Artificial Intelligence in Hand Surgery - How Generative AI is Transforming the Hand Surgery Landscape.

Artificial intelligence (AI) has witnessed significant advancements, reshaping various industries, including healthcare. The introduction of ChatGPT by OpenAI in November 2022 marked a pivotal moment, showcasing the potential of generative AI in revolutionising patient care, diagnosis and treatment. Generative AI, unlike traditional AI systems, possesses the ability to generate new content by understanding patterns within datasets. This article explores the evolution of AI in healthcare, tracing its roots to the term coined by John McCarthy in 1955 and the contributions of pioneers like John Von Neumann and Alan Turing. Currently, generative AI, particularly Large Language Models, holds promise across three broad categories in healthcare: patient care, education and research. In patient care, it offers solutions in clinical document management, diagnostic support and operative planning. Notable advancements include Microsoft's collaboration with Epic for integrating AI into electronic medical records (EMRs), enhancing clinical data management and patient care. Furthermore, generative AI aids in surgical decision-making, as demonstrated in plastic, orthopaedic and hepatobiliary surgeries. However, challenges such as bias, hallucination and integration with EMR systems necessitate caution and ongoing evaluation. The article also presents insights from the implementation of NUHS Russell-GPT, a generative AI chatbot, in a hand surgery department, showcasing its utility in administrative tasks but highlighting challenges in surgical planning and EMR integration. The survey showed unanimous support for incorporating AI into clinical settings, with all respondents being open to its use. In conclusion, generative AI is poised to enhance patient care and ease physician workloads, starting with automating administrative tasks and evolving to inform diagnoses, tailored treatment plans, as well as aid in surgical planning. As healthcare systems navigate the complexities of integrating AI, the potential benefits for both physicians and patients remain significant, offering a glimpse into a future where AI transforms healthcare delivery. Level of Evidence: Level V (Diagnostic).

Surgical Anatomy and Exercises Using the Chicken Thigh Sciatic Nerve for Microsurgery Training.

Introduction Vessel repair in a chicken thigh is commonly used in microsurgery training model. The sciatic nerve is closely associated with the vessels and has been used for training nerve coaptation, which has different technical considerations from vessel anastomosis. We describe in detail the relevant surgical anatomy and training exercises that can be used with this model. Methods With 32 fresh store-bought chicken thighs, 16 were used to analyze the gross and histological features of the sciatic nerve, and 16 were intended to create and perform training models. Results The average visible length of the nerve in the thigh was 51 mm (standard deviation [SD] 2.57 mm). The average diameter of the nerve was 2 mm (SD 0.33 mm) and was largest at its proximal end (3.21 mm, SD 0.27 mm). The nerve consistently branched into two along the chicken thigh, with more branching subsequently. This simulation model is appropriate not only for the classical end-to-end epineural suture, but also for advanced exercises, in terms of longitudinal fasciculus dissection, mismatched size nerve transfer, injured nerve preparation, and vein conduit technique. Dyeing of nerve fascicles enhanced the visibility of nerve surface quality. Conclusion The sciatic nerve in the chicken thigh is a suitable and accessible model for microsurgery training. The branching and fascicular patterns of the nerve lends itself well to both novice training and advanced simulation. We have incorporated this model into our training curricula.

Novices can assess microsurgery performance, and this is enhanced using the Manual Suture Parameters for Training and Assessment (M-SParTA) scoring system.

This study explores how novices could effectively evaluate the quality of microsurgical suturing. That would be enhanced with using a novel Manual Suture Parameters for Training and Assessment (M-SParTA), which supported novices with guidance on the objective parameters, in order to increased the accuracy of scoring ability. We also propose the following initial framework to train novices in microsuturing using a standardised task: 1) Exposure; 2) Assessment; 3) Hands-on and self-assessment. The independent learning cycle with targeted supervision provides novices with greater autonomy and a less stressful environment that could enhance skills training.

Lexicon for classifying ear-canal shapes.

