Asian Pacific Federation of Societies for Surgery of the Hand

Fuminori Kanaya, President Elect, APFSSH
fkanaya@med.u-ryukyu.ac.jp

Hyunsik Gong, Treasurer, APFSSH
hsgong@snu.ac.kr

Sandeep Sebastin, Editor-in-Chief, JHS-AP
sandeepsebastin@gmail.com

Formation of SSHS: Singapore Society for Hand Surgery (SSHS) was formed in 1982. It was made up of orthopaedic and plastic surgeons with the common focus of exchanging ideas and experiences with emphasis on the training, education, research and development of the specialty with the international hand community.

Early days: Hand conditions in Singapore used to be managed by general surgeons till the formation of the Orthopaedic Department at Singapore General Hospital (SGH) in 1952. There was an increase in hand surgical conditions due to leprosy and the rapid pace of industrialization in Singapore. This increase demand for dedicated hand surgery care led to Pesi B Chacha being tasked by VK Pillay in 1967 to develop a hand surgery unit at SGH. This first outpatient hand clinic started at SGH in 1968 and was manned by Chacha, Yeoh Kean Hong and Kanwaljit Soin.

Robert WH Pho joined the Orthopaedic Department of SGH in 1974 after training in hand surgery in the United Kingdom. Together with Chacha, they worked to develop the instrumentation, laboratories and processes required to do microsurgery in Singapore. With all this in play, the first thumb replantation in Singapore was performed in 1977, followed by Singapore’s first toe to thumb transplantation thereafter in 1980. Pho also described the world’s first free vascularised fibular transplant for reconstruction of the distal radius post giant cell tumour resection in 1978. All these clinical achievements helped Singapore engage with the international hand surgery community.

Role of the society: Since its inception, the SSHS has been actively involved in organizing conferences, workshops, and quarterly educational programs for our members and residents to disseminate knowledge and skills related to hand

surgery. In recent years, we have held combined meetings with other international societies such as the combined Malaysia-Finland-Estonia-Latvia societies (2013), American Society for Surgery of the Hand (2015, 2018), Societa Italiana di Chirugia della Mano(SICM) (2016), British Society for Surgery of the Hand (BSSH) (2023).

The latest international conference organised was the 13th APFSSH congress held in conjunction with the 9th APFSHT and the 8th APWA meetings from 31 May 2023 – 3 June 2023 at Singapore Expo which saw 840 participants attending from over 33 countries. During this meeting, the book “Crafting a Legacy” was launched. It is a compilation featuring 48 Asian Pacific hand surgery pioneers and 8 of them were present at the meeting to receive their own copy.

in a hybrid fashion and we also expanded our program to include a nursing and hand therapist symposium.

To date, our society is growing. We have 58 hand surgeon members, 19 residents, 22 hand therapists and 3 honorary senior hand surgeon members. We recently participated and won the bid to host the 17th IFSSH-IFSHT meeting in 2028. Our theme in keeping with the current global trend will be that of sustainability in hand surgery and hand therapy. As we work toward organising a diverse and inclusive meeting, we look forward to meeting one and all in Singapore in 2028.

Renita Sirisena, Treasurer, Singapore Society for Hand Surgery
renita.sirisena@gmail.com

Buck-Gramcko technique is one of the most popular techniques used for pollicisation. Apart from being time-tested, it particularly is comfortable to the surgeon because of the good exposure to the palmar neuro-vascular structures through the proximal palmar skin extension. However, this longer palmar skin flap and relatively smaller palmar-radial flap sometimes leads to a ‘finger-like’ appearance of the thumb with a sharp interdigital cleft and a triphalangeal form. Authors of this article propose a few technical tips to improve the aesthetics of the thumb and make it look more like a ‘thumb’. The technical tips at each stage of the operation (namely- designing the skin flaps; incision and elevation of the skin flaps; bone resection and flap inset) has been legibly tabulated. This appears to be an elegant cook-book to make your next pollicisation look better.

