{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.349,"endTime":14.459,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.69,"endTime":16.55,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.69,"endTime":16.55,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.329,"endTime":25.259,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.63,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.63,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.63,"endTime":28.17,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.499,"endTime":29.339,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.499,"endTime":29.339,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.819,"endTime":30.959,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.819,"endTime":30.959,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.319,"endTime":33.359,"body":"I am pretty"},{"speaker":"Charles Goldfarb","startTime":31.319,"endTime":33.359,"body":"well, Happy New Year."},{"speaker":"Chris Dy","startTime":33.66,"endTime":36.12,"body":"Happy New Year to you,"},{"speaker":"Chris Dy","startTime":33.66,"endTime":36.12,"body":"too. And this is the first time"},{"speaker":"Chris Dy","startTime":36.12,"endTime":38.7,"body":"we've taken a couple of weeks"},{"speaker":"Chris Dy","startTime":36.12,"endTime":38.7,"body":"off from the podcast. How does"},{"speaker":"Chris Dy","startTime":38.7,"endTime":39.15,"body":"that feel?"},{"speaker":"Charles Goldfarb","startTime":40.41,"endTime":43.02,"body":"It was weird."},{"speaker":"Charles Goldfarb","startTime":40.41,"endTime":43.02,"body":"I was looking forward to it, to"},{"speaker":"Charles Goldfarb","startTime":43.02,"endTime":45.63,"body":"be honest. But I've been kind of"},{"speaker":"Charles Goldfarb","startTime":43.02,"endTime":45.63,"body":"you know, looking forward to a"},{"speaker":"Charles Goldfarb","startTime":45.63,"endTime":48.63,"body":"break in general. But I kind of"},{"speaker":"Charles Goldfarb","startTime":45.63,"endTime":48.63,"body":"missed it."},{"speaker":"Chris Dy","startTime":50.16,"endTime":52.89,"body":"Yeah, me too. And the"},{"speaker":"Chris Dy","startTime":50.16,"endTime":52.89,"body":"amount of feedback we've gotten"},{"speaker":"Chris Dy","startTime":52.89,"endTime":58.17,"body":"even on things like fellowship"},{"speaker":"Chris Dy","startTime":52.89,"endTime":58.17,"body":"applications have been amazing."},{"speaker":"Chris Dy","startTime":58.68,"endTime":61.62,"body":"So we really do appreciate"},{"speaker":"Chris Dy","startTime":58.68,"endTime":61.62,"body":"everybody giving us the feedback"},{"speaker":"Chris Dy","startTime":61.62,"endTime":65.19,"body":"on the podcast. And it clearly,"},{"speaker":"Chris Dy","startTime":61.62,"endTime":65.19,"body":"I think has found, found an"},{"speaker":"Chris Dy","startTime":65.19,"endTime":67.53,"body":"audience. And we're hoping that"},{"speaker":"Chris Dy","startTime":65.19,"endTime":67.53,"body":"the audience continues to grow."},{"speaker":"Chris Dy","startTime":67.53,"endTime":69.6,"body":"But we certainly appreciate"},{"speaker":"Chris Dy","startTime":67.53,"endTime":69.6,"body":"everybody out there who's been"},{"speaker":"Chris Dy","startTime":69.6,"endTime":70.05,"body":"tuning in."},{"speaker":"Charles Goldfarb","startTime":70.33,"endTime":71.71,"body":"Yeah, Chris,"},{"speaker":"Charles Goldfarb","startTime":70.33,"endTime":71.71,"body":"and I are continuing to"},{"speaker":"Charles Goldfarb","startTime":71.71,"endTime":75.37,"body":"strategize how to, I don't know"},{"speaker":"Charles Goldfarb","startTime":71.71,"endTime":75.37,"body":"it's not, it's a little awkward,"},{"speaker":"Charles Goldfarb","startTime":75.37,"endTime":77.83,"body":"because we're not trying to push"},{"speaker":"Charles Goldfarb","startTime":75.37,"endTime":77.83,"body":"ourselves on anyone. But we just"},{"speaker":"Charles Goldfarb","startTime":77.83,"endTime":81.1,"body":"want to make people aware and"},{"speaker":"Charles Goldfarb","startTime":77.83,"endTime":81.1,"body":"give people a chance to see if"},{"speaker":"Charles Goldfarb","startTime":81.1,"endTime":84.01,"body":"they enjoy the conversation."