Plastics in Practice (Resident Review)

Plastics in Practice
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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

  1. 3d ago

    Principles of Tendon Transfers

    A tendon transfer can be perfectly woven and still fail if the joint is stiff, the tissue bed is scarred, or the donor cannot match the lost motion. In this episode of Plastics in Practice, we build a practical framework for tendon transfers—from donor selection and tensioning to radial, median, and ulnar nerve palsy reconstruction and postoperative retraining. Key takeaways: • Make the hand ready first: joints must be supple, and the transfer must glide through a quiet soft-tissue bed. A contracture release and tendon transfer require incompatible rehabilitation and should not be combined. • Match excursion and power: finger flexors provide about seventy millimeters of excursion, finger extensors fifty, and wrist motors thirty; a donor can lose up to one motor grade after transfer.[1,4] • Favor an expendable donor, a direct line of pull, synergistic motion, one donor for one function, and tension near the donor's working length.[1,4] • For high radial palsy, the classic FCR set restores wrist extension with PT to ECRB, finger MCP extension with FCR to EDC, and thumb extension with PL to a rerouted EPL. A fused wrist favors an FDS donor because tenodesis cannot supplement FCR excursion.[1,2] • Median palsy opponensplasty commonly uses FDS or EIP; the donor and pulley must recreate palmar abduction, flexion, and pronation rather than abduction alone.[3] • In ulnar palsy, a positive Bouvier test identifies simple clawing that may accept a static MCP block; a negative test signals complex clawing that needs dynamic intrinsic replacement. • Protect the transfer for four weeks, add passive stretching around week six, begin strengthening around week eight, and progress toward unrestricted activity at three months.[1] 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?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #TendonTransfer #RadialNervePalsy #MedianNervePalsy #UlnarNervePalsy #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Gardenier J, Garg R, Mudgal C. Upper extremity tendon transfers: a brief review of history, common applications, and technical tips. Indian J Plast Surg. 2020;53(2):177-190. doi:10.1055/s-0040-1716456 2. Jain NS, Barr ML, Kim D, Jones NF. Tendon transfers, nerve grafts, and nerve transfers for isolated radial nerve palsy: a systematic review and analysis. Hand (N Y). 2024;19(3):343-351. doi:10.1177/15589447221150516 3. Coulshed N, Xu J, Graham D, Sivakumar B. Opponensplasty for nerve palsy: a systematic review. Hand (N Y). 2024;19(7):1037-1043. doi:10.1177/15589447231174481 4. Coulet B. Principles of tendon transfers. Hand Surg Rehabil. 2016;35(2):68-80. doi:10.1016/j.hansur.2015.12.011

  2. 4d ago

    Upper Extremity Tenosynovitis and Tendinopathy

    Radial wrist pain, a locking digit, and lateral elbow pain can all be called overuse—but a few centimeters can change the diagnosis, treatment, and surgical target. In this episode of Plastics in Practice, we map de Quervain tenosynovitis, intersection syndrome, trigger finger, and lateral elbow tendinopathy from focused examination through splinting, injection, rehabilitation, and surgical release. Key takeaways: • Map radial-sided symptoms by location: de Quervain disease localizes at the radial styloid, while intersection syndrome produces dorsoradial pain and often crepitus four to six centimeters proximal to Lister tubercle. • De Quervain disease involves the APL and EPB in the first dorsal compartment; a separate EPB subcompartment can explain incomplete response after injection or release. • Current evidence supports considering corticosteroid injection plus three to four weeks of thumb-spica immobilization as first-line management for de Quervain disease; ultrasonography can help target anatomic subcompartments.[1,2] • Trigger finger localizes to the A1 pulley near the volar metacarpal head—even when the patient feels the click at the PIP joint. • Corticosteroid injection succeeds in roughly two thirds of trigger digits in pooled randomized trials; persistent locking, fixed contracture, or failed conservative care should prompt evaluation for A1 pulley release.[3] • Lateral epicondylitis is better framed as lateral elbow tendinopathy: confirm focal pain with grip or resisted wrist extension, consider radial tunnel symptoms, and avoid promising a rapid cure from any single intervention.[4] 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?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #Tenosynovitis #TriggerFinger #DeQuervain #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Challoumas D, Ramasubbu R, Rooney E, et al. Management of de Quervain tenosynovitis: a systematic review and network meta-analysis. JAMA Netw Open. 2023;6(10):e2337001. doi:10.1001/jamanetworkopen.2023.37001 2. He KS, He KS, Cheah A, et al. Unblinding de Quervain: a systematic review of ultrasound-guided injection of corticosteroids for treatment of stenosing tenosynovitis of the first extensor compartment. J Med Radiat Sci. 2023;70(3):319-326. doi:10.1002/jmrs.681 3. Pathak SK, Salunke AA, Menon PH, et al. Corticosteroid injection for the treatment of trigger finger: a meta-analysis of randomised control trials. J Hand Surg Asian Pac Vol. 2022;27(1):89-97. doi:10.1142/S242483552250014X 4. Lowdon H, Chong HH, Dhingra M, et al. Comparison of interventions for lateral elbow tendinopathy: a systematic review and network meta-analysis for Patient-Rated Tennis Elbow Evaluation pain outcome. J Hand Surg Am. 2024;49(7):639-648. doi:10.1016/j.jhsa.2024.03.007

