Biomedical subjects

Kevin C Chung

Publications and source records attributed to Kevin C Chung.

At least 37 records · Page 2Linked to original sources

PubMed2006

Treatment of complex below-the-elbow gunshot wounds.

Firearm injuries, many of which involve the hand, wrist, or forearm, pose a serious public health concern in the United States in both medical and economic terms. Despite the preponderance of low-velocity weapons, complex below-the-elbow gunshot injuries are commonly seen. A successful approach to these patients requires efficient treatment and early initiation of rehabilitation. Unfortunately, this goal is often not met because of multiple factors including wound infections, the need to coordinate multiple surgical specialties, long hospital stays, and delayed definitive reconstruction. At our institution, the plastic surgery hand service is able to treat all aspects of below-the-elbow trauma. A protocol of early aggressive debridement and skeletal stabilization, with definitive reconstruction within 1 week of injury, is used. We retrospectively reviewed all complex below-the-elbow gunshot injuries treated by the senior author between 1996 and 2003. Eighteen such patients were identified. All limbs were salvaged and all patients regained functional use of the extremity. There was no incidence of wound infection. The average length of inpatient stay was 8.9 days (median, 7 days). The use of this protocol by a single surgical specialty allows efficient reconstruction, short hospital stays, and early initiation of rehabilitation.

Adolescent↗

PubMed2006

Use of thoracodorsal artery perforator flap for soft tissue reconstruction in children.

Perforator free flap (PFF) is now performed with increasing frequency for soft tissue reconstruction in adults. When compared with conventional free skin flaps, PFFs are thinner and have less donor-site morbidity because only the skin is harvested. The advancement of the PFF design has spurred the identification of many skin flaps based on the perforator principle. Although PFFs are used in adults, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 4 consecutive cases of successful transfer of thoracodorsal artery perforator flap in children. We present our flap design and surgical technique to highlight the usefulness of this flap for reconstructing soft tissue defects in children.

Adolescent↗

PubMed2006

Treatment of unstable distal radial fractures with the volar locking plating system.

BACKGROUND: The best treatment for an inadequately reduced fracture of the distal part of the radius is not well established. We collected prospective outcomes data for patients undergoing open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. METHODS: Over a two-year period, 161 patients underwent open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. Patients were enrolled in the present study three months after the fracture on the basis of strict entry criteria and were evaluated three, six, and twelve months after surgery. Outcome measures included radiographic parameters, grip strength, lateral pinch strength, the Jebsen-Taylor test, wrist range of motion, and the Michigan Hand Outcomes Questionnaire. RESULTS: Eighty-seven patients with a distal radial fracture were enrolled. The mean age at the time of enrollment was 48.9 years. Forty percent (thirty-five) of the eighty-seven fractures were classified as AO type A, 9% (eight) were classified as type B, and 51% (forty-four) were classified as type C. Radiographic assessment showed that the plating system maintained anatomic reduction at the follow-up periods. At the time of the twelve-month follow-up, the mean grip strength on the injured side was worse than that on the contralateral side (18 compared with 21 kg; p<0.01), the mean pinch strength on the injured side was not significantly different from that on the contralateral side (8.7 compared with 8.9 kg; p=0.27), and the mean flexion of the wrist on the injured side was 86% of that on the contralateral side. All Michigan Hand Outcomes Questionnaire domains approached normal scores at six months, with small continued improvement to one year. CONCLUSIONS: The volar locking plating system appears to provide effective fixation when used for the treatment of initially inadequately reduced distal radial fractures.

Adolescent↗

PubMed2005

Physician perceptions of upper extremity reconstruction for the person with tetraplegia.

PURPOSE: Upper extremity reconstruction for people with tetraplegia can improve upper-limb function substantially and enhance independence; however, these surgical procedures rarely are performed. This study attempted to identify barriers preventing appropriate candidates from receiving these procedures. METHODS: A questionnaire was mailed to a national sample of 379 hand surgeons and 384 physiatrists with an interest in spinal cord medicine. The statistical model assessed 2 main outcomes of the physician survey: (1) whether the provider had been involved in at least one of these procedures in the past year and (2) whether the provider desired to be more involved. We hypothesized that these outcomes were associated with provider attitudes and beliefs and failures of the health care system referral networks. RESULTS: Most hand surgeons and physiatrists believed that these procedures were beneficial; however, few had either performed or referred even one case over the past year. Multivariable models suggested that a predominant factor in whether these procedures were being performed was the presence of a relationship between the surgeon and physiatrist. CONCLUSIONS: A lack of coordinated cross-specialty relationships appears to present the largest barrier to the appropriate use of upper extremity reconstruction for people with tetraplegia.