},{"speaker":"Charles Goldfarb","startTime":81.1,"endTime":84.01,"body":"And, and like we've said so many"},{"speaker":"Charles Goldfarb","startTime":84.01,"endTime":86.89,"body":"times before, the enjoyment we"},{"speaker":"Charles Goldfarb","startTime":84.01,"endTime":86.89,"body":"get out of this is, is not just"},{"speaker":"Charles Goldfarb","startTime":86.89,"endTime":89.5,"body":"Chris and I going back and"},{"speaker":"Charles Goldfarb","startTime":86.89,"endTime":89.5,"body":"forth, but what we hear on"},{"speaker":"Charles Goldfarb","startTime":89.5,"endTime":93.34,"body":"Twitter, hear by email or the"},{"speaker":"Charles Goldfarb","startTime":89.5,"endTime":93.34,"body":"interaction we get from each of"},{"speaker":"Charles Goldfarb","startTime":93.34,"endTime":96.88,"body":"you. So we really do value that"},{"speaker":"Charles Goldfarb","startTime":93.34,"endTime":96.88,"body":"and in whichever form you would"},{"speaker":"Charles Goldfarb","startTime":96.88,"endTime":99.52,"body":"provide it, it really makes this"},{"speaker":"Charles Goldfarb","startTime":96.88,"endTime":99.52,"body":"all worthwhile."},{"speaker":"Chris Dy","startTime":101.14,"endTime":103.51,"body":"Well, we want to point"},{"speaker":"Chris Dy","startTime":101.14,"endTime":103.51,"body":"everybody towards our listener"},{"speaker":"Chris Dy","startTime":103.51,"endTime":107.62,"body":"survey. And that's, that's up on"},{"speaker":"Chris Dy","startTime":103.51,"endTime":107.62,"body":"our website. And you can find us"},{"speaker":"Chris Dy","startTime":107.62,"endTime":111.16,"body":"at"},{"speaker":"Chris Dy","startTime":107.62,"endTime":111.16,"body":"theupperhandpodcast.wustl.edu."},{"speaker":"Chris Dy","startTime":111.28,"endTime":115.39,"body":"And the survey is posted there,"},{"speaker":"Chris Dy","startTime":111.28,"endTime":115.39,"body":"we've had 67 responses, and"},{"speaker":"Chris Dy","startTime":115.39,"endTime":118.93,"body":"thanks to everybody who has"},{"speaker":"Chris Dy","startTime":115.39,"endTime":118.93,"body":"filled it out, it is your way to"},{"speaker":"Chris Dy","startTime":118.96,"endTime":121.78,"body":"win an upper hand coffee mug,"},{"speaker":"Chris Dy","startTime":118.96,"endTime":121.78,"body":"which we'll be doing a drawing"},{"speaker":"Chris Dy","startTime":121.78,"endTime":122.8,"body":"for in the coming weeks."},{"speaker":"Charles Goldfarb","startTime":123.9,"endTime":125.94,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":123.9,"endTime":125.94,"body":"absolutely. Can I share a little"},{"speaker":"Charles Goldfarb","startTime":125.94,"endTime":128.04,"body":"bit from one of the survey"},{"speaker":"Charles Goldfarb","startTime":125.94,"endTime":128.04,"body":"responses?"},{"speaker":"Chris Dy","startTime":128.88,"endTime":129.78,"body":"I think that'd be"},{"speaker":"Chris Dy","startTime":128.88,"endTime":129.78,"body":"great."},{"speaker":"Charles Goldfarb","startTime":130.71,"endTime":132.81,"body":"This one said"},{"speaker":"Charles Goldfarb","startTime":130.71,"endTime":132.81,"body":"have been listening since the"},{"speaker":"Charles Goldfarb","startTime":132.81,"endTime":135.93,"body":"podcast aired the thoughtfulness"},{"speaker":"Charles Goldfarb","startTime":132.81,"endTime":135.93,"body":"behind the discussion in the"},{"speaker":"Charles Goldfarb","startTime":135.93,"endTime":139.32,"body":"dialogue, which I assume is"},{"speaker":"Charles Goldfarb","startTime":135.93,"endTime":139.32,"body":"representative of the culture of"},{"speaker":"Charles Goldfarb","startTime":139.32,"endTime":142.56,"body":"the orthopedic hand program at"},{"speaker":"Charles Goldfarb","startTime":139.32,"endTime":142.56,"body":"Wash U has piqued my interest"},{"speaker":"Charles Goldfarb","startTime":142.59,"endTime":145.62,"body":"even more in the fellowship"},{"speaker":"Charles Goldfarb","startTime":142.59,"endTime":145.62,"body":"program there. And I think this"},{"speaker":"Charles Goldfarb","startTime":145.62,"endTime":149.19,"body":"has been I don't want to say"},{"speaker":"Charles Goldfarb","startTime":145.62,"endTime":149.19,"body":"easy, but I think this has been"},{"speaker":"Charles Goldfarb","startTime":149.19,"endTime":152.1,"body":"relatively straightforward for"},{"speaker":"Charles Goldfarb","startTime":149.19,"endTime":152.1,"body":"Chris and I because this is kind"},{"speaker":"Charles Goldfarb","startTime":152.1,"endTime":153.0,"body":"of our culture here."