Preliminary Program

Patients presenting with atraumatic vascular disorders of the hand are often treated medically for a prolonged period of time before being referred for surgical intervention. In this course, workup and patient selection for vasospastic and vaso-occlusive disorders of the hand will be reviewed. Nonsurgical intervention including botulinum toxin injection and therapy options will be discussed. Surgical options including sympathectomy and vascular reconstruction will be reviewed.

Objectives: Following this session, the participant will be able to:

1. Understand strategies for diagnosis and workup of patients with vasospastic and vaso-occlusive disorders of the hand.
2. Discuss current indications and techniques utilizing botox injections in treatment of vasospastic disorders of the hand.
3. Appreciate therapy options for treatment of patients with vasospastic and vaso-occlusive disorders of the hand.
4. Describe surgical strategies for reconstruction in vasospastic and vaso-occlusive disorders of the hand.

Treatment of patients with neuropathic pain is challenging. The peripheral component of the pain is often complicated by central sensitization in patients with chronic pain. This course will explore causes and workup of neuropathic pain as well as the range of nonoperative and operative treatment including medications, therapy options, electrical stimulation and surgical treatment of neuromas. A holistic approach will be presented to optimize treatment for patients with nerve pain.

Objectives: Following this session, the participant will be able to:

1. Discuss causes of neuropathic pain.
2. Describe pharmaceutical options for treatment of neuropathic pain.
3. List therapy modalities for treating nerve pain.
4. Appreciate different surgical strategies for treatment of neuropathic pain.

Denervation provides new, less invasive options for surgical treatment of chronic joint pain as a bridge between conservative treatment options and arthroplasty or arthrodesis. While initially popularized for treatment of radiocarpal arthritis, new techniques are available for treatment of chronic joint pain in other areas. This ICL will discuss the anatomic basis of denervation and current surgical strategies for treatment of elbow, wrist, thumb and small joint arthritis and pain.

Objectives: Following this session, the participant will be able to:

1. Discuss the anatomical basis of denervation for chronic joint pain.
2. Appreciate surgical techniques utilizing denervation for treatment of chronic elbow pain.
3. Appreciate surgical techniques utilizing denervation for treatment of chronic wrist pain.
4. Appreciate surgical techniques utilizing denervation for treatment of chronic small joint pain.

This session will focus on the evaluation and surgical management of distal radius malunions, with emphasis on understanding deformity patterns and selecting the optimal corrective strategy. Participants will learn to classify extra-articular and intra-articular malunions, assess the functional consequences of deformity, and develop comprehensive preoperative plans for correction. The course will review volar, dorsal, and radial-sided osteotomy techniques, including fixation methods, grafting considerations, and management of complex multiplanar deformities. Indications, contraindications, expected outcomes, and salvage options will also be discussed to help surgeons determine when corrective osteotomy is appropriate and when alternative treatment strategies may provide better patient outcomes.

Objectives: Following this session, the participant will be able to:

1. Define and classify the different types of distal radius malunions, distinguishing intra-articular from extra-articular deformities and characterizing the planes of deformity (dorsal angulation, radial shortening, loss of radial inclination, and intra-articular incongruity).
2. Describe the surgical technique for volar approach correction of distal radius malunion, including osteotomy planning, fixation strategies, and the role of structural versus non-structural bone grafting.
3. Describe the surgical technique for dorsal approach correction of distal radius malunion, including indications for a dorsal opening-wedge osteotomy and considerations for extensor tendon management.
4. Describe the surgical technique for correction of radial-sided and combined-plane malunions, including radial column osteotomy and approaches to multiplanar deformity.
5. Identify the contraindications to corrective osteotomy and recognize the clinical scenarios in which accepting the deformity, or pursuing salvage alternatives, represents the more appropriate management strategy.

The spectrum of pediatric hand surgery is wide, and most often treated by specialized pediatric hand surgeons. However, every hand surgeon will encounter pediatric cases in clinical practice. This course will focus on common pathology related to congenital and traumatic hand conditions. Pearls for diagnosis and treatment of patients will be presented and discussed by a panel of specialized pediatric hand surgeons.