The ear canal is usually described as an S-shaped funnel. In attempting to classify ear-canal shapes obtained from point clouds digitized from molds of 300 ears, the problem of designing criteria for distinguishing and organizing the canal shapes arose. In this work, we extracted features inspired by the S-shape characteristic (critical point, maximum, minimum, twist, writhe, translation, rotation) and, through them, introduced 14 types of ear-canal shapes. This classification allowed comparison of ears within a type and of ears between different types. It expanded our range of descriptors of canal shapes and unlocked perspectives for applications.

Chicken Feet: A Model for Practising Locoregional Flaps of the Hand.

Background: The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. Methods: A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot model: fingertip volar V-Y advancement flap, four-flap and five-flap Z-plasty, cross-finger flap and first dorsal metacarpal artery (FDMA) flap. The study was performed in a surgical training laboratory on non-live chicken feet. No participants were involved in this study, apart from authors performing the descriptive techniques. Results: All flaps were successfully performed. Anatomical landmarks, soft tissue texture and flap harvest, as well as inset closely resembled clinical experience with patients. Maximal flap sizes were 12 × 9 mm for volar V-Y advancement, 5 mm limbs for Z-plasties, 22 × 15 mm for cross-finger flaps and 22 × 12 mm for FDMA flaps. The maximal webspace deepening with four-flap/five-flap Z-plasty was 20 mm and the FDMA pedicle length and diameter was 25 and 1 mm, respectively. Conclusions: Chicken feet can be effectively used as simulation models for hand surgical training with respect to gaining familiarity with the use of locoregional flaps of the hand. Further research requires testing for reliability and validity of the model on junior trainees.

Traumatic Rupture of the Flexor Carpi Ulnaris Muscle Belly in a Circus Rigger.

Closed traumatic rupture of forearm flexor muscles has been reported rarely. Previous reports have included ruptures of the flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, flexor carpi radialis, pronator quadratus and the palmaris longus. We report a patient with a closed traumatic rupture through the muscle belly of the flexor carpi ulnaris and summarise the published literature on ruptures involving the forearm flexor muscles. Overall, conservative treatment can result in excellent outcomes. Early surgical intervention is recommended in patients with nerve involvement and compartment syndrome and delayed reconstruction may be considered for patients with functional deficits.

Randomized controlled trial comparing the effectiveness of mass and spaced learning in microsurgical procedures using computer aided assessment.

Spaced-learning refers to teaching spread over time, compared to mass-learning where the same duration of teaching is completed in one session. Our hypothesis is that spaced-learning is better than mass-learning in retaining microsurgical suturing skills. Medical students were randomized into mass-learning (single 8-h session) and spaced-learning (2-h weekly sessions over 4 weeks) groups. They were taught to place 9 sutures in a 4 mm-wide elastic strip. The primary outcome was precision of suture placement during a test conducted 1 month after completion of sessions. Secondary outcomes were time taken, cumulative performance, and participant satisfaction. 42 students (24 in the mass-learning group; 18 in spaced-learning group) participated. 3 students in the spaced-learning group were later excluded as they did not complete all sessions. Both groups had comparable baseline suturing skills but at 1 month after completion of teaching, the total score for suture placement were higher in spaced-learning group (27.63 vs 31.60,p = 0.04). There was no statistical difference for duration and satisfaction in either group. Both groups showed an improvement in technical performance over the sessions, but this did not differ between both groups. Microsurgical courses are often conducted in mass-learning format so spaced learning offers an alternative that enhances retention of complex surgical skills.

Hand Infections.

Hand infections can lead to debilitating and permanent disability, particularly if they are not treated promptly or properly. The unique anatomy of the hand, with its numerous enclosed and confined spaces, warrants special considerations. For instance, infections in deep spaces of the hand may require surgical drainage despite an appropriate course of antimicrobial treatment. Thorough history and examination are crucial in guiding further investigations and management, particularly because there are numerous mimickers of hand infections, such as gout and pseudogout.

Hand Assessment for Elderly People in the Community.

BACKGROUND: Hand conditions are common in elderly persons. PURPOSE: To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome. METHODS: The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions. RESULTS: Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002). CONCLUSIONS: Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.