},{"speaker":"Chris Dy","startTime":154.26,"endTime":156.18,"body":"Yeah, it is kind of"},{"speaker":"Chris Dy","startTime":154.26,"endTime":156.18,"body":"what we do, except you don't"},{"speaker":"Chris Dy","startTime":156.18,"endTime":158.55,"body":"have to go home and edit all the"},{"speaker":"Chris Dy","startTime":156.18,"endTime":158.55,"body":"conference at the end of the"},{"speaker":"Chris Dy","startTime":158.55,"endTime":162.21,"body":"day. But I appreciate the"},{"speaker":"Chris Dy","startTime":158.55,"endTime":162.21,"body":"technical expertise that you"},{"speaker":"Chris Dy","startTime":162.21,"endTime":164.52,"body":"bring to the table here among"},{"speaker":"Chris Dy","startTime":162.21,"endTime":164.52,"body":"all of your other technical"},{"speaker":"Chris Dy","startTime":164.52,"endTime":165.18,"body":"expertise."},{"speaker":"Charles Goldfarb","startTime":165.84,"endTime":168.54,"body":"Yeah, but it"},{"speaker":"Charles Goldfarb","startTime":165.84,"endTime":168.54,"body":"is, but it does hit the it does"},{"speaker":"Charles Goldfarb","startTime":168.54,"endTime":171.81,"body":"hit a point. And that is what"},{"speaker":"Charles Goldfarb","startTime":168.54,"endTime":171.81,"body":"we're proud of, which is the"},{"speaker":"Charles Goldfarb","startTime":171.84,"endTime":175.98,"body":"collaboration and the you know,"},{"speaker":"Charles Goldfarb","startTime":171.84,"endTime":175.98,"body":"respectfulness of each other's"},{"speaker":"Charles Goldfarb","startTime":175.98,"endTime":178.59,"body":"views, even though Chris and I"},{"speaker":"Charles Goldfarb","startTime":175.98,"endTime":178.59,"body":"seem as though we agree all the"},{"speaker":"Charles Goldfarb","startTime":178.59,"endTime":180.69,"body":"time. We really don't. And"},{"speaker":"Charles Goldfarb","startTime":178.59,"endTime":180.69,"body":"there's subtleties to our"},{"speaker":"Charles Goldfarb","startTime":180.69,"endTime":183.45,"body":"disagreements. But hopefully"},{"speaker":"Charles Goldfarb","startTime":180.69,"endTime":183.45,"body":"more of that will come out in"},{"speaker":"Charles Goldfarb","startTime":183.45,"endTime":187.59,"body":"the new year, as we kind of try"},{"speaker":"Charles Goldfarb","startTime":183.45,"endTime":187.59,"body":"to get into some of the things"},{"speaker":"Charles Goldfarb","startTime":187.59,"endTime":190.02,"body":"that have been requested, such"},{"speaker":"Charles Goldfarb","startTime":187.59,"endTime":190.02,"body":"as surgical techniques. And"},{"speaker":"Charles Goldfarb","startTime":190.02,"endTime":192.42,"body":"Chris and I certainly vary a bit"},{"speaker":"Charles Goldfarb","startTime":190.02,"endTime":192.42,"body":"on some of these."},{"speaker":"Chris Dy","startTime":193.47,"endTime":196.47,"body":"Yeah, so the 67 people"},{"speaker":"Chris Dy","startTime":193.47,"endTime":196.47,"body":"who have been kind enough to"},{"speaker":"Chris Dy","startTime":196.47,"endTime":200.4,"body":"fill out the survey 50, have"},{"speaker":"Chris Dy","startTime":196.47,"endTime":200.4,"body":"asked for more info on surgical"},{"speaker":"Chris Dy","startTime":200.4,"endTime":203.79,"body":"techniques. So we will try to"},{"speaker":"Chris Dy","startTime":200.4,"endTime":203.79,"body":"get into the nuts and bolts of"},{"speaker":"Chris Dy","startTime":203.79,"endTime":207.81,"body":"why we do it. And the reasons"},{"speaker":"Chris