Forearm deformities in birth brachial plexus palsy are common and children could present with limitation in pronation (supination deformity) or supination (pronation deformity). However, there is paucity of literature dealing with them. Moreover, the assessment and decision making regarding the indication for surgery and choosing the type of surgery remains perplexing. This article presents detailed information about the pathogenesis, clinical presentation, decision making considerations and choosing an appropriate operation for a given child. Authors provide an algorithm of management based on their experience of managing 129 children with birth brachial plexus palsy related forearm deformities.

The patient selection and management algorithm for correcting supination and pronation deformities is described in detail. A child with supination deformity is more likely to present for surgical intervention as a fixed supinated forearm is aesthetically unpleasing and results in a functional deficit which is much more than what the motor profile would dictate. Hence, a meagre change in position of the hand by a rotational correction greatly improves the appearance, function and is associated with substantial patient satisfaction. Authors empahsise on individualising the treatment based on the existing hand function and patient demands. Nonetheless, a supinated forearm at presentation is often stiff and radius pronation osteotomy is the commonest operation required for these children.

Helping Women in Hand Surgery be Seen and Heard

The Hand Surgery specialty has seen an increase in the percentage of women and minority races over the years, rising to 30% and 25% of hand surgery fellows respectively.(1) Despite the rise in numbers, females and minorities continue to be under-represented overall within the specialty. Specialty mentors and leadership roles continue to have few females. The number of hand surgery fellowship programs with female directors stood at 13%, and female faculty members at 15%.(2)

On a positive note, the demographics in the Asia Pacific hand surgery community is evolving, and we see more females entering the specialty. The increased presence and contributions of females in our Asia Pacific region is visible. We had 9 women holding the President position of the Asia Pacific Orthopaedic Association beginning with Dr Teresita Altre from the Philippines in 1986. We saw Prof Tunku Sara Ahmad from Malaysia honoured as a keynote speaker at the most recent APFSSH Congress in 2023, and the International Orthopaedic Diversity Alliance (IODA) immediate Past President is Dr Jennifer Green from Australia. There are also an increasing number of female surgeons sitting on the various national hand societies’ executive committees. With the APFSSH celebrating its 30th year of founding in 2024, we look forward to increasing diversity and gender equality as our young specialty continues to grow in the region.

To encourage the continued representation of women in a male dominated specialty, I share a few aspects considered significant in my own career development as a hand surgeon, and believe are important to strengthen and inspire others to continue the journey for professional equality.

Redefine Roles & Accept Challenges
A hurdle that the underrepresented face is the lack of self-confidence or imposter syndrome. When presented with an unfamiliar task, especially in the formative years of residency and in the early phases of our career, the reflex response is often “I can’t do that, I’m not the expert” and reject the opportunity. It is also recognised that females and other minorities face increased discrimination in getting promoted into roles, such as senior leadership positions, as there can be gender or behavioural bias.(3) When such situations are encountered, take a moment to consider reframing our perceptions, adopt an open mindset, and to reset the fear of accepting challenges. Additionally, there are many opportunities and advancements waiting to be pursued, and one should not assume to be ineligible or pigeonholed to a particular path, in order to start working on a project of interest.

Support Networks & Collaboration
Being part of a network supporting the minority also provides an avenue for advocacy of diversity for the underrepresented. Besides providing a community for the various diverse groups such as females in orthopaedics and ethnic minorities, it also provides

a voice to speak on their behalf to promote equality. These networks are important in raising overall awareness and creating a safe environment for these diverse groups. The effort to build these communities inspire people to grow, and nurture continued engagement and promote collaborations with the greater community.

Mentors & Role Models
Mentorship plays a significant role in shaping the individual. Same-gender mentorship is particularly valuable in providing insight into shared experiences, assisting in conflict and bias management, and guiding career development.(4) Most of us are able to easily identify mentors and role models who have had a significant impact on our training and career path. Their actions are seen through demonstration of field expertise, devotion to patient care, commitment to teaching, time generosity to guide a younger generation, contributions back to society and underserved communities, and giving recognition and support to junior surgeons to achieve further accomplishments.

As we welcome successive generations of hand surgeons into the fraternity, it is a critical period where we need to promote increasing awareness of the presence of diversity and its challenges. With advocacy for equality and equity, it heralds an era for greater representation and better relationships, and safer work and social environments.

