multiple passes, optimizing tunnel trajectory, and preventing overtensioning of the suture-button construct, and patient counseling regarding early postoperative loading may mitigate risk.

Introduction Peripheral intravenous (PIV) extravasation is a common complication in pediatric patients, particularly neonates and critically ill children. While most injuries are self-limited, extravasation involving the extremities often produces marked edema and erythema that can raise concern for compartment syndrome and prompt early surgical consultation. In the absence of standardized institutional protocols, management varies widely across services, leading to inconsistent early interventions and potentially avoidable escalation of care. This study (1) reviews current evidence on pediatric PIV extravasation management and (2) proposes a protocol designed to support quality improvement efforts by emphasizing conservative treatment, bedside education, and defined consultation thresholds. Methods A literature review (2010–2025) using PubMed, ScienceDirect, and publicly available pediatric hospital protocols identified best practices in prevention, grading, and management of PIV extravasation. Findings were synthesized and combined with institutional experience to develop a pragmatic, bedside-applicable management and consultation algorithm designed for multidisciplinary use and paired with focused bedside education. Results Extravasation injuries most commonly present with localized edema and erythema, with progression to skin necrosis or full-thickness injury occurring in a minority of cases. Published pediatric protocols consistently emphasize early recognition, prompt cessation of infusion, extremity elevation, agent-appropriate thermal therapy, and selective pharmacologic intervention (e.g., hyaluronidase). However, elevation technique descriptions are frequently nonspecific, and no identified protocol addressed the practical challenge of maintaining continuous elevation in pediatric patients - particularly in young children who cannot cooperate with positioning. Surgical consultation criteria vary substantially across institutions. Discussion The proposed algorithm standardizes early management through stepwise injury stratification and universal initiation of conservative therapy. Upon recognition, infusion is immediately stopped, injury extent and agent class are assessed, neurovascular status is evaluated, and borders are marked. First-line treatment for all extravasations includes sustained extremity elevation for 24–48 hours, agent-appropriate thermal therapy, close serial examination, and targeted pharmacologic intervention (e.g., hyaluronidase) when indicated. A key component of the protocol is education on sustained, gravity-dependent extremity elevation, as passive elevation on pillows or blankets is frequently inadequate to counteract dependent edema in severe injuries. Bedside teaching emphasizes vertical or near-vertical suspension of the affected extremity using a stockinette secured to the IV pole, eliminating the need for active patient effort or repositioning and ensuring continuous elevation is maintained throughout the critical 24–48 hour window - in our experience producing meaningful improvement in swelling and tissue tension. Plastic Surgery consultation is stratified by injury severity and clinical progression. Early consultation is recommended for high-risk agents, rapidly progressive swelling, neurovascular compromise, or concern for evolving compartment syndrome. Delayed or expectant consultation is appropriate for injuries that progress to skin necrosis or full-thickness tissue loss, at which point continued elevation and local wound care are maintained until the injury fully declares and operative planning can be safely undertaken. By clarifying early management steps, emphasizing bedside education, and defining consultation thresholds, this protocol aims to reduce unnecessary early surgical consults while ensuring timely involvement for patients who ultimately require operative management.

Purpose

High-voltage electrical injuries (HVEI) of the upper extremity are uncommon yet devastating injuries that often require complex reconstruction or limb amputation [1,2] . Despite improved burn care over recent decades, the optimal timing and type of intervention remains unstandardized [2]. The objective of this study is to improve clinicians' understanding of injury patterns, management approaches, outcomes, and the role of hand surgery consultation when treating high-voltage electrical injuries to the upper extremity.

Methods

A retrospective chart review was conducted of patients at our institution (ABA certified Burn Center/Level 1 Trauma Center) who sustained high-voltage electrical injuries to the upper extremity. Ten patients met criteria for inclusion. Data collected included patient demographics, mechanism of injury, total body surface area (TBSA) burned, time to hand surgery consultation and initial intervention, treatment modalities, complications, and outcomes including amputation rates.