Dy","startTime":203.79,"endTime":207.81,"body":"why I mean, I, I tend to be the"},{"speaker":"Chris Dy","startTime":207.81,"endTime":210.78,"body":"kind of surgeon I think that has"},{"speaker":"Chris Dy","startTime":207.81,"endTime":210.78,"body":"a reason pretty much for every"},{"speaker":"Chris Dy","startTime":210.9,"endTime":213.27,"body":"kind of decision I make in the"},{"speaker":"Chris Dy","startTime":210.9,"endTime":213.27,"body":"operating room, whether it's"},{"speaker":"Chris Dy","startTime":213.27,"endTime":216.12,"body":"starting with the way things are"},{"speaker":"Chris Dy","startTime":213.27,"endTime":216.12,"body":"set up in the room, or the"},{"speaker":"Chris Dy","startTime":216.12,"endTime":219.06,"body":"implants I use or why each screw"},{"speaker":"Chris Dy","startTime":216.12,"endTime":219.06,"body":"goes in a certain order. So and"},{"speaker":"Chris Dy","startTime":219.06,"endTime":222.03,"body":"I know you are very similar in"},{"speaker":"Chris Dy","startTime":219.06,"endTime":222.03,"body":"that in that manner."},{"speaker":"Charles Goldfarb","startTime":222.0,"endTime":223.86,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":222.0,"endTime":223.86,"body":"that's exactly right. And one of"},{"speaker":"Charles Goldfarb","startTime":223.86,"endTime":226.29,"body":"the things I'll share in our"},{"speaker":"Charles Goldfarb","startTime":223.86,"endTime":226.29,"body":"anatomy session yesterday, I"},{"speaker":"Charles Goldfarb","startTime":226.29,"endTime":229.14,"body":"thought this was just really"},{"speaker":"Charles Goldfarb","startTime":226.29,"endTime":229.14,"body":"interesting. We were talking"},{"speaker":"Charles Goldfarb","startTime":229.14,"endTime":233.79,"body":"about the CMC joint and the"},{"speaker":"Charles Goldfarb","startTime":229.14,"endTime":233.79,"body":"relationship of the radial"},{"speaker":"Charles Goldfarb","startTime":233.79,"endTime":236.34,"body":"artery, you know, passing"},{"speaker":"Charles Goldfarb","startTime":233.79,"endTime":236.34,"body":"beneath the first compartment"},{"speaker":"Charles Goldfarb","startTime":236.34,"endTime":240.21,"body":"wrapping around heading from"},{"speaker":"Charles Goldfarb","startTime":236.34,"endTime":240.21,"body":"volar to dorsal. And I just have"},{"speaker":"Charles Goldfarb","startTime":240.21,"endTime":244.71,"body":"been very interested and we"},{"speaker":"Charles Goldfarb","startTime":240.21,"endTime":244.71,"body":"discussed, I share that, in"},{"speaker":"Charles Goldfarb","startTime":244.71,"endTime":250.8,"body":"general, it is not my style, to"},{"speaker":"Charles Goldfarb","startTime":244.71,"endTime":250.8,"body":"find every theoretically at risk"},{"speaker":"Charles Goldfarb","startTime":250.8,"endTime":254.67,"body":"structure during a procedure."},{"speaker":"Charles Goldfarb","startTime":250.8,"endTime":254.67,"body":"And I think the CMC joint and"},{"speaker":"Charles Goldfarb","startTime":254.67,"endTime":257.97,"body":"the radial artery are a perfect"},{"speaker":"Charles Goldfarb","startTime":254.67,"endTime":257.97,"body":"example because historically, I"},{"speaker":"Charles Goldfarb","startTime":257.97,"endTime":261.93,"body":"did not specifically find that"},{"speaker":"Charles Goldfarb","startTime":257.97,"endTime":261.93,"body":"structure. I have evolved. And"},{"speaker":"Charles Goldfarb","startTime":261.93,"endTime":265.38,"body":"now maybe it's because I work"},{"speaker":"Charles Goldfarb","startTime":261.93,"endTime":265.38,"body":"with trainees or for whatever"},{"speaker":"Charles Goldfarb","startTime":265.38,"endTime":268.77,"body":"reason, I a couple of spreads."},{"speaker":"Charles Goldfarb","startTime":265.38,"endTime":268.77,"body":"It's not a big deal. A couple of"},{"speaker":"Charles Goldfarb","startTime":268.77,"endTime":271.95,"body":"spreads of the scissors, I find"},{"speaker":"Charles Goldfarb","startTime":268.77,"endTime":271.95,"body":"the radial artery I feel more"},{"speaker":"Charles Goldfarb","startTime":271.95,"endTime":274.35,"body":"comfortable knowing where it is."