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Page 8 of 17 Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08

related physical discomfort (WRPD) will guide strategies to prolong surgeon well-being, job satisfaction,
and career duration.

Methods: After IRB approval, a 30-question survey was administered to the American Society of
Craniofacial Surgery and the American Society of Maxillofacial Surgery members to evaluate surgeons’
current physical discomfort. Responses were collected by the Mayo Clinic Survey Center.

Results: Ninty-five respondents, 75% male, 56% aged 31-50 years old, 73% in academic practice. On a
scale of 0-10 (0 no pain, 10 worst pain), WRPD had a median of 3 (surgery without loupes/microscope),
4 (loupe surgery), and 5 (microscope surgery). Pain during, immediately after, and day after surgery
was most common in the neck. Pain within 4 h of surgery was present in 55%. Thirty-eight percent
had pain influencing future surgical performance. Operating time was > 6 h per day (68%) and > 3 days
per week (72%). Surgeon discomfort affects posture (72%), stamina (32%), sleep (28%), surgical speed
(24%), relationships (18%), and concentration (17%). Twenty-two percent sought medical treatment for
discomfort while 9% took time off work for treatment.

Conclusion: WRPD is a critical issue amongst CMS. Nearly all surveyed experience physical discomfort
regularly. This negatively impacts daily life and often requires medical treatment. Thirty-eight percent
of respondents felt that WRPD would limit their future careers, perhaps the most concerning finding.
It is imperative that CMS employ preventive strategies to combat WRPD.

13. A2 pulley reconstruction - a novel approach using allograft

Andrew Peredo, Ashley Ignatiuk

University of Colorado - Denver

Flexor tendon pulley injuries are most commonly seen in rock climbers, but reports of ruptures in non-
climbers have been increasing. It is common belief that A2 and A4 pulleys are important in preventing
bowstringing of the tendon which is associated with loss of flexion, flexion contracture and altering
the kinematics of the tendon. We present a 24-year-old male who underwent reconstruction of his
Left index finger A2 pulley using allograft. The patient sustained a zone II flexor tendon injury to his
left index finger. He had a complete laceration of his FDS and FDP tendons, and underwent repair of
both. Postoperatively he regained full finger active and passive range of motion. However, 4 months
postoperatively he suffered a rupture of his A2 pulley with bowstringing. Based on his age, post-
operative course and presentation, and discussion of different treatment options. His A2 pulley was
reconstructed with dermal allograft (Flex HD Structural-2 cm × 4 cm × 0.3 mm). The allograft was
passed through a bone tunnel made within the midportion of proximal phalanx. The allograft was
wrapped in a one and a half loop fashion encircling only the flexor tendons and avoiding the extensor
mechanism and neurovascular bundles. The patient is currently doing well and the reconstruction
of the A2 pulley is still intact. Will start occupational therapy soon. Flexor tendon pulley injuries
and ruptures can lead to pain, decreased range of motion, loss of strength, bowstringing and fixed
flexion contractures. Although different methods have been described with success, each method has
potential drawbacks.