Employing New Techniques
By Jaehon Kim, MD, FAAOS
I’m a mid-career hand surgeon in an academic center with a passion for trauma. Recently, my residents declared me to be the necrotizing fasciitis specialist in New York City after seeing three of them in a span of two weeks. It’s a title I desperately wish to shed as soon as possible.
In my practice, new techniques and modified procedures are based on clinical need and individual patients. For many hand surgeons, the diversity of the cases in our subspecialty can present as a personal “first-ever” case. I recently encountered a stiff Boutonniere deformity as a result of extensive pulley rupture but an intact central slip tendon. The diagnosis was made from the MRI due to a lack of improvement and progressive longitudinal webbing of the finger (Figure 1).
When preparing for an unfamiliar case, I generally rely on several sources of information (in order) – a personal experience of similar surgeries, case series and technique papers from the literature review, technique videos from our professional societies, and the advice from trusted mentors,
For this case, the quadruple-loop pulley reconstruction was performed with an autograft (Figure 2) with proximal interphalangeal joint contracture and temporary pinning. From my personal experience with finger fractures, I knew that the tenolysis with manipulation (in the office) could be performed safely at 3-4 weeks to prevent tendon adhesions. The patient is back to playing rugby and left my office promising to be back with another injury.
For me, the intimidation of a new technique comes from the uncertainty of outcomes. When the case is successfully performed, I found the experience to be highly rewarding. There is a considerable personal advancement of surgical knowledge, a firmer grasp of anatomy and function, and an expansion of surgical repertoire. It’s simple logic. The more ways you know how to help the patients, the more patients you will have, which will lead to a more satisfying career.
Jaehon Kim, MD, FAAOS
Upper Extremity and Microvascular Surgery
Mount Sinai Icahn School of Medicine
New York, NY