Fatigue worsens your surgery, "fake" melanoma & ST3 Interview Guide.

Also: trending microsurgery articles, tweets of the week and a scaphoid anatomy test.
Fatigue worsens your surgery, "fake" melanoma & ST3 Interview Guide.

In this week's edition

  1. ✍️ Letter from P'Fella
    Fatigue worsens your surgery. Fact.
  2. 🤓 The Sunday Quiz
    Scaphoid & its ligaments
  3. 🫵 Picks of the Week
    AI Melanoma (Fake??) & Finger Injury Robots.
  4. 🚀 New Features
    ST3 Interview Guide (updated).
  5. 🔥 3 Hot Mico Articles
    Kiss Flaps, Lower Limb Recon, Assessment Tools.
    With 1 sentence summaries!

A Letter from P'Fella

Fatigue worsens your surgery.

Happy Sunday!

This week, we're peeling back the surgical drapes to reveal an often-overlooked aspect of our operating theatres: our own energy levels. Yes, I'm talking about fatigue – the silent shadow that trails every dedicated surgeon.


A groundbreaking systematic review in the British Journal of Surgery has cast new light on this familiar foe, analyzing over 1.6 million cases to uncover how fatigue truly affects our work. The revelation?

Simulated surgeries show performance drops due to fatigue, yet real-life results reveal surgeons' resilience to fatigue.

This resilience is commendable, yet it brings forth a crucial consideration. The ability to 'push through' should not obscure the importance of addressing fatigue head-on for the sake of our well-being and our patients'.This discrepancy raises an important dialogue about the nature of our profession and the inherent drive to maintain high standards of care, regardless of the circumstances.

This chart shows % of outcome measures negatively affected, positively affected, or unaffected by fatigue per category. Its interesting 👇

Percentage of outcome measures negatively affected, positively affected, or unaffected by fatigue per category
Original Publication

This conversation is not about questioning our dedication or ability. It is about recognizing that acknowledging and managing fatigue can enhance our performance, patient outcomes, and personal health. It's about fine-tuning our practice to ensure we are always operating (pun intended) at our best.




- Simulated surgery studies reveal performance decreases with fatigue.
- Real-life surgical outcomes show surgeons' resilience, maintaining quality care despite fatigue.

The Sunday Quiz

The Scaphoid & its ligaments

Summary Card

Bone Anatomy The scaphoid has three regions: proximal pole, waist (corresponding to the anatomical snuffbox), and distal pole.

Ligament Anatomy Key ligaments include Scapholunate Interosseous and Radioscaphocapitate, with volar ligaments being stronger.

Vascular Anatomy Radial artery provides 70-80% of blood supply. Dorsal blood enters via dorsal ridge foraminae; volar supply is 20-30% of internal vascularity, mainly in the distal pole.

Imaging Multiple angles needed, including PA view in ulnar deviation, 60° pronation, and 60° supination. Lateral view detects DISI or VISI deformities


The Sunday Quiz is under construction (updating Leaderboard). Check back next week for the new version 😄

Picks of the Week

Weekly highlights from the plastic surgery community.

Every Sunday, thePlasticsFella will curate all the highlights in the world of plastic surgery. If you have a highlight, just reply to this email!

Tweet of the Week

Robotics for Hand Injuries

Image of the Week

AI-Generated Melanoma

The quality is 🔥 (more coming to Clinical Cases soon)

Question of the Week

Generated by the AI Search Tool currently in beta-testing for thePlasticsPro's.

"Why does claw hand occur in cubital tunnel syndrome?"

Claw hand deformity in Cubital Tunnel Syndrome occurs due to the compression of the ulnar nerve at the elbow level. The ulnar nerve provides motor innervation to the majority of the intrinsic muscles of the hand, including the hypothenar muscles, the medial two lumbricals, all interossei, adductor pollicis, and the deep head of the flexor pollicis brevis.

When the ulnar nerve is compressed, these muscles can become weak or paralyzed, leading to the characteristic claw hand deformity. Specifically, the loss of function of the lumbricals and interossei results in hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints, creating the appearance of a claw.

In addition, the ulnar nerve innervates the skin of the medial one and a half fingers and the associated palm area, so sensory deficits can also be present in these areas.

Event of the Week

P'Fella showcases one upcoming event you might like

The Aesthetic Meeting 2024
More Info Here

New Features

Updated Guide for ST3 Interviews (UK)

Heard your feedback loud and clear: "Make finding stuff easier!" Challenge accepted. First fix? Dropdown menus! Small change, big impact. More improvements on the way. Stay tuned.

Articles of the Week

3 Trending Articles

  1. Kiss Flaps for the Hand (PRS, Feb '24)
    The "mini-shaped kiss flap" technique, developed for palmar and digital soft-tissue resurfacing, successfully reconstructs with minimal donor-site morbidity, using flaps based on common palmar digital arteries for excellent aesthetic and functional outcomes

  2. Microsurgery Assessment Tool (JPRAS, Oct' 21)
    The study introduced a novel benchmarking tool in a 5-day simulated microsurgery course with 118 participants, revealing that as trainees performed more micro-anastomoses, their Global Rating Scale scores significantly increased from a range of 45.5-62 to 89.5-93, indicating a direct correlation between practice and skill improvement in microsurgery.

  3. Best Lower Limb Free Flaps (Micro, Jan' 16)
    A meta-analysis of 30 studies involving 1,397 free flaps for lower extremity soft tissue reconstruction reported a 6% total flap loss rate, indicating that microsurgical reconstruction in this area is both safe and reliable, although standardization in reporting perioperative parameters and outcomes is needed

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