More than 15% of all soft-tissue tumors arise in the hand. Because of the location of these tumors, even small abnormalities may be alarming to patients on presentation. Although the majority of lesions are benign and can be diagnosed solely by history and physical examination, additional imaging workup may be required to confirm a diagnosis or define anatomic extent of involvement. This paper aims to review the basic epidemiology, clinical presentation, imaging findings, and treatment options of the more common soft-tissue tumors of the hand.

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations.

Background: The use of soleus muscle flaps for traumatic middle-third injuries to the lower leg can have variable viability, as there is no standardized way to evaluate the muscle before flap selection. This case series investigated both the utility and accuracy of computed tomography angiogram (CTA) imaging in determining the viability of the soleus muscle for reconstructive use after traumatic injuries of the lower extremity. Methods: An international review board–approved retrospective chart review was conducted of patients who underwent lower extremity soleus-based flap reconstruction by a single surgeon from January 2020 to December 2022. Patient demographics, comorbidities, and postoperative complications were recorded. Preoperative CTA reports were reanalyzed by a blinded musculoskeletal radiologist. Descriptive statistics were performed. Results: Five patients underwent lower extremity flap reconstruction with soleus muscle over the study period. All patients had lower extremity Gustilo type IIIB or IIIC open fractures. Four out of 5 patients showed no signs of muscle injury on CTA; of those, 2 did not develop postoperative complications, and 2 required repeated irrigation and debridement, but no alternative flap coverage. One patient with preoperative CTA demonstrating soleus muscle injury developed postoperative complications requiring alternate flap reconstruction. Conclusions: Further research is required to determine a statistically significant correlation between soleus muscle injury on preoperative CTA and postoperative complications. However, this case series illustrated the need for larger studies and a computed tomography–based standardized grading system for traumatic muscle injury to better predict soleus flap survival.

Introduction: The current, mainstay surgical prophylaxis for neuropathic and phantom limb pain post amputation, namely targeted muscle reinnervation (TMR), presents complexities in the setting of digit amputation, given the sparsity of distal motor nerve targets. In this case series, we describe a novel approach of direct skin neurotization on distal sensory targets post amputation. This technique draws upon the principles of targeted sensory reinnervation (TSR) and targeted nipple reinnervation (TNR) as alternatives to limit the onset of neuropathic and phantom limb pain postoperatively. Methods: We performed a retrospective analysis of clinical outcomes over a 5-year period (2020–2024). This series includes two patients: a 66-year-old male treated for lentiginous melanoma of the left thumb in 2020 and a 57-year-old male treated for squamous cell carcinoma (SCC) of the left index finger in 2022, with a subsequent recurrent SCC in the left small digit in 2024. Clinical data were reviewed to evaluate surgical results and pain outcomes, specifically the onset and resolution of neuropathic pain. Results: The first patient underwent amputation of the left thumb at the interphalangeal joint with direct skin neurotization. Postoperatively, he demonstrated improved digit sensation and reported minimal neuropathic pain. The second patient initially underwent amputation of the left index finger at the DIP joint with direct skin neurotization in 2022; later, in 2024, he required amputation of the left small digit for recurrent SCC, which was performed with standard traction neurectomy. Notably, this patient reported minimal neuropathic pain 3 months following the initial neurotization procedure. Conversely, following the subsequent traction neurectomy, he experienced significant neuropathic pain and minimal sensory improvement. Conclusion: The use of direct skin neurotization, an adaptation of the principles of TSR and TNR, may improve skin sensation and prevent or reduce neuropathic pain in distal digital amputations where motor targets for TMR are unavailable.

Current evidence suggests that achieving the desired level of osseointegration necessitates a hierarchical approach to implant design. This is particularly relevant for osseointegration around implant systems such as those presenting vertical decompression chambers and acid-etched surfaces which could further be augmented by non-thermal plasma (NTP) treatment. Three implant systems were compared in this study: (i) ND (GM Helix Acqua Implant; Neodent^®, Curitiba, PR, Brazil—hybrid, acid-etched thread design treated with isotonic sodium chloride solution), (ii) Sin (Epikut Plus; S.I.N. Implant System, São Paulo, Brazil—V-shaped, acid-etched thread design treated with nano-hydroxyapatite), and (iii) Mp (Maestro; Implacil De Bortoli, São Paulo, Brazil—buttress, acid-etched thread design with decompressing vertical chambers). The ND and Sin implants were used directly as supplied by the manufacturer. For the Mp implants, the manufacturer-supplied surface was subjected to supplemental acid etching with 37% hydrochloric acid followed by Argon-based NTP treatment administered with a pulsed plasma generator prior to implantation into the iliac crest of n = 12 adult female sheep. Histomorphometric analysis was conducted at 3- and 12-week post-implantation (n = 6 sheep per time point) to assess bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). After 3 weeks in vivo, the healing chambers of all implant groups consisted predominantly of newly forming woven bone. By 12 weeks, bone maturation was observed, with the presence of remodeling sites and some areas of well-organized lamellar structures occupying the healing chambers. At both 3 and 12 weeks, the Mp implants demonstrated significantly higher BAFO values relative to ND (p = 0.015 and p = 0.008, respectively). The combination of vertical healing chambers, acid etching, and NTP treatment promoted early vascular infiltration and sustained bone deposition.