Attitude of Health Personnel↗

PubMed2005

Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery.

PURPOSE: Symptom resolution and functional improvement are the 2 primary reasons for patients to seek treatment for carpal tunnel syndrome (CTS). This study aimed to measure the responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH) when evaluating outcomes after carpal tunnel surgery. METHODS: Fifty patients prospectively completed the MHQ and the DASH before and 6 months after open carpal tunnel release. Data were analyzed using paired t tests and responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS: All domains of the MHQ significantly improved after carpal tunnel release: the pain scale had a large SRM of 0.9 and the function scale showed medium responsiveness of 0.6. The combined function/symptom scale of the DASH significantly improved after surgery; the SRM revealed a medium effect of 0.7. CONCLUSIONS: The MHQ and the DASH are both responsive in measuring outcomes of carpal tunnel surgery. The MHQ has subscales that can measure symptom and function improvement independently. The MHQ and the DASH can be used for outcomes research related to carpal tunnel surgery with the advantage of also being useful for assessing and comparing outcomes for various other hand disorders.

Activities of Daily Living↗

PubMed2005

Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study.

PURPOSE: More than 100,000 Americans live with the disability of tetraplegia. For these people their level of independence often is related to the function of the upper extremity. Reconstructive procedures can improve the use of the upper limb and multiple case series have shown benefit from these procedures for appropriate candidates. Discussions with patients and surgeons, however, suggest that these procedures rarely are performed. This study attempted to assess whether upper extremity reconstruction for the tetraplegic population is being used properly. METHODS: Data from 2 inpatient national databases were used (the National Inpatient Sample and Veterans Affairs patient treatment files) for 1988, 1989, 1999, and 2000. Patients were selected by International Classification of Diseases (ICD-9) diagnosis codes for tetraplegia and procedure codes that could represent upper extremity reconstruction. The recommended rate of these surgeries was based on the annual incidence of tetraplegia (5,000) and expert opinion that suggests at least 50% of these people would benefit from upper extremity surgery. RESULTS: Our health care data analysis showed that fewer than 355 of these surgeries were performed in the United States in any year queried. The calculated recommended rate was 2,500 procedures a year, meaning that only 14% of appropriate candidates were receiving upper extremity reconstruction. We also found changes in the expected primary payor, with Medicaid paying for far fewer procedures in 2000 compared with 1988 claims. Finally over the course of time it appears that far fewer of these procedures are being performed. CONCLUSIONS: Functional upper extremity reconstruction for the tetraplegic population is profoundly underused in the United States. Various factors could be causing this disparity of care and we recommend further research into the potential barriers to health care for this vulnerable population.

Adult↗

PubMed2005

A qualitative assessment of rheumatoid hand surgery in various regions of the world.

Differences in opinion between rheumatologists and hand surgeons result in disparate practice patterns among different states in the United States regarding the use of surgery for hand deformities in the rheumatoid population. The purpose of this project was to study the practices of rheumatoid hand surgery from countries in various regions of the world.

Arthritis, Rheumatoid↗

PubMed2005

Survey research: a primer for hand surgery.

Survey research is an important and commonly used research tool. The findings of survey research help set national practice guidelines and guide health care policy decision making. The process of survey design and administration is rigorous, complex, and involved. The Journal of Hand Surgery contains on average 3 articles involving surveys per issue. This report serves as a reference for readers of the many survey articles published in this journal. It also provides a guide for hand surgeons or others interested in how to conduct survey research.

Hand↗

PubMed2005

A historical report on Robert Kienböck (1871-1953) and Kienböck's Disease.

Robert Kienböck was the first to identify and describe Kienböck's disease. Considered one of the early fathers of radiology, he was a prolific researcher who made an immense contribution to the early development of radiology. In addition to groundbreaking work in therapeutic radiology Kienböck had a special interest in diseases of the bones and joints, especially those that involved the hand. Kienböck's contribution to medicine, particularly the diagnosis of hand disorders, continues to resonate today.

History, 19th Century↗

PubMed2005

A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures.