Andes with easy access by metro, taxi and buses arranged by the hosts. There were two large meeting rooms, a third room for the therapists and a central area for the many trade exhibitors. The audio-visual support was extremely professional with large clear screens, seamless transition of presentations and simultaneous translation through Zoom. The IFSSH-sponsored keynote speakers - Don Lalonde, Amy Moore, Andrea Atzei, Marc Garcia Elias, and Chaitanya Mudgal – provided excellent masterclass lectures. Several workshops and innumerable lectures covering all aspects of hand surgery were offered.

Participants travelled from all over to the centre of the world. There were 493 attendees (including 54 Hand Therapists) from 25 countries. This international representation provided the course with global viewpoints on many topics. Participants were also provided with opportunities to “Meet and Greet” a number of the speakers in small, informal groups. These sessions inspired many and allowed time to ask the questions that each had always wanted to ask. The Course was strongly supported by the industry and we are very grateful to each exhibitor for their input.

In June 2024 we will be calling for submissions to host the 2nd IFSSH Mid-Term Course in Hand Surgery and we hope that all are inspired by the success of this inaugural Course.

HKSSH was invited as the guest society for the Swiss hand congress 2023, held on 23rd to 24th November 2023 in Switzerland. HKSSH representatives conducted hospital visits and presentations at the congress as invited guest speakers. We had a productive meeting and strengthened our connections with fellow hand surgeons in Switzerland.

HKSSH 36th Annual Congress will be held on 23rd-24th March 2024, with the theme “Occupational & Recreational Hand Disorders”. Experts from Swiss Society for Hand Surgery and local experienced speakers from Hong Kong have been invited. A half-day cadaveric workshop on hand and wrist arthroscopy and reconstruction will be held on 24th March 2023, following the congress. For more information, please visit our website www.hkssh.org.

This Mini Symposium was organized to provide space for PERAMOI-INASHUM members to gather and discuss the innovative new technique: Wide-Awake Local Anesthesia No Tourniquet (WALANT) in the management of different upper extremities conditions. This technique removes the requirement for operations to be performed with a tourniquet and general/regional anesthesia, relying on local anesthetic and hemostatic agents to provide suitable conditions for surgery. This educational and interactive event invited experts on this field from both the national and international scene, namely: dr. Putut Sugiantoro, SpOT (K), Amir Adham Ahmad, MD, and Shams Amir Samsul Bahar, MD. The symposium was a hybrid event for all PERAMOI-INASHUM members to enjoy.

This series of events and activities ended with a family gathering and work meeting for PERAMOI-INASHUM members. Ninety members and invited guests joined the Pirate Cruise dinner and enjoyed the beauty of the sunset golden hour at Tanjung Benoa Beach. The atmosphere during the work meeting was conducive and resulted in ideas and suggestions which were pertinent to the progress and future of PERAMOI-INASHUM. We invite and welcome all APFSSH members to our future meetings and I look forward to meeting all of you in person soon. Stay healthy and stay safe!

Reflecting the success of the Mini Symposium and Family Gathering events, PERAMOI-INASHUM will host the upcoming “INASHUM Biennial Meeting in Conjunction with the 4th ASEAN Hand Society Meeting”, which will be held in Bandung, West Java on the 25th to 27th of July 2024. We looking forward to meet you all during this event.

With a timing that already seemed bizarre for courses, there was probably no crazier way to ‘handle nerves’ than to immerse oneself in a cadaveric workshop on nerve surgery which journeyed deep into the twilight zone. Our Malaysian participants definitely wrote themselves into local Orthopaedic folklore by being the first oddballs to participate in a workshop of this nature.

With a timing that already seemed bizarre for courses, there was probably no crazier way to ‘handle nerves’ than to immerse oneself in a cadaveric workshop on nerve surgery which journeyed deep into the twilight zone. Our Malaysian participants definitely wrote themselves into local Orthopaedic folklore by being the first oddballs to participate in a workshop of this nature.

