By Jung-Pan Wang, MD, PhD

Hand surgery is an amazing art, but it has been overlooked. However, as fortunate as I am, my institute, in the Orthopedics Department of Taipei Veterans General Hospital (listed in the top 15 hospitals in the world in 2016, https://gazettereview.com/2016/09/top-hospitals-in-the-world/), has been supporting the development of a robust Orthopedics Department, particularly in hand surgery. Between 2010-2013, I had the opportunity to have fellowship training with Drs. Chwei-Chin Chuang, Yuan-Kun Tu, and Jui-Tien Shih, who are the pioneers and innovators of surgical treatment for brachial plexus injury and wrist arthroscopy. In 2014, I had my dream come true, which was to have fellowship training at the Hospital for Special Surgery in New York, USA. I was so glad that I was given the chance to be mentored by Dr. Scott Wolfe, who is truly a legendary hand expert for me since I was a young resident reading the hand surgery textbook written by him. Dr. Wolfe not only taught and shared his refined clinical experience, but he also gave me the opportunity to meet other hand experts, including Drs. Steve Lee and Duretti Fufa, and he helped me to broaden my horizon of hand surgery and obtain updated knowledge. I would like to express my greatest thanks to all my mentors; they deeply inspired me to polish my surgical skills and brainstorm new surgical ideas in clinical practice. Here, I would like to share some practical experience that I can do today that I was not capable of 5 years ago:

• Since I love treating brachial plexus injury (BPI) and peripheral nerve injuries/problems, I always try to refine the surgical procedure of nerve transfer to make it simpler with satisfactory clinic outcomes. For example, when I treated the patients with a posterior cord lesion in the BPI, which presented isolated triceps and deltoid paralysis with preserved radial nerve function to the wrist and hand, I found that double nerve transfers from the motor fascicles of both the median and ulnar nerve to the deltoid and triceps could simplify the surgical approach and be beneficial for simple postoperative rehabilitation to achieve the synergistic “reaching” motion recovery. (J Hand Surg Eur Vol. 2020 Oct;45(8):876-878)

• It is not uncommon that persisted distal radioulnar joint (DRUJ) instability might happen with distal radius fracture, even after volar plating. Although this situation could be treated by soft tissue or bony stabilization and prolonged immobilization, postoperative limited motion and technique demanding were still troublesome. Therefore, I came up the idea of using radius distraction as indirect ulnar shortening to achieve DRUJ stability during volar plating. (J Hand Surg Am 2018 May;43(5):493.e1-493.e4)

• In treating digital mucous cysts, I shift my treatment from open excision to percutaneous capsulotomy, which could not only bring a satisfactory low recurrence rate, but could also be a minimal invasive treatment that I can perform at the outpatient clinics. (J Hand Surg Eur Vol. 2019 Mar;44(3):321-323)

• In the past, it was almost impractical to treat proximal phalanx malunion and flexor tendon adhesion at the same time due to dorsal wound for plating and volar wound for tenolysis, and it would be a challenge if the malunion was previously treated by plating. Therefore, I choose stepwise tenolysis to ensure the full tendon gliding and antegrade intramedullary pinning to balance the strength of osteosynthesis and soft tissue stripping. (J Hand Surg Eur Vol 2019 Dec;44(10):1091-1092)

• While performing more surgeries of the arthroscopic reduction and association of the scaphoid and lunate (ARASL), I now utilize the scapholunate screw fixation in treating most of my cases of the proximal scaphoid nonunion added with arthroscopic debridement and bone grafting. The arthroscopic bone grafting and scapholunate screw fixation can even be used in the management of proximal scaphoid nonunion after plate fixation. In addition, the scapholunate screw fixation could be accompanied with vascularized bone grafting in treating the proximal scaphoid fracture nonunion where the compromised vascularity was noted. (BMC Musculoskelet Disord. 2020 Dec 10;21(1):834.)

I spent more than ten years stepping into the palace of the hand surgery. The corridor in front of me is filled with abundant beauty of knowledge and the skills of hand surgery. I would humbly invite you all to share the fruitful experience with each other. Let’s go together, enjoy together of the beauty of hand surgery.