PURPOSE: External fixation and open reduction and internal fixation have been the traditional techniques for surgical fixation of unstable distal radius fractures. The existing literature has not identified which is superior, primarily because of the lack of comparative trials. We performed a comprehensive systematic review and meta-analysis of the current literature on external fixation and internal fixation of distal radius fractures to determine the dominant strategy based on available scientific evidence. METHODS: We searched MEDLINE and EMBASE for English-language articles published between 1980 and 2004 that satisfied predetermined inclusion and exclusion criteria. The outcomes of internal and external fixation were compared using continuous measures of grip strength, wrist range of motion, and radiographic alignment and categoric measures of pain, physician-rated outcome scales, and complication rates. Outcomes were pooled by random-effects meta-analysis and meta-regression analysis was used to control for patient age, presence of intra-articular fracture, duration of follow-up period, and date of publication. Sensitivity analyses were used to test the stability of the meta-analysis results under different assumptions. RESULTS: Forty-six articles were included in the review with 28 (917 patients) external fixation studies and 18 (603 patients) internal fixation studies. Meta-analysis did not detect clinically or statistically significant differences in pooled grip strength, wrist range of motion, radiographic alignment, pain, and physician-rated outcomes between the 2 treatment arms. There were higher rates of infection, hardware failure, and neuritis with external fixation and higher rates of tendon complications and early hardware removal with internal fixation. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis. CONCLUSIONS: The current literature offers no evidence to support the use of internal fixation over external fixation for unstable distal radius fractures. Comparative trials using appropriately sensitive and validated outcome measurements are needed to guide treatment decisions.

Bone Plates↗

PubMed2004

Silas Weir Mitchell, MD: the physician who discovered causalgia.

Silas Weir Mitchell discovered and treated causalgia, a condition most often encountered by hand surgeons. He is considered the father of neurology as well as an early pioneer in scientific medicine. He was also a psychiatrist, toxicologist, author, poet, and a celebrity in America and Europe. His many skills and interests led his contemporaries to consider him a genius on par with Benjamin Franklin. His contributions to medicine and particularly hand surgery continue to resonate today.

Causalgia↗

PubMed2004

A prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand.

PURPOSE: Destruction and dislocation of the metacarpophalangeal (MCP) joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. METHODS: We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. RESULTS: Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24 degrees and MCP joint range of motion increased, but this change was not significant. CONCLUSIONS: Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term.

Activities of Daily Living↗

PubMed2004

Volunteering in the developing world: The 2003-2004 Sterling Bunnell Traveling Fellowship to Honduras and Cambodia.

One of the goals of my Sterling Bunnell Traveling Fellowship, sponsored by the American Society for Surgery of the Hand and the American Foundation for Surgery of the Hand, was to serve the poor in developing countries. I had the unique opportunities to work in Honduras and Cambodia, 2 countries with rich cultural heritage residing at opposite ends of the world. This report describes my observations and my experiences in these 2 countries.

Adult↗

PubMed2004

Factors influencing residents' decisions to pursue a career in hand surgery: a national survey.

PURPOSE: The number of programs offering hand surgery fellowships has remained approximately the same over a 6-year period while the number of fellows within these programs has decreased by 46%. This study aimed to identify factors that persuaded or dissuaded orthopedic and plastic surgery residents in choosing hand surgery as a career. METHODS: We conducted a national survey of final-year orthopedic (n = 600) and plastic surgery (n = 177) residents. We developed an internet questionnaire based on literature review and focus group discussions. A Web site link was sent via e-mail to program directors of accredited orthopedic and plastic surgery programs for distribution of this anonymous survey to the residents. Factor analysis combined items into an "intellectual issues" category and a "lifestyle issues" category. Logistic regression was used to evaluate factors that predict an outcome of entering a hand surgery fellowship. RESULTS: We achieved a 30% response rate. Respondents and nonrespondents were not significantly different in terms of gender and race. After controlling for age, gender, marital status, and specialty, residents who enjoyed the intellectual issues of the hand surgery field were more likely to pursue a hand surgery fellowship (odds ratio = 10.1; 95% confidence interval = 3.3-30.8). Although a positive attitude toward lifestyle issues of the hand surgery field tended to be associated with pursuit of a hand surgery fellowship, the relationship was much weaker (odds ratio = 2.5; 95% confidence interval = 0.8-7.3). CONCLUSIONS: Lifestyle issues associated with a career in hand surgery such as low reimbursement and long hours were not the most important factors to residents when considering a career in the field. Residents pursued hand surgery primarily because of factors such as interest in and exposure to this field. To prevent a potential shortfall of hand surgeons, both orthopedic and plastic surgery programs must strengthen residents' exposure to hand surgery education in their training.