The second event was a cadaveric upper limb fracture fixation course sponsored by Medartis and Scionex from 18-19th March 2023 where 24 participants had an excellent time improving their plating and screw fixation skills. It was held again at the ASSC centre in Hospital UKM.

The third and final event for the year was MSSH’s Annual Scientific Meeting with the theme of “The Growing Hand and Trauma Hand” course held at Kinta Riverfront Hotel in Ipoh from 18th – 20th August 2023 which saw the attendance of approximately 150 participants encompassing medical officers, surgeons and physiotherapists.

The 74th Annual Philippine Orthopedic Association (POA) was held last November 15-18, 2023 with a theme “At Par and Attuned with Global Advances” and it had a whole day scientific session by the AHSP. The key note speaker for the Convention was Prof Kevin Chung (USA). Among our other international delegates were Christopher Dy and Jovito Angeles from the USA and Amir Ahmad of Malaysia.

Professor Kevin C Chung gave a lecture on his approach to complicated distal radius fracture fixation, and the role of AI in orthopaedics. He also gave his inputs on evidence-based orthopaedics and how it can guide the orthopadists in the clinical setting. Christopher Dy also gave a lecture on brachial plexus management and the role of research

TSSH also welcomed travelling fellows, including Dr. Hiroo Kimura and Dr. Kazuhiro Kohata from Japan, and Dr. Chang-Sik John Pak and Dr. Hyun-Joo Lee from Korea. They joined our fellow sessions to share their studies with our members. Further hospital visits were also arranged. The Chairman, Prof. Fu, expressed his appreciation to Linkou Chang Gung Memorial Hospital (CGMH), National Taiwan University Hospital (NTUH), China Medicine University Hospital (CMUH), Kaohsiung Medical University Hospital (KMUH), and E-Da Hospital for their hospitality towards these travelling fellows.

Following the Asian-Pacific Federation of Societies for Surgery of the Hand (APFSSH) annual meeting in Singapore, we were delighted to welcome Prof. Alexander Shin to Taiwan. We organized a Distal Radius Fracture Symposium at Kaohsiung Medical University on June 4. We are grateful to Prof. Shin and Prof. Yuan-Hun Tu for their insightful speeches.

On October 5, the General Secretary of TSSH, Tien-Ching Lee, attended the annual International Federation of Societies for Surgery of the Hand (IFSSH) Delegates’ council meeting in Toronto. During the Annual Meeting of the Taiwan Orthopaedic Society (TOA), we invited the President of JSSH-Prof Iwasaki, to deliver a keynote speech about a novel cartilage repair technique for advanced elbow osteochondral dissecans on October 28.

On November 16, TSSH organized a cadaver workshop at Hualian Tzu-Chi University, where many experts demonstrated surgical skills and approaches in detail to the participants. The attendees found these lessons very beneficial to their clinical practice.

The 2024 TSSH Annual Meeting is scheduled to take place at Kaohsiung Medical University Hospital on May 4-5. We plan to invite JSSH as our guest society for this meeting. Additionally, the 9th Asia Pacific Wrist Association Annual Congress will be held at TVGH on November 15-16. We anticipate that these meetings will provide our ambassadors and attendees with a memorable experience.

Later on, we organized the "Regional Hand Meeting 2023" on August 17-18, held in Nan province, the northern part of Thailand, where experts discussed local challenges. We believe it's important to have these meetings in different parts of Thailand to include as many people as possible.

A standout event in our calendar is the 45th Annual Meeting of the Royal College of Orthopaedic Surgeons of Thailand and the 43rd Annual Meeting of the ASEAN Orthopaedic Association. This event, featuring Professor Gregory Bain from Australia was scheduled for October 20-22, 2023, at the Royal Cliff Hotel in Pattaya, Thailand. Themed "BEYOND THE HORIZON & ABOVE THE LIMITS," the conference underscores our dedication to pushing the boundaries of orthopedic and hand surgery.

We actively encourage our members to participate in other significant international meetings, fostering global collaboration and learning. Furthermore, we organize hands-on workshops to assist residents and fellows in enhancing their surgical skills and knowledge. The TSSH remains committed to advancing the field of hand surgery, promoting learning, collaboration, and pushing the limits for a brighter future.