  3. 5d ago

    Extensor Tendon Surgery: Zones, Traps, and Early Motion

    Extensor tendon injuries are easy to underestimate: a small dorsal wound can conceal a complete laceration, a contaminated MCP joint, or a central slip injury that declares itself later. In this episode of Plastics in Practice, we review the examination, zone-based repair strategy, rehabilitation, complications, and reconstruction of extensor tendon injuries. Key takeaways: • Use the eight-zone map to localize injury and choose a repair and rehabilitation plan; odd-numbered zones lie over joints. • Test beyond simple active extension: juncturae can mask a complete zone-six EDC laceration, the Elson test assesses the central slip, and table-top thumb lift helps isolate EPL function. • Repair lacerations involving more than half of the tendon in zone two, the zone-three central slip, and zone four; avoid unnecessary bulk or shortening in the thin distal mechanism. • Treat a zone-five fight bite as a contaminated joint injury—explore the capsule, debride and irrigate, and defer tendon repair until the wound is clean. • Match rehabilitation to repair strength: zones one and two usually need continuous extension protection for six to eight weeks, while stronger repairs in zones four through eight can support protected early motion. Recent randomized trials support relative-motion extension protocols for selected zone-four to zone-six repairs.[1,2] • Anticipate extensor lag, loss of flexion, adhesions, and tendon rupture; consider tenolysis only after a sustained therapy plateau and use grafts or tendon transfers selectively. 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?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #ExtensorTendonSurgery #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #PlasticsInPractice References: 1. Cela-López M, Méndez-Pérez C, Domínguez-Prado DM, et al. Relative motion extension orthosis versus classic immobilization in extensor tendon repairs (zones IV-VI of the hand): a randomized controlled trial. Hand (N Y). Published online February 27, 2026. doi:10.1177/15589447261422483 2. Hirth MJ, Hunt I, Briody K, et al. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: a randomized equivalence trial. J Hand Ther. 2023;36(2):347-362. doi:10.1016/j.jht.2021.06.006

  4. Aug 13

    Flexor Tendon Repair: Strength, Glide, and Early Motion

    Flexor tendon repair succeeds only when construct strength, tendon glide, pulley preservation, and rehabilitation are planned as one system. In this episode of Plastics in Practice, we review the evaluation, zone-based strategy, repair principles, rehabilitation, complications, and salvage of flexor tendon injuries. Key takeaways: • Detect loss of the normal cascade or tenodesis effect, test flexor digitorum profundus and superficialis independently, and document neurovascular status. • Let the injury zone drive exposure and repair; zone II demands especially careful sheath and pulley management. • Build a strong, smooth multistrand repair with accurate tendon-end coaptation and no obstructive bulk at the repair interface.[1,2] • Preserve the critical A2 and A4 pulleys when possible, and vent judiciously when needed to restore free tendon glide.[1,2] • Begin therapist-directed protected motion early when the construct, associated injuries, and patient factors permit. The 2026 IFSSH consensus favors true early active flexion, whereas a 2024 randomized trial found better five-year motion after passive mobilization with place-and-hold; protocol choice remains debated and should be individualized.[1-3] • Recognize adhesions, gapping or rupture, bowstringing, quadriga, lumbrical-plus, and the situations that require grafting or staged reconstruction. 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?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #FlexorTendonRepair #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #PlasticsInPractice References: 1. Miller EA, Teal L. Principles for achieving predictable outcomes in flexor tendon repair. Clin Plast Surg. 2024;51(4):445-457. doi:10.1016/j.cps.2024.02.011 2. Tang JB, Lalonde D, Fernandes CH, Sadek AF, Besmens IS. The IFSSH consensus and current guidelines on flexor tendon repairs and reconstruction. J Hand Surg Eur Vol. 2026;51(2):127-138. doi:10.1177/17531934251404821 3. Chevalley S, Wängberg V, Åhlén M, Strömberg J, Björkman A. Passive mobilization with place-and-hold versus active mobilization therapy after flexor tendon repair: 5-year minimum follow-up of a randomized controlled trial. J Hand Surg Am. 2024;49(12):1165-1172. doi:10.1016/j.jhsa.2024.08.011