Results

A SPARC query identified 10 patients with high-voltage upper extremity injuries treated since the establishment of our Burn Center in 2020. All patients were male with a mean age of 34.4 years (range 13–68). Mechanisms of injury primarily involved occupational or environmental electrical exposure, including tree trimming (n=4), direct contact with power lines (n=2), and isolated incidents such as copper wire stripping, residential electrical work, pole climbing, and vehicular contact with a live line. Most patients were transferred from outside hospitals (n=7), with 2 presenting as primary trauma activations and 1 presenting in a delayed outpatient setting. Mean total body surface area burned was 10.5% (range <1%–31%), and mean hospital length of stay was 40 days (range 12–123). Hand surgery consultation was obtained in 7 patients, with 5 occurring within 24 hours of admission. Of these, 4 patients underwent operative intervention. Procedures included compartment releases (n=4), digital amputations (n=2), transradial amputations (n=2), and one required free tissue transfer. Among patients without formal hand surgery involvement, one underwent distal thumb amputation, while the remainder required debridement and skin grafting alone. The mean number of upper extremity procedures per patient was 6.2, with only 12.5% performed by hand surgery teams.

Conclusion

High voltage electrical injuries to the upper extremity, while rare, are associated with significant morbidity, frequently requiring multiple surgical interventions, prolonged hospitalizations, and life altering sequelae [1,2]. Our institutional experience highlights the risk of compartment syndrome and limb loss in this patient population. These findings suggest a potential benefit of early involvement of hand surgery specialists in these injuries to optimize outcomes. Given the complexity and variability of these injuries, further research is essential to develop standardized treatment guidelines and evidence-based management algorithms.

References

1. Lee, D. H., Desai, M. J., & Gauger, E. M. (2019). Electrical Injuries of the Hand and Upper Extremity. Journal of the American Academy of Orthopaedic Surgeons, 27(1), e1–e8. https://doi.org/10.5435/JAAOS-D-17-00833

2. Cole Stephany, Natalie K Blanc, Jenna Adalbert, Gil Gontre, Seth D Dodds, 532. Protocols for High-voltage Upper Extremity Electrical Burns at level 1 Trauma Centers: A Scoping Review, Journal of Burn Care & Research, Volume 47, Issue Supplement_1, March-April 2026, Page S204, https://doi.org/10.1093/jbcr/irag033.229

Introduction: Patients experiencing housing insecurity have been found to have increased rates of adverse outcomes in the general and vascular surgery populations. However, the impact of housing insecurity in the hand trauma population has not been well studied. The aim of this study was to examine the association of housing insecurity with complications in patients undergoing flexor tendon repair.

Methods: A retrospective cohort study was conducted using the TriNetX research database to identify patients who underwent primary flexor tendon repair between 2005-2025. Primary flexor tendon repair Current Procedural Terminology (CPT) codes were used for patient identification. Outcomes such as surgical site infection, need for subsequent tenolysis, hand therapy attendance, emergency department (ED) visits, and readmission were compared between patients with housing insecurity (denoted by ICD 9 or 10 code) and those without.

Results: 25948 patients who underwent primary flexor tendon repair were included. 2.47% (n=641) patients were identified to have housing insecurity at the time of their procedure while 97.53% (n=25307) did not. Patients in the housing insecurity group had higher rates of surgical site infection (6.86% vs 1.70%; p <0.001), ED visits (51.01% vs 14.47%; p <0.001), and readmission (33.39% vs 9.84%; p <0.001). Patients without housing insecurity had higher rates of subsequent tenolysis (1.87% vs 4.67%; p <0.001). There were no significant differences in hand therapy attendance between groups.

Conclusion: Patients with housing insecurity at the time of primary flexor tendon repair have higher rates of surgical site infection, ED visits, and readmission. Patients without housing insecurity have higher rates of subsequent tenolysis, which may reflect increased access to care.