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Phone a Friend – From a Different Subspecialty

By Fred O’Brien, MD

In the Covid era, there has been no shortage of challenges in hand surgery, at the individual practice level and as a field. As an active duty member of the military, I work in an Army hospital. While we have all faced variants of the same practice problems recently, there have been opportunities for learning and helping patients in our unique institutional environment. For the right cases, I have benefited from operating with subspecialists whose training and ongoing education (journals, meetings, conferences) have minimal overlap with ours in hand surgery. While the ‘business model’ of our military hospital may lend itself more easily to scrubbing cases with surgeons of varying backgrounds, when feasible, it offers new and interesting ways to approach problems and may be widely beneficial.

During a recent deployment, I was on a team with a general surgeon whose fellowship training was in pediatric surgery. In our deployed setting, we were responsible for stabilizing patients prior to transfer to a higher level of care. During one of our first cases, we treated a patient who had sustained a penetrating neurovascular injury to his axilla. To secure the arterial shunt, my colleague employed a technique with vessel loops commonly used in pediatric patients undergoing ECMO treatment. In our patient with a battlefield injury, this provided the next surgical team easier visualization of the vascular defect and a less traumatic transition to an interposition vein graft. Similarly, for this patient and in other peripheral nerve cases, I have been able to share lessons that I have learned from leaders in the field on treatment of these injuries: repair, reconstruction, transfers and recent concepts on intraoperative nerve stimulation.

Back in our US military hospitals, surgeons from different backgrounds have also benefited from working together. While I was still in training, a pair of surgeons from another subspecialty found that they benefited from using orthopaedic positioning devices for stabilization during a fibular graft harvest. In subsequent cases (and likely after some diplomatic resource-sharing discussions), they were able to incorporate and develop this technique. From our plastic surgery colleagues, I have learned techniques and novel indications for botulinum toxin therapy and autologous fat grafting. We have tried to find mutual cases where we can help patients that we may not have identified individually.

In the current pandemic, surgeons and others have used technology to stay current on medical knowledge and operative techniques, communicate with patients, sustain annual meetings and other vital events, and otherwise move the field forward. The innovations in hand surgery alone have been awe inspiring. Although not a new concept, I have found that working on cases with surgeons outside of our subspecialty is another great way to supplement learning, generate creative thinking, exchange interesting ideas and ultimately benefit patients. 

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