},{"speaker":"Charles Goldfarb","startTime":271.95,"endTime":274.35,"body":"It hasn't changed my general"},{"speaker":"Charles Goldfarb","startTime":274.35,"endTime":279.3,"body":"philosophy. Do you find the"},{"speaker":"Charles Goldfarb","startTime":274.35,"endTime":279.3,"body":"radial artery for every CMC"},{"speaker":"Charles Goldfarb","startTime":279.3,"endTime":280.44,"body":"procedure you do, Chris?"},{"speaker":"Chris Dy","startTime":281.59,"endTime":284.14,"body":"Well, I do and I guess"},{"speaker":"Chris Dy","startTime":281.59,"endTime":284.14,"body":"if we were looking for areas"},{"speaker":"Chris Dy","startTime":284.14,"endTime":286.96,"body":"where we disagree, this would"},{"speaker":"Chris Dy","startTime":284.14,"endTime":286.96,"body":"not be one but I think that's"},{"speaker":"Chris Dy","startTime":286.96,"endTime":291.22,"body":"the legacy of how Dr. Gelberman"},{"speaker":"Chris Dy","startTime":286.96,"endTime":291.22,"body":"taught me. And he is of the"},{"speaker":"Chris Dy","startTime":291.22,"endTime":294.52,"body":"mindset of finding every"},{"speaker":"Chris Dy","startTime":291.22,"endTime":294.52,"body":"structure. Now there are times"},{"speaker":"Chris Dy","startTime":294.52,"endTime":297.61,"body":"where I think it is important to"},{"speaker":"Chris Dy","startTime":294.52,"endTime":297.61,"body":"find it for you know, for the"},{"speaker":"Chris Dy","startTime":297.61,"endTime":300.61,"body":"reason of you know, if something"},{"speaker":"Chris Dy","startTime":297.61,"endTime":300.61,"body":"goes haywire. I need to know"},{"speaker":"Chris Dy","startTime":300.61,"endTime":303.52,"body":"where it is in the field, I know"},{"speaker":"Chris Dy","startTime":300.61,"endTime":303.52,"body":"where it is right away. I think"},{"speaker":"Chris Dy","startTime":303.52,"endTime":306.13,"body":"one example of where I"},{"speaker":"Chris Dy","startTime":303.52,"endTime":306.13,"body":"personally will go look at a"},{"speaker":"Chris Dy","startTime":306.13,"endTime":309.1,"body":"structure that maybe not"},{"speaker":"Chris Dy","startTime":306.13,"endTime":309.1,"body":"everybody else does is when I'm"},{"speaker":"Chris Dy","startTime":309.1,"endTime":313.06,"body":"doing a sub muscular ulnar nerve"},{"speaker":"Chris Dy","startTime":309.1,"endTime":313.06,"body":"transposition, I will look over"},{"speaker":"Chris Dy","startTime":313.06,"endTime":316.15,"body":"the top of the flexor pronator"},{"speaker":"Chris Dy","startTime":313.06,"endTime":316.15,"body":"mass and see the median nerve as"},{"speaker":"Chris Dy","startTime":316.15,"endTime":319.48,"body":"I'm dividing the flexor pronator"},{"speaker":"Chris Dy","startTime":316.15,"endTime":319.48,"body":"mass, which I know not everybody"},{"speaker":"Chris Dy","startTime":319.48,"endTime":322.51,"body":"does. But I want to know where"},{"speaker":"Chris Dy","startTime":319.48,"endTime":322.51,"body":"that nerve is so I can protect"},{"speaker":"Chris Dy","startTime":322.51,"endTime":324.85,"body":"it and move it away, especially"},{"speaker":"Chris Dy","startTime":322.51,"endTime":324.85,"body":"if we're using pottery for that"},{"speaker":"Chris Dy","startTime":324.85,"endTime":326.98,"body":"portion of the procedure. It"},{"speaker":"Chris Dy","startTime":324.85,"endTime":326.98,"body":"just makes me feel better."