Objectives: Following this session, the participant will be able to:

1. Appreciate common congenital hand differences encountered by hand surgeons.
2. Appreciate common traumatic hand conditions in pediatric patients encountered by hand surgeons.
3. Discuss treatment of common congenital hand differences.
4. Discuss treatment of common pediatric hand trauma pathology.

While surgical treatment of tetraplegia has focused traditionally on tendon transfers, newer techniques incorporating nerve transfers have become popular. This course will focus on comprehensive treatment of patients requiring upper extremity reconstruction in tetraplegia. Workups and selection of patients who would benefit from surgery will be discussed. Traditional and newer surgical options will be presented to guide state-of-the-art surgical treatment for patients with tetraplegia.

Objectives: Following this session, the participant will be able to:

1. Discuss indications for upper extremity surgery in patients with tetraplegia.
2. Appreciate tendon transfer options for surgery in tetraplegia.
3. Appreciate nerve transfer options for surgery in tetraplegia.
4. Describe new advances relating to upper extremity reconstruction for tetraplegia.

This session will review minimally invasive techniques for nerve surgery and technologies to improve the safety of these procedures. The speakers on this panel will review a variety of specific applications for minimally invasive techniques.

Objectives: Following this session, the participant will be able to:

1. Discuss how to balance patients' desire for small incisions and minimal downtime with surgical safety
2. Recognize when minimally invasive techniques are or are not indicated
3. Understand specific technical pearls for implementation of minimally invasive techniques

Thoracic outlet syndrome can be difficult to diagnose and even more difficult to manage. This session will address diagnostic pearls, surgical indications, unique features for adolescent patients, controversies in management, and emerging surgical techniques.

Objectives: Following this session, the participant will be able to:

1. Discuss the diagnostic options for thoracic outlet syndrome and the pitfalls associated with these diagnostic tests
2. Understand the pros and cons of rib resection and pectoralis minor release
3. Appreciate the variety of surgical techniques available for management of thoracic outlet syndrome

The lecture highlights the remarkable influence and contributions immigrant women physicians made to the advancement of American medical education and healthcare. Immigrant hand surgeons are featured, highlighting the groundbreaking innovations they introduced to their field that are still benefiting patients today. The lecture emphasizes that embracing diversity and inclusivity policy by the AAHS towards its members has been the secret sauce for its success and benefited this organization and its members.

Objectives: Following this session, the participant will be able to:

1. Examine the evolution of medical thought across multiple periods of history.
2. Explore American medical history from colonial time into turn of the century.
3. Appreciate the status of immigrant physicians in refining U.S. healthcare.
4. Highlight the role immigrant women physicians played in advancing medicine.
5. Discover the gift of knowledge immigrant hand surgeons gave to their field.
6. Know the significance of immigration for cultural & technological development.
7. Acknowledge the significance of diversity and inclusivity for U.S. superiority

Peripheral nerve surgery is undergoing rapid evolution, with ongoing debate regarding optimal treatment strategies for nerve injuries, compression neuropathies, and painful neuromas. Emerging techniques such as nerve transfers, targeted muscle reinnervation (TMR), regenerative peripheral nerve interfaces (RPNI), and processed nerve allografts have expanded reconstructive options but continue to generate questions regarding indications, timing, outcomes, and cost-effectiveness. This session will review the current evidence, highlight areas of controversy, and provide practical guidance for decision-making in complex upper-extremity nerve disorders.

Objectives: Following this session, the participant will be able to:

1. Determine when nerve transfers should replace traditional nerve grafting.
2. Critically evaluate whether TMR should be performed prophylactically at the time of amputation.
3. Assess the evidence supporting RPNI versus TMR for prevention and treatment of symptomatic neuromas.
4. Debate the role of processed nerve allografts versus autografts for mixed and motor nerve defects.
5. Examine whether supercharged end-to-side (SETS) nerve transfers improve outcomes in severe cubital tunnel syndrome and proximal ulnar neuropathy.
6. Evaluate indications for revision decompression and nerve wrapping procedures in recurrent compression neuropathies.
7. Analyze the cost-effectiveness and clinical value of emerging biologic and implantable technologies in peripheral nerve reconstruction.