  5. Aug 12

    Wrist Fractures: Distal Radius and Scaphoid Decision Points

    Wrist fracture decisions turn on a few measurements, but the right threshold depends on the patient, the image, and the bone. In this episode of Plastics in Practice, we review distal radius and carpal fractures with an emphasis on reduction, fixation, and the diagnostic traps that change management. Key takeaways: • Document median nerve function and distal radioulnar joint stability before and after distal radius reduction. • In study-defined non-geriatric adults, post-reduction radial shortening greater than three millimeters, dorsal tilt greater than ten degrees, or intra-articular displacement or step-off greater than two millimeters supports operative fixation.¹ • Age sixty-five is a study proxy, not a biologic cutoff. Functional demand and patient priorities still matter, and routine fixation has not improved long-term patient-reported outcomes in geriatric cohorts.¹ • Fixation constructs have similar long-term outcomes; volar locking plates mainly offer earlier functional recovery.¹ • A negative scaphoid radiograph does not close the case. Immobilize a clinically suspicious wrist, obtain early MRI for an occult fracture, and use long-axis CT when a fracture is visible.² • Initial below-elbow casting is appropriate for bicortical scaphoid waist fractures displaced two millimeters or less, with prompt fixation if nonunion is confirmed.²˒³ • Fixation is favored beyond two millimeters of scaphoid waist displacement, for any displaced proximal-pole fracture, or with an unstable carpal injury. Confirm union before discharge.² This content is for education only and does not replace clinical judgment, institutional protocols, or individualized patient care. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO 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 #HandSurgery #WristFracture #DistalRadiusFracture #ScaphoidFracture #SurgicalEducation #PlasticsInPractice References: 1. American Academy of Orthopaedic Surgeons. Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline. Published December 5, 2020; adopted by the American Society for Surgery of the Hand May 22, 2021. https://www.aaos.org/globalassets/quality-and-practice-resources/distal-radius/drfcpg.pdf 2. British Society for Surgery of the Hand. Scaphoid Fractures: Standards for Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/Scaphoid%20standards.pdf 3. Dias JJ, et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT). Lancet. 2020;396:390–401. doi:10.1016/S0140-6736(20)30931-4

  6. Aug 9

    Hand Fractures: Reduction, Fixation, and Early Motion

    Hand fracture outcomes often hinge on what radiographs miss — rotation, post-reduction stability, and whether fixation permits early motion. In this episode of Plastics in Practice, we review metacarpal and phalangeal fracture management — rotational alignment, stability, fixation strategy, early motion, thumb-base injuries, proximal interphalangeal joint fracture-dislocations, and complications. Key takeaways: • Examine each injured digit in maximal extension and flexion. Scissoring reveals malrotation; persistent rotation after reduction is operative.³ • Stable, nondisplaced closed fractures usually need splinting or buddy taping, early motion, and radiographs at seven to ten days. Clinical union commonly takes three to four weeks.¹ • Open hand fractures except tuft fractures need same-day review and antibiotics. Treat definitively — or wash out and close — within twenty-four hours; stop antibiotics after closure or by seventy-two hours, whichever comes first.² • Selected isolated, closed fifth-metacarpal neck fractures with less than seventy degrees of volar angulation and no rotation can do well with buddy taping and early motion. Open, complex, displaced, rotational, or occupation-limiting patterns need separate judgment.³,⁴ • Choose the least invasive construct that holds reduction and permits motion. Use at least two K-wires in different planes for rotational control; plates add rigidity but also dissection and tendon-adhesion risk.¹,⁷ • For a Bennett fracture, restore a stable, concentric thumb carpometacarpal joint. Less than one millimeter of step-off is a target, not an absolute cutoff; congruity and stability drive treatment.⁶ • For a dorsal proximal interphalangeal joint fracture-dislocation, less than thirty percent involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Confirm dynamically after reduction.⁵ 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?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO 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 #HandFractures #MetacarpalFracture #PhalanxFracture #BennettFracture #PIPFractureDislocation #PlasticsInPractice #SurgicalEducation References:1. BSSH. Closed hand fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/1%20Closed%20hand%20fractures%20final.pdf2. BSSH. Open fractures other than tuft fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/2%20Open%20fractures%20Final.pdf3. BSSH. Fifth metacarpal neck fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/9%20Metacarpal%20neck%20fractures.pdf4. Martínez-Catalán N et al. Buddy taping versus reduction/casting for fifth-metacarpal neck fractures. J Hand Surg Am. 2020;45:1134-1140. doi:10.1016/j.jhsa.2020.05.0135. Tyser AR et al. Stability of acute dorsal PIP fracture-dislocations. J Hand Surg Am. 2014;39:13-18. doi:10.1016/j.jhsa.2013.09.0256. Kjaer-Petersen K, Langhoff O, Andersen K. Bennett's fracture. J Hand Surg Br. 1990;15(1):58-61. doi:10.1016/0266-7681_90_90049-A7. Curtis BD et al. Metacarpal shaft fixation: biomechanical comparison. Orthop Surg. 2015;7:256-260. doi:10.1111/os.12195