},{"speaker":"Charles Goldfarb","startTime":327.8,"endTime":329.45,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":327.8,"endTime":329.45,"body":"interesting. I had a recent"},{"speaker":"Charles Goldfarb","startTime":329.45,"endTime":332.69,"body":"case, that actually those are"},{"speaker":"Charles Goldfarb","startTime":329.45,"endTime":332.69,"body":"the pictures that I shared with"},{"speaker":"Charles Goldfarb","startTime":332.69,"endTime":336.8,"body":"you, Chris, where I do not"},{"speaker":"Charles Goldfarb","startTime":332.69,"endTime":336.8,"body":"routinely find the median nerve,"},{"speaker":"Charles Goldfarb","startTime":336.83,"endTime":340.37,"body":"despite having been taught that"},{"speaker":"Charles Goldfarb","startTime":336.83,"endTime":340.37,"body":"the goal of a sub muscular"},{"speaker":"Charles Goldfarb","startTime":340.37,"endTime":344.06,"body":"transposition is to put the"},{"speaker":"Charles Goldfarb","startTime":340.37,"endTime":344.06,"body":"ulnar nerve adjacent to the"},{"speaker":"Charles Goldfarb","startTime":344.06,"endTime":346.43,"body":"median nerve, but I did not"},{"speaker":"Charles Goldfarb","startTime":344.06,"endTime":346.43,"body":"routinely find the median nerve."},{"speaker":"Charles Goldfarb","startTime":346.85,"endTime":352.04,"body":"And in this particular case, as"},{"speaker":"Charles Goldfarb","startTime":346.85,"endTime":352.04,"body":"I carefully cut all the muscle"},{"speaker":"Charles Goldfarb","startTime":352.04,"endTime":354.59,"body":"of the flexor pronator mass,"},{"speaker":"Charles Goldfarb","startTime":352.04,"endTime":354.59,"body":"which absolutely kills me every"},{"speaker":"Charles Goldfarb","startTime":354.59,"endTime":358.55,"body":"time I do it, all of a sudden,"},{"speaker":"Charles Goldfarb","startTime":354.59,"endTime":358.55,"body":"the median nerve was right there"},{"speaker":"Charles Goldfarb","startTime":358.58,"endTime":363.86,"body":"very ulnar sided, and actually"},{"speaker":"Charles Goldfarb","startTime":358.58,"endTime":363.86,"body":"compressed a bit. But it was"},{"speaker":"Charles Goldfarb","startTime":363.86,"endTime":367.01,"body":"remarkable how ulnar it was, and"},{"speaker":"Charles Goldfarb","startTime":363.86,"endTime":367.01,"body":"I laid the, I laid the ulnar"},{"speaker":"Charles Goldfarb","startTime":367.01,"endTime":369.5,"body":"nerve down directly, I could"},{"speaker":"Charles Goldfarb","startTime":367.01,"endTime":369.5,"body":"have put it on top of the median"},{"speaker":"Charles Goldfarb","startTime":369.5,"endTime":371.72,"body":"nerve, which was fascinating."},{"speaker":"Charles Goldfarb","startTime":369.5,"endTime":371.72,"body":"And I think it gets to your"},{"speaker":"Charles Goldfarb","startTime":371.72,"endTime":374.12,"body":"point, you know, should I be"},{"speaker":"Charles Goldfarb","startTime":371.72,"endTime":374.12,"body":"doing that? For every case? I'm"},{"speaker":"Charles Goldfarb","startTime":374.12,"endTime":377.75,"body":"not sure. But certainly a high"},{"speaker":"Charles Goldfarb","startTime":374.12,"endTime":377.75,"body":"level of awareness is critical."},{"speaker":"Chris Dy","startTime":379.4,"endTime":381.65,"body":"Yeah, and there are"},{"speaker":"Chris Dy","startTime":379.4,"endTime":381.65,"body":"times where, you know, based on"},{"speaker":"Chris Dy","startTime":381.65,"endTime":385.16,"body":"the preoperative clinical exam,"},{"speaker":"Chris Dy","startTime":381.65,"endTime":385.16,"body":"I will find patients that have"},{"speaker":"Chris Dy","startTime":385.16,"endTime":387.92,"body":"median nerve compression in the"},{"speaker":"Chris Dy","startTime":385.16,"endTime":387.92,"body":"forearm. And at the same time,"},{"speaker":"Chris Dy","startTime":387.92,"endTime":390.2,"body":"as I'm doing a sub muscular"},{"speaker":"Chris Dy","startTime":387.92,"endTime":390.2,"body":"ulnar nerve transposition, I'll"},{"speaker":"Chris Dy","startTime":390.2,"endTime":392.75,"body":"go and do a formal"},{"speaker":"Chris Dy","startTime":390.2,"endTime":392.75,"body":"decompression, but usually, it's"},{"speaker":"Chris Dy","startTime":392.75,"endTime":395.99,"body":"just because I want to know"},{"speaker":"Chris Dy","startTime":392.75,"endTime":395.99,"body":"where it is. And I think that"},{"speaker":"Chris Dy","startTime":395.99,"endTime":399.11,"body":"I'm also still and I shared this"},{"speaker":"Chris Dy","startTime":395.99,"endTime":399.11,"body":"in the prior episode last year,"},{"speaker":"Chris Dy","startTime":399.47,"endTime":402.77,"body":"still trying to figure out my"},{"speaker":"Chris