Search

The reconstruction of complex cutaneous tendinous dorsal hand injuries represents a problem that is not easy to solve. The transferral in a single surgical stage, with a single flap, of skin, tendons, and nerves, all completely vascularized, is probably the ideal solution. Between 1988 and 1999 the one-stage reconstruction method was used in 13 patients. A cutaneous tendinous dorsalis pedis free flap was used in 7 cases, and a cutaneous tendinous radial forearm island flap with an inverted flow was used in 6. The dorsalis pedis flap allows for the inclusion of 4 tendons that are completely vascularized (extensor digitorum communis), while the radial flap allows us to completely insert a single tendon (palmaris brevis) and two vascularized tendinous strips taken from the flexor carpi radialis and from the brachioradialis. All of the flaps transferred survived perfectly with good functional recovery. One-stage reconstruction that is "completely vascularized" allows us to reduce the amount of time spent in hospital, the number of operations, and above all it provides cosmetic and functional results that are close to normal. The dorsalis pedis flap is indicated in cases of cutaneous tendinous dorsal hand injuries that require the simultaneous reconstruction of three or four extensor tendons. On the other hand, the radial flap may be used in situations where it is necessary to reconstruct only 1 or 2 tendons.

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

The Italian Society for Microsurgery (SIM, Società Italiana di Microchirurgia) developed a 5 steps training program for surgeons from different specialties who want to learn microsurgery as part of their practice. This 5 steps program has been established in 2013 and each course has a unique program and its own logo.Presently, there are 10 basic courses in Italy recognized by the SIM in Italy. The basic courses have a theoretical part and a practice of at least 20 hours each, performed on an ex-vivo model. There are minimum requirements for each step must be competed to be able to move to the consequent exercise. At the end of the course, each student is evaluated following an extract of the GRS score.The advanced course is exclusive, it opens to only 20 students each year and involve 35 self-funded tutors.Тhe program stated by the Italian Society for Microsurgery is very comprehensive and gives the opportunity to young surgeons to learn many aspects of the microsurgical reconstruction.