Postoperative free flap monitoring is considered a key component of care after microsurgical reconstruction. To achieve successful flap salvage after surgical revision, early recognition of vascular compromise is required. The aim of this study was to assess and compare the time-dependent evolution of microcirculation in gracilis muscle (GM) and anterolateral thigh (ALT) flaps. This study included continuous measurements of blood flow (flow), hemoglobin oxygenation (SO₂) and the relative amount of hemoglobin (rHb) using laser-doppler flowmetry and tissue-spectrometry (O2C, LEA Medizintechnik, Gießen, Germany) over a time-period of 72 h. Microcirculation was assessed in a total of 66 viable free flaps (GM n = 40; ALT n = 26). A statistically significant positive correlation between time post-anastomosis and microvascular flow was found for both GM and ALT flaps with r_s = 0.384 (p < 0.001) and r_s = 0.178 (p = 0.015), respectively. No significant positive or negative correlations between time post-anastomosis and SO₂ were found for both GM and ALT flaps with r_s = 0.052 (p = 0.387) and r_s = −0.018 (p = 0.805), respectively. Overall, a significant negative correlation between time post-anastomosis and rHb was found for GM flaps with r_s = −0.140 (p = 0.019). For ALT flaps, no significant positive or negative correlation was found with r_s = −0.011 (p = 0.887). Microcirculation differs in different flap entities, and surgeons should be aware of these differences in order to correctly evaluate and classify the values of flow, SO₂ and rHb obtained when using the O2C device for postoperative monitoring.

Background and Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by chronic compression of the median nerve within the carpal tunnel. Patient education is a cornerstone of informed consent and postoperative outcomes, yet time constraints often limit traditional consultations. Recently, generative AI tools such as ChatGPT have emerged as potential adjuncts in delivering standardized medical information. Materials and Methods: This study evaluated the quality and comprehensiveness of ChatGPT-generated patient education on CTS and open carpal tunnel release. A standardized prompt was used with ChatGPT-4o to generate educational material. A structured and standardized questionnaire was then administered to both patients and physicians (n = 8) to assess content quality, clarity, comprehensiveness, and perceived usefulness. Results: Both patients and physicians reported high satisfaction with the information provided. The etiology, procedural risks, and general anatomical principles were well conveyed. However, certain intraoperative concepts—such as neurolysis, synovectomy, and hemostasis—were underrepresented. While conservative therapies were addressed, the omission of endoscopic surgical options limited informational completeness. Prognostic information and long-term consequences of untreated CTS were rated as average by some participants. Postoperative guidance was adequately covered but lacked individualized nuance. Conclusions: ChatGPT shows promise as an adjunct in surgical patient education, offering clear and standardized information. Nevertheless, it is not a substitute for clinician–patient interaction. While it may bridge preliminary knowledge gaps, emotional support and individualized consent discussions remain essential. Further refinement and clinical validation of AI-generated educational content are needed to ensure safe and effective integration into routine practice.

Background/Objectives: The autologous reconstruction of the female breast using a microsurgical DIEP flap is a reliable and safe method. To detect impairments early and preserve the microvascular flap through timely revision, a better understanding of physiologic perfusion dynamics is necessary. This exploratory study examines changes in microcirculation in free DIEP flaps within the first 72 h after vascular anastomosis using laser Doppler flowmetry and white-light spectrophotometry. Methods: This single-center study analyzed retro- and prospectively collected data from female patients who underwent uneventful breast reconstruction using a DIEP flap and were monitored using the O2C device (LEA Medizintechnik, Giessen, Germany). Microcirculation was monitored continuously postoperatively for a period of 72 h. Results: A total of 36 patients with a mean age of 48.86 (9.36) years and a mean BMI of 26.78 (4.12) kg/m² received 40 DIEP flaps (four bilateral reconstructions). Microcirculatory blood flow showed a continuous increase, reaching up to 15% above its initial value within the first 72 h following anastomosis. The average tissue oxygen saturation (sO2) and relative hemoglobin (rHB) levels remained fairly stable throughout the study period, with overall reductions of 5.46% and 5.30%, respectively. Conclusions: Autologous breast reconstruction using a microvascular DIEP flap is a safe and reliable technique. This study showed an increase in blood flow over the 72 h study period. At the same time, sO2 and rHb showed stable levels. Deviations in these values could be interpreted as indicators of a perfusion disorder of the microvascular flap.

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance.

Background: Dupuytren’s disease (DD) is a systemic connective tissue disorder of the palm, predominantly affecting men of Northern European or Caucasian origin over 55. In addition to conventional surgery, Dupuytren’s contracture can be treated in a minimally invasive way by injecting bacterial collagenase into the cord. However, studies on the long-term success rate when compared to the gold standard, surgical limited fasciectomy, are limited. Methods: This monocentric retrospective study examined 35 patients who had been treated with bacterial collagenase for Dupuytren’s contracture, conducting a long-term follow-up after an average of 5.7 years. The results were compared to a control group of 40 patients treated with surgical limited fasciectomy on average 5.5 years ago. Finger extension (Tubiana stage), strength, sensitivity, the effect of possible risk factors, and patient-reported outcome measures (PROMs) were compared between the two groups. Results: The long-term results after therapy for DD showed a significant reduction in the Tubiana stage for both groups (p < 0.001). Additionally, we observed a longer mean preintervention Tubiana stage and a better long-term improvement in the Tubiana stage for patients with limited fasciectomy when compared to the collagenase group. (both p < 0.001). Neither grip strength nor the pinch test showed significant differences when compared within each group or when comparing both groups. Both the treated and untreated fingers of patients with limited fasciectomy had a superior two-point discrimination (p < 0.001). For the URAM questionnaire, we observed a significantly better result in the control group (p < 0.01). Retrospectively, significantly more patients in the collagenase group would not choose the same therapy to treat DD (35 vs. 8%; p < 0.05). Conclusions: The two therapy options should be seen as complementary for the treatment of DD. Collagenase therapy seems a sensible option for DD with an earlier Tubiana stage and contractures that predominantly affect the MCP joint. Contractures with higher Tubiana stages that also affect the PIP joint should predominantly be treated with limited fasciectomy.