Dy","startTime":399.47,"endTime":402.77,"body":"own sweet spot for how much,"},{"speaker":"Chris Dy","startTime":403.73,"endTime":405.74,"body":"when I need to do a"},{"speaker":"Chris Dy","startTime":403.73,"endTime":405.74,"body":"decompression of the median"},{"speaker":"Chris Dy","startTime":405.74,"endTime":408.56,"body":"nerve in the forearm. Because I"},{"speaker":"Chris Dy","startTime":405.74,"endTime":408.56,"body":"think it is a procedure in some"},{"speaker":"Chris Dy","startTime":408.56,"endTime":411.5,"body":"practices that is over utilized"},{"speaker":"Chris Dy","startTime":408.56,"endTime":411.5,"body":"and in under, other practices"},{"speaker":"Chris Dy","startTime":411.5,"endTime":412.61,"body":"might be underutilized."},{"speaker":"Charles Goldfarb","startTime":413.3,"endTime":414.56,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":413.3,"endTime":414.56,"body":"we could probably devote an"},{"speaker":"Charles Goldfarb","startTime":414.56,"endTime":417.08,"body":"episode to that, honestly,"},{"speaker":"Charles Goldfarb","startTime":414.56,"endTime":417.08,"body":"because I think there's a wide"},{"speaker":"Charles Goldfarb","startTime":417.08,"endTime":420.83,"body":"range of feelings about it. And"},{"speaker":"Charles Goldfarb","startTime":417.08,"endTime":420.83,"body":"certainly the strength of"},{"speaker":"Charles Goldfarb","startTime":420.83,"endTime":423.44,"body":"feelings varies amongst"},{"speaker":"Charles Goldfarb","startTime":420.83,"endTime":423.44,"body":"different surgeons, that might"},{"speaker":"Charles Goldfarb","startTime":423.44,"endTime":424.37,"body":"be a good one to hit on."},{"speaker":"Chris Dy","startTime":424.48,"endTime":426.91,"body":"But that would mean we"},{"speaker":"Chris Dy","startTime":424.48,"endTime":426.91,"body":"have to do more nerve. And I"},{"speaker":"Chris Dy","startTime":426.91,"endTime":429.67,"body":"know that's gonna bother you a"},{"speaker":"Chris Dy","startTime":426.91,"endTime":429.67,"body":"lot. So we'll have to figure out"},{"speaker":"Chris Dy","startTime":430.42,"endTime":433.24,"body":"some other sporty type topics to"},{"speaker":"Chris Dy","startTime":430.42,"endTime":433.24,"body":"do before we go back into"},{"speaker":"Chris Dy","startTime":433.24,"endTime":433.57,"body":"nerves."},{"speaker":"Charles Goldfarb","startTime":433.78,"endTime":435.82,"body":"To rejuvenate"},{"speaker":"Charles Goldfarb","startTime":433.78,"endTime":435.82,"body":"me. Yes, thank you. Thank you."},{"speaker":"Charles Goldfarb","startTime":436.78,"endTime":438.79,"body":"Alright, well, since we're"},{"speaker":"Charles Goldfarb","startTime":436.78,"endTime":438.79,"body":"talking about nerves, should we"},{"speaker":"Charles Goldfarb","startTime":438.79,"endTime":439.48,"body":"jump into it?"},{"speaker":"Chris Dy","startTime":440.29,"endTime":443.29,"body":"Yeah, nerve Episode"},{"speaker":"Chris Dy","startTime":440.29,"endTime":443.29,"body":"One was, I think really well"},{"speaker":"Chris Dy","startTime":443.29,"endTime":446.47,"body":"received. I'll give a shout out"},{"speaker":"Chris Dy","startTime":443.29,"endTime":446.47,"body":"to a colleague in Orlando, I"},{"speaker":"Chris Dy","startTime":446.47,"endTime":449.98,"body":"think he's in Orlando Karan"},{"speaker":"Chris Dy","startTime":446.47,"endTime":449.98,"body":"Desai. And he wrote me a nice"},{"speaker":"Chris Dy","startTime":449.98,"endTime":452.98,"body":"message on Twitter saying how"},{"speaker":"Chris Dy","startTime":449.98,"endTime":452.98,"body":"much he appreciated us diving"},{"speaker":"Chris Dy","startTime":452.98,"endTime":456.34,"body":"into the basics. Because that's"},{"speaker":"Chris Dy","startTime":452.98,"endTime":456.34,"body":"not the stuff that's always out"},{"speaker":"Chris Dy","startTime":456.34,"endTime":458.59,"body":"there in terms of what you see"},{"speaker":"Chris Dy","startTime":456.34,"endTime":458.59,"body":"at a meeting or what's in a"},{"speaker":"Chris Dy","startTime":458.59,"endTime":461.32,"body":"textbook. And I think you know,"},{"speaker":"Chris Dy","startTime":458.59,"endTime":461.32,"body":"some of the little practical"},{"speaker":"Chris Dy","startTime":461.32,"endTime":465.34,"body":"details, I think, are helpful."