Peripheral nerve injuries present significant surgical challenges. Existing repair and protection strategies are often limited by handling characteristics, tension at the repair site, scarring, and adhesion formation. This symposium will explore how Remplir™, a collagen epineurial substitute, is being used to address these challenges across a range of nerve repair procedures. Through surgeon-led case presentations, faculty will discuss applications in nerve transection repair, grafting, decompression, and nerve transfer surgery, highlighting how the product's unique design and clinical utility makes a difference in both routine and complex nerve surgery. The session will conclude with published clinical outcomes and real-world evidence demonstrating the role of Remplir in supporting functional recovery following peripheral nerve repair.

This session provides hand therapists, hand surgeons, and upper-extremity rehabilitation professionals with a practical framework for differentiating acute and chronic edema from primary and secondary lymphedema. Participants will review relevant pathophysiology, risk factors, clinical presentation, objective measurement methods, tissue characteristics, and functional implications of upper-extremity swelling. Emphasis will be placed on examination findings that help distinguish expected postoperative edema from presentations that warrant modification of rehabilitation interventions, medical reassessment, or referral for specialized lymphedema care.
Evidence-informed management approaches will be discussed, including positioning, elevation, active motion, compression, manual edema mobilization, scar management, skin protection, patient education, and home-program development. The session will introduce principles of basic upper-extremity lymphedema bandaging, including indications, precautions, materials, layering concepts, pressure gradients, and patient monitoring. Attention will also be given to red flags, including infection, vascular compromise, complex regional pain syndrome, deep vein thrombosis, progressive neurologic symptoms, and suspected lymphedema requiring interdisciplinary management. Through case-based clinical reasoning, participants will gain strategies to optimize tissue mobility, functional recovery, and safe interdisciplinary care for patients with upper-extremity edema and lymphedema.

Objectives: Following this session, the participant will be able to:

1. Differentiate common postoperative and traumatic upper-extremity edema from primary and secondary lymphedema using patient history, distribution of swelling, tissue characteristics, and clinical presentation.
2. Perform and interpret an upper-extremity swelling assessment using objective measurement methods, skin and tissue examination, range-of-motion assessment, scar mobility, sensory findings, and functional performance measures.
3. Explain the effects of edema and lymphedema on wound healing, scar maturation, tendon gliding, joint mobility, peripheral nerve symptoms, pain, and hand function.
4. Select appropriate edema-management interventions within hand therapy practice, including positioning, elevation, active motion, compression, manual edema mobilization, scar management, and patient education.
5. Demonstrate the principles and basic application of upper-extremity lymphedema bandaging, including appropriate material selection, layering sequence, pressure-gradient concepts, safety precautions, and patient monitoring.

Experienced faculty will deliver a review of commonly encountered hand and upper extremity conditions using a combination of case-based presentations and lectures. They will cover principles of diagnosis and treatment, while providing an overview of conditions encountered on board examinations and resident in-training examinations. The course is ideal for residents, fellows and hand therapists who wish to increase the depth of knowledge in hand surgery as well as surgeons in practice seeking a knowledge update or preparing for a MOC exam.

Objectives: Following this session, the participant will be able to:

1. Discuss non-operative and operative treatment approaches for various commonly encountered disorders of the hand and wrist.
2. Identify treatment options available for disorders of the hand and upper extremity.
3. Recognize various uncommon and/or unusual clinical conditions of the hand and wrist including carpal and DRUJ conditions, peripheral nerve, tendon and other common problems.
4. Compare different treatment methods to avoid complications and improve patient outcomes.

Carpal and cubital tunnel syndrome are the most commonly encountered sites of nerve compression in the upper extremity. Often atypical compression neuropathies such as thoracic outlet syndrome, quadrilateral space, suprascapular nerve entrapment, radial tunnel syndrome, pronator syndrome and ulnar tunnel syndrome are misdiagnosed or diagnosed late. This course will focus on simplifying the diagnosis and treatment of atypical compression neuropathies. Therapy options will be presented and discussed.