  7. Aug 8

    Upper Extremity Nerve Injuries and Compression Neuropathies

    Peripheral nerve deficits are a race against irreversibledenervation — misclassify the lesion or miss the level of compression, and observation becomes lost recovery time. In this episode of Plastics in Practice, we review traumaticperipheral nerve injury and the compression neuropathies that matter across the median, ulnar, and radial nerves — how to classify the lesion, time electrodiagnostic testing, recognize localization traps, and choose observation versus decompression or repair.   Key takeaways: · Neurapraxia is a conduction block with intactaxons and expected recovery within two to three months; axonotmesis regeneratesat roughly one millimeter per day under ideal conditions; neurotmesis requiressurgical coaptation. ·   Neurologic deficits after penetrating trauma arepresumed neurotmetic and warrant early exploration. Primary repair is ideallyperformed within seventy-two hours for a sharp, clean laceration, while mostgunshot deficits are concussive and initially observed. ·  After axonal injury, distal nerve-conductionabnormalities develop over one to two weeks and EMG fibrillations appear at three to four weeks; electrodiagnostic testing is traditionally repeated at four to six weeks. ·    If a closed deficit shows no clinical orelectrodiagnostic recovery by three to six months, exploration is generally recommended. Denervated muscle loses an estimated one percent per week, and significant motor recovery is unlikely beyond twelve to eighteen months. ·    Nocturnal radial-digit paresthesias with sparedthenar-eminence sensation support carpal tunnel syndrome; activity-related symptoms involving the thenar eminence suggest pronator syndrome; an isolatedfailed “OK” sign without sensory loss suggests anterior interosseous syndrome. ·   Dorsoulnar sensory loss localizes ulnarcompression to the elbow rather than Guyon canal. Within Guyon canal, Zone I produces mixed deficits, Zone II motor deficits, and Zone III sensory deficits. ·   Radial tunnel syndrome is pain-only with normalstrength, posterior interosseous syndrome is painless motor loss, and Wartenberg syndrome is sensory-only.   This content is for educational purposes only and is notmedical advice.   🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  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#PeripheralNerve #CompressionNeuropathy #CarpalTunnel #CubitalTunnel#PlasticsInPractice #SurgicalEducation   References: 1. Seddon HJ. A classification of nerve injuries. Br Med J.1942;2:237-239. 2. Sunderland S. A classification of peripheral nerveinjuries producing loss of function. Brain. 1951;74:491-516. 3. Rydevik B, Lundborg G, Bagge U. Effects of gradedcompression on intraneural blood flow. An in vivo study on rabbit tibial nerve.J Hand Surg Am. 1981;6:3-12. 4. Gelberman RH, Aronson D, Weisman MH. Carpal-tunnelsyndrome. Results of a prospective trial of steroid injection and splinting. JBone Joint Surg Am. 1980;62:1181-1184. 5. Johnson RK, Spinner M, Shrewsbury MM. Median nerveentrapment syndrome in the proximal forearm. J Hand Surg Am. 1979;4:48-51. 6. Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnarnerve at the elbow. Plast Reconstr Surg. 1973;51:79-81. 7.Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anteriortransposition compared with simple decompression for treatment of cubitaltunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone JointSurg Am. 2007;89:2591-2598

  8. May 31

    Hand Infections: Diagnosis and Management

    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: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO 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 #HandInfections #UpperExtremity #SurgicalEducation #PlasticsInPractice #Tenosynovitis

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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

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