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Abstract 53: Optimizing Carpometacarpal Arthroplasty Of The Thumb: A Prospective Clinical Trial Comparing Suture Suspension To Ligament Reconstruction And Tendon Interposition

Conclusion: In both clinical patients and experimental NHP, acute rejection of VCA is nearly inevitable in the early post-transplantation period despite current immunosuppression regimens. The enhanced local drug delivery from FK506 implants in this study has shown promise in preventing acute rejection which would negate successful tolerance induction due to sensitization (as has been observed in previous delayed tolerance induction models in solid organ transplantation). This adjunct may allow reduction of overall immunosuppression load and improve patient compliance to avoid unnecessary VCA loss. Most importantly, it represents a promising bridge towards the development of future tolerance protocols based on mixed chimerism.

Background: Thumb carpometacarpal (CMC) arthritis is the most common arthritis of the hand and thumb CMC arthroplasty is the most commonly performed surgical reconstruction for arthritis in the upper extremity. The most common technique is the ligament reconstruction and tendon interposition (LRTI) where, following trapeziectomy, the flexor carpi radialis (FCR) tendon is passed through a bone tunnel at the base of the first metacarpal to reconstruct the palmar oblique ligament and prevent collapse, with the remaining tendon used to fill the space vacated by the trapezium. In 2009 DelSignore published the suture suspension technique in which, after trapeziectomy, the FCR is sutured to the abductor pollicis longus to create a sling under the first metacarpal to correct subluxation and maintain the joint space. The purpose of this study is to compare outcomes between to the two techniques and determine if one is superior.

Methods:
Following IRB approval, 38 consecutive patients undergoing CMC arthroplasty for basilar thumb osteoarthritis were enrolled by four senior, fellowship trained surgeons; two of whom prefer the LRTI technique and two who routinely perform suture suspension arthroplasty. Outcome measures were recorded including: first metacarpal subsidence measured on radiographs, thumb range of motion, pinch and grip strength, functionality assessed through the Disability of Arm, Shoulder and Hand (DASH) and Michigan Hand Questionnaires (MHQ), and pain measured on a 10-point Visual Analog Scale (VAS).
Conclusions: LRTI and suture suspension arthroplasty techniques are equally effective for improving pain and functionality. Both techniques are subject to some subsidence of the first metacarpal. The suture suspension technique has less restriction of abduction and opposition in Purpose: There remains a paucity of randomized clinical trials or high-grade evidence substantiating the use of florescent angiography following reconstructive breast surgery. We utilize a national, multi-institutional, surgical outcomes database to design a pseudorandomization study that evaluates the comparative effectiveness of florescent angiography during breast surgery.

Methods:
Using the American College of Surgeon National Quality Improvement Program database, we performed a retrospective, exposure-matched, cohort analysis over a 13-year period (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). International Classification of Disease-9/10 codes along with Current Procedure Terminology codes were used to identify all patients undergoing mastectomy with immediate implant-based, expander-based, or autologous breast reconstruction. We stratified patients into two cohorts: those receiving and not receiving fluorescent angiography (FA & nFA groups). We used propensityscore matching to mitigate selection bias and reduce baseline heterogeneity between >50 demographic, clinical, and perioperative variables. Using a caliper distance of 0.2 and nearest-neighbor matching technique, we identified two identical matches from nFA for each patient in FA (1:2 matching). Our outcomes of interest were 30-day rates of postoperative morbidity and mortality. [161], nFA: 8.5%, P = 0.645) remained similar between both groups. There was no postoperative mortality in either group.

Results
Conclusion: This national appraisal of surgical outcomes demonstrates that fluorescent angiography did not decrease postoperative morbidity following reconstructive breast surgery. Well-powered, prospective, randomized trials may help elucidate the effect of such technology within specific surgical cohorts or high-risk groups.