Objectives: Following this session, the participant will be able to:

1. List the differential diagnosis for atypical compression neuropathies in the upper extremity.
2. Discuss tools for workup and diagnosis of atypical nerve compression sites in the upper extremity.
3. Appreciate surgical treatment options for thoracic outlet syndrome, shoulder entrapment neuropathies, radial tunnel, pronator tunnel and ulnar tunnel syndrome.

Every hand surgeon will encounter at some point a patient with a mangling hand injury requiring urgent surgical intervention. In this course, tips and tricks for managing the hand will be presented using a case-based approach. Holistic management strategies incorporating primary and secondary reconstruction strategies will be presented. Tips and tricks will be discussed to optimize initial management and final surgical outcomes.

Objectives: Following this session, the participant will be able to:

1. Appreciate initial treatment strategies for management of the mangled hand.
2. Discuss principles for staged reconstruction in mangling hand injuries.
3. Describe holistic treatment strategies for optimizing outcomes in mangling hand injuries.

Patients presenting after failed nerve surgery are difficult to manage. Persistent symptoms relating to pain, paresthesias and motor weakness may relate to failed nerve decompression or failed nerve reconstruction. In this course, strategies for assessment as well as timing of intervention will be discussed for re-exploration and treatment of failed carpal and cubital tunnel decompression and nerve repair. Up-to-date surgical techniques for treatment of nerve gaps and persistent, recurrent or new symptoms after initial surgical treatment of carpal and cubital syndrome will be discussed.

Objectives: Following this session, the participant will be able to:

1. Identify causes of failed nerve decompression and nerve repair.
2. Discuss tools for assessment including physical examination, electrodiagnostic studies, ultrasound and MRI.
3. Appreciate surgical strategies for treatment of persistent, recurrent or new symptoms in carpal and cubital tunnel syndrome.
4. Appreciate surgical strategies for treatment of nerve gaps after failed primary nerve repair.

While restoration of motor function is often a focus, restoration of sensory function is very important to patients and important for maximizing function. The experts on this panel will address sensory reinnervation across a variety of issues and indications.

Objectives: Following this session, the participant will be able to:

1. Discuss the importance of sensation in real-world function
2. Understand the indications and techniques for sensory restoration
3. Recognize opportunities to improve sensory outcomes

Management of facial nerve palsy continues to evolve, now with multiple approaches available to improve facial function. This panel will discuss options available for early and late management of facial nerve palsy.

Objectives: Following this session, the participant will be able to:

1. Describe the procedures available for treatment of facial nerve palsy
2. Understand the indications for facial nerve palsy procedures
3. Discuss technical pearls for the procedures to treat facial nerve palsy

During this session, participants will learn basics of using ultrasound, perforator mapping with an ultrasound, lymphatic mapping with an ultrasound, how to use ultrasound in breast reconstruction practice for implant surveillance/seroma/hematoma, and postoperative use of ultrasound.

Objectives: Following this session, the participant will be able to:

1. Describe the basic physics, knobology, and probe selection relevant to point-of-care ultrasound in reconstructive microsurgery practice.
2. Perform perforator mapping with ultrasound, including identification of vessel course, caliber, and depth to optimize flap design and operative efficiency.
3. Apply ultrasound techniques for lymphatic mapping and channel selection to guide lymphaticovenous anastomosis and related procedures.
4. Utilize ultrasound in breast reconstruction to evaluate implants, seroma, hematoma, and fat grafting sites in the clinic and postoperative setting.
5. Integrate ultrasound into postoperative monitoring algorithms to differentiate normal findings from complications and reduce unnecessary imaging or re-exploration

A growing population of patients presents with dysvascular limbs deemed "no-option" for conventional endovascular or open bypass revascularization, with major amputation as the historical endpoint. Distraction angiogenesis and venous arterialization are two emerging strategies expanding the reconstructive algorithm and offering durable salvage where traditional approaches have failed.