Adult↗

PubMed2004

Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process.

Fritz de Quervain was the first surgeon to describe and treat chronic stenosing tendovaginitis at the radial styloid process. The current management of this condition differs little from his initial description and as a result the condition now bears his name. He and his mentor, Nobel Prize winner Theodor Kocher, advanced the understanding and treatment of thyroid disease, especially subacute nonsuppurative thyroiditis, another condition to which his name is attached. He was a pioneer of surgical technology and author of books and articles read worldwide and is largely responsible for the introduction of iodized table salt.

History, 19th Century↗

PubMed2004

Risk of melanoma arising in large congenital melanocytic nevi: a systematic review.

Large congenital melanocytic nevi are cutaneous lesions regarded by many as premalignant; estimates of malignancy incidence range from 0 to 42 percent. Given the often complex and extensive nature of large congenital melanocytic nevi resection and reconstruction, the risk of malignant transformation is a crucial factor that surgeons and families must weigh when deciding whether or not to excise the lesion. The authors conducted a systematic analysis of data from the existing literature to critically evaluate the published studies and to establish a crude incidence rate for the risk of malignant melanoma transformation in large congenital melanocytic nevi. After a comprehensive literature search, they analyzed data from eight studies (containing a total of 432 large congenital melanocytic nevi patients) of sufficient scientific quality. Twelve patients (2.8 percent) in this sample developed cutaneous malignant melanoma during the reported follow-up periods. Using a subset of this data and comparing the incidence rates to those of the Surveillance, Epidemiology, and End Results population-based database using a standardized morbidity ratio, the authors found that the large congenital melanocytic nevi patients had an increased risk of melanoma (standardized morbidity ratio, 2599; 95 percent confidence interval, 844 to 6064) compared with the general population. Regarding treatment before developing melanoma in the 12 patients, 50 percent were observed before diagnosis, 17 percent had partial excision, 8.3 percent had dermabrasion, 8.3 percent had a chemical peel, and 17 percent did not have any treatment information. These combined data are clinically useful when consulting with the parents of children with large congenital melanocytic nevi and in the management of older patients with existing lesions. This study shows that there is a significantly increased risk of melanoma in large congenital melanocytic nevi patients. The data also reveal the need for a standardized definition of large congenital melanocytic nevi and a long-term, prospective outcomes study to determine the true lifetime risk of melanoma in patients with and without surgical excision.

Humans↗

PubMed2004

The Tinel sign: a historical perspective.

The Tinel sign is one of the most well-known and widely used clinical diagnostic tools in medicine. Aside from Jules Tinel, after whom the sign is named, several authors have described the famous "tingling" sign seen in regenerating injured nerves. In fact, Tinel was not the first to present the sign to the scientific community. The clinical value and utility of the Tinel sign have remained in question since its introduction; many may misinterpret the sign as a prelude to complete functional recovery of injured nerves, when in fact it only signals the progress of nerve regeneration. Today the Tinel sign is widely associated with the diagnosis of carpal tunnel syndrome and in the evaluation of regenerating peripherally injured nerves. Knowledge of the history and misconceptions surrounding the sign provides clinicians today with a greater appreciation of current debates on the use of the Tinel sign.

France↗

PubMed2003

Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients.

The advantages of endoscopic carpal tunnel release, compared with traditional open techniques, include smaller incisions, less scar tenderness, and faster recoveries. However, endoscopic carpal tunnel release has also been associated with higher complication rates. The goal of this study was to evaluate the safety and functional outcomes of minimal-incision open carpal tunnel release. In this prospective study involving a 2-year period, 104 patients (149 hands) underwent open carpal tunnel release with a 1-cm incision. Prospective data on complications among 104 patients were recorded, and functional outcomes among 20 patients were assessed by using the Michigan Hand Outcomes Questionnaire, the Jebsen-Taylor Hand Function Test, and pinch/grip strength testing. Data were collected before the operation and 3 weeks and 6 months after the operation. Complications included three wound infections and one carpal tunnel syndrome recurrence, 18 months after the initial release procedure. Michigan Hand Outcomes Questionnaire scores improved significantly between the preoperative and postoperative periods. There were no significant changes in Jebsen-Taylor Hand Function Test results or pinch/grip strength. Minimal-incision open carpal tunnel release can be performed safely and is associated with good functional outcomes.

Adult↗