Hand infections deteriorate fast — the same anatomy that gives the hand its function turns ordinary swelling into ischemia, tendon necrosis, and permanent loss of motion. This episode walks through how to recognize and manage everything from paronychia and felon to pyogenic flexor tenosynovitis, deep space infections, bite injuries, and necrotizing fasciitis — with the surgical pitfalls every resident needs to know cold.

In this episode of Plastics in Practice, we cover the anatomy that makes the hand vulnerable, when to splint and when to cut, the Kanavel signs you'll be quizzed on, the herpetic whitlow trap, the high-mortality red flags of nec fasc, and how rising community-acquired MRSA changes empiric antibiotic selection.

Key takeaways:

• Drainage is non-negotiable for any abscess. Antibiotics are an adjunct, not a substitute.

• Never infiltrate local anesthesia into cellulitis — it spreads the infection. Use regional blocks for deep space infections.

• Herpetic whitlow is medical, not surgical. Cutting risks systemic viral spread. Confirm with Tzanck smear.

• Kanavel's four signs of pyogenic flexor tenosynovitis: semi-flexed digit, fusiform swelling, tenderness along the sheath, pain on passive extension.

• Clenched-fist bite injuries seed the MCP joint. Polymicrobial with Eikenella — admit, x-ray, tetanus, and explore in the OR if the extensor mechanism is breached.

• Necrotizing fasciitis carries up to 40% mortality. Bright shiny skin, nonpitting edema, violaceous patches — broad-spectrum antibiotics and aggressive debridement now.

• Community-acquired MRSA is rising. Culture before empiric antibiotics whenever possible.

This content is for educational purposes only and is not medical advice.

🎧 Full episodes available now:

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Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

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📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

#PlasticSurgery #Residency #HandSurgery #HandInfections #UpperExtremity #SurgicalEducation #PlasticsInPractice #Tenosynovitis

Upper extremity surgery is, at its core, a regional anesthesia specialty. Choose the right block in the right place and most hand and arm cases never need general anesthesia.

In this episode of Plastics in Practice, we work through the practical anesthesia decision tree for the upper extremity: brachial plexus block locations and their trade-offs, peripheral nerve blocks at the elbow and wrist, the Bier block, digital block techniques, and the modern, evidence-based truth about epinephrine in the finger.

Key takeaways:

- Severe systemic toxicity is almost always an intravascular accident - aspirate before every injection, and never trust pain as a safety signal in a sedated or proximally blocked patient.

- Interscalene for the shoulder, supraclavicular for fast complete arm anesthesia, infraclavicular for elbow and distal, axillary for the hand.

- Brachial plexus blocks take 15-25 minutes to mature - perform them in a dedicated block area about 30 minutes before incision.

- Bier blocks fit cases under 60 minutes. Keep the tourniquet up for 30 minutes minimum and cycle it down in three releases.

- Epinephrine 1:200,000 is safe in fingers and hands - the necrosis fears come from pre-1950s procaine and cocaine reports.

- Single subcutaneous volar digital block beats the transthecal block on onset and pain.

This content is for educational purposes only and is not medical advice.

Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

Free Study Guides: https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

#PlasticSurgery #Residency #HandSurgery #UpperExtremity #RegionalAnesthesia #BrachialPlexus #SurgicalEducation #PlasticsInPractice

Every hand case rests on the same foundation: knowing which joints need mobility, which need stability, and how to run an acute hand with a trauma-first mindset. Get this layer right, and every chapter after it makes sense.

In this episode of Plastics in Practice, we cover the foundational anatomy and operative principles of the upper extremity: how the thumb, finger, and wrist joints differ in their tolerance for stiffness and instability; the classic deformities (swan-neck, boutonniere, DISI, VISI) and the ligaments that produce them; the acute hand workup from "life over limb" through ER reduction; how to image and describe fractures in anatomic terms rather than eponyms; intrinsic plus splinting; safe tourniquet use; Bruner incisions; and why elevation is the single most important postoperative instruction you'll ever give.

Key takeaways:

• MCP joints have low tolerance for stiffness; the DIP tolerates it well - stability matters more there than motion.
• Volar plate disruption at the PIP causes swan-neck; central slip rupture causes boutonniere - opposite mechanisms, opposite deformities.
• Scapholunate ligament tear leads to DISI; lunotriquetral tear leads to VISI. The lunate follows the ligament that's still intact.
• Tourniquet time should be 90 to 120 minutes max to avoid ischemic reperfusion injury; pressure about 100 mmHg above systolic.
• Splint in the intrinsic plus position: wrist in slight extension, MCPs flexed, IPs extended.
• Routine soft-tissue cases under 2 hours: postop antibiotics show no clear benefit. Open fractures and bony work: 24 hours of perioperative IV coverage.
• Bruner zigzag incisions across the volar finger and palm prevent contracture; never cross flexion creases perpendicularly.

This content is for educational purposes only and is not medical advice.

Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

Free Study Guides: https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

#PlasticSurgery #Residency #HandSurgery #UpperExtremity #SurgicalEducation #PlasticsInPractice #HandAnatomy #BoardReview