Objectives: Following this session, the participant will be able to:

1. Define distraction angiogenesis and venous arterialization and explain their mechanistic rationale in limb salvage for "no-option" dysvascular patients.
2. Identify appropriate patient selection criteria and imaging workup for considering distraction angiogenesis or venous arterialization in dysvascular limbs.
3. Outline stepwise surgical techniques for performing distraction angiogenesis and venous arterialization, including key technical pitfalls and strategies to avoid failure.
4. Compare expected outcomes, complication profiles, and durability of these emerging strategies relative to traditional bypass, endovascular options, and major amputation.
5. Develop an algorithm for incorporating distraction angiogenesis and venous arterialization into a multidisciplinary limb salvage program.

Augmented intelligence will play a defining role in the next era of reconstructive microsurgery, reshaping how we select patients, plan operations, and design practices. This instructional course positions augmented intelligence not as a research novelty, but as core infrastructure for the future microsurgical ecosystem.

Objectives: Following this session, the participant will be able to:

1. Describe core concepts in augmented intelligence, including predictive modeling and decision-support tools, and how they apply to reconstructive microsurgery.
2. Interpret and critically appraise risk prediction and patient-reported outcome models to inform patient selection, counseling, and shared decision-making.
3. Identify perioperative use cases for augmented intelligence, such as pathway optimization, resource forecasting, and intraoperative or postoperative decision support.
4. Discuss how operational and business analytics can be used to plan capacity, improve throughput, and optimize financial performance in microsurgical practices.
5. Outline practical steps, including data, governance, and ethical considerations, for implementing augmented intelligence tools within academic and private practice environments.

"What Keeps You Up at Night: Grafting Challenges Across Reconstructive Microsurgery, Hand Surgery, and Peripheral Nerve Surgery" brings together expert panelists from ASRM/AAHS/ASPN to confront the cases, complications, and clinical dilemmas that haunt even the most experienced reconstructive surgeons. From arterial and venous grafting in the setting of zone-of-injury trauma, to nerve grafting across long gaps with uncertain recovery, to vascularized bone grafting in complex skeletal defects, the challenges that cross subspecialty boundaries are often the ones with no clean answers. This panel leverages the complementary expertise of three distinct surgical communities to examine shared problems through different lenses — fostering the kind of cross-disciplinary dialogue that is increasingly essential as reconstructive surgery pushes into ever more complex territory. Through case-based discussion and candid exchange, panelists will explore the decision-making processes, technical pitfalls, and hard-won lessons that define the frontier of grafting in reconstruction.

Objectives: Following this session, the participant will be able to:

1. Identify the key technical and biological factors that influence graft selection — arterial, venous, nerve, or bone — in complex reconstructive scenarios, and articulate how decision-making differs across microsurgical, hand, and peripheral nerve surgical contexts.
2. Analyze challenging grafting cases through a multidisciplinary lens, recognizing how the perspectives of reconstructive microsurgeons, hand surgeons, and peripheral nerve surgeons can complement and inform one another in the management of difficult clinical problems.
3. Apply practical strategies for anticipating and managing the complications, failures, and ethical dilemmas most commonly encountered in grafting procedures, including discussions of when to proceed, when to stage, and when to consider alternative reconstructive approaches.

Peripheral nerve gap repair continues to evolve as surgeons weigh autograft, allograft and synthetic conduit options for each patient. This industry-sponsored lunch symposium introduces NeuroSpan Bridge™, an FDA 510(k)-cleared, biomimetic multichannel nerve repair graft for gaps of 1–3 cm in nerves 1.5–3.0 mm in diameter. Presenters will trace the research behind the device's multichannel architecture and explain how its design is intended to provide structured guidance across the repair site. They will then move from bench to bedside, covering patient selection, sizing, handling and implantation technique, with time for discussion and Q&A. Attendees will leave with a practical understanding of where NeuroSpan Bridge fits in their nerve reconstruction approach.