},{"speaker":"Chris Dy","startTime":461.32,"endTime":465.34,"body":"So hopefully, you know, this"},{"speaker":"Chris Dy","startTime":465.34,"endTime":467.89,"body":"part two will be helpful for"},{"speaker":"Chris Dy","startTime":465.34,"endTime":467.89,"body":"those that are listening, no"},{"speaker":"Chris Dy","startTime":467.89,"endTime":470.98,"body":"matter whether you're a trainee,"},{"speaker":"Chris Dy","startTime":467.89,"endTime":470.98,"body":"a seasoned surgeon or a hand"},{"speaker":"Chris Dy","startTime":470.98,"endTime":471.55,"body":"therapist."},{"speaker":"Charles Goldfarb","startTime":472.18,"endTime":473.59,"body":"Yeah, it is"},{"speaker":"Charles Goldfarb","startTime":472.18,"endTime":473.59,"body":"interesting, when you get to a"},{"speaker":"Charles Goldfarb","startTime":473.59,"endTime":477.31,"body":"certain point in one's career,"},{"speaker":"Charles Goldfarb","startTime":473.59,"endTime":477.31,"body":"you make assumptions about what"},{"speaker":"Charles Goldfarb","startTime":477.31,"endTime":480.22,"body":"you know. And as you and I have"},{"speaker":"Charles Goldfarb","startTime":477.31,"endTime":480.22,"body":"talked about before, and could"},{"speaker":"Charles Goldfarb","startTime":480.22,"endTime":483.13,"body":"revisit again, the dogma of what"},{"speaker":"Charles Goldfarb","startTime":480.22,"endTime":483.13,"body":"we do and why we do it. And"},{"speaker":"Charles Goldfarb","startTime":483.13,"endTime":486.37,"body":"sometimes you miss points, or"},{"speaker":"Charles Goldfarb","startTime":483.13,"endTime":486.37,"body":"I'll speak for myself, sometimes"},{"speaker":"Charles Goldfarb","startTime":486.37,"endTime":490.3,"body":"I miss points or critical issues"},{"speaker":"Charles Goldfarb","startTime":486.37,"endTime":490.3,"body":"and conversations like this."},{"speaker":"Charles Goldfarb","startTime":490.51,"endTime":493.18,"body":"While everyone will certainly"},{"speaker":"Charles Goldfarb","startTime":490.51,"endTime":493.18,"body":"not agree with everything we"},{"speaker":"Charles Goldfarb","startTime":493.18,"endTime":496.06,"body":"say, I think it will raise some"},{"speaker":"Charles Goldfarb","startTime":493.18,"endTime":496.06,"body":"issues which bear further"},{"speaker":"Charles Goldfarb","startTime":496.06,"endTime":496.63,"body":"discussion."},{"speaker":"Chris Dy","startTime":497.92,"endTime":499.87,"body":"I think there's"},{"speaker":"Chris Dy","startTime":497.92,"endTime":499.87,"body":"actually a pretty good case that"},{"speaker":"Chris Dy","startTime":499.87,"endTime":503.02,"body":"would help facilitate this part"},{"speaker":"Chris Dy","startTime":499.87,"endTime":503.02,"body":"two in the discussion, that I"},{"speaker":"Chris Dy","startTime":503.02,"endTime":507.85,"body":"had recently, I had a patient"},{"speaker":"Chris Dy","startTime":503.02,"endTime":507.85,"body":"with a radial nerve injury, in,"},{"speaker":"Chris Dy","startTime":508.09,"endTime":512.56,"body":"you know, at the same time, a"},{"speaker":"Chris Dy","startTime":508.09,"endTime":512.56,"body":"bad humerus fracture. And it was"},{"speaker":"Chris Dy","startTime":512.56,"endTime":515.74,"body":"from a motor vehicle accident."},{"speaker":"Chris Dy","startTime":512.56,"endTime":515.74,"body":"So you would have thought that"},{"speaker":"Chris Dy","startTime":515.74,"endTime":519.76,"body":"this was a kind of a stretch"},{"speaker":"Chris Dy","startTime":515.74,"endTime":519.76,"body":"injury to the nerve. Our trainee"},{"speaker":"Chris Dy","startTime":519.76,"endTime":522.55,"body":"astutely pointed out that there"},{"speaker":"Chris Dy","startTime":519.76,"endTime":522.55,"body":"was a radial nerve palsy before"},{"speaker":"Chris Dy","startTime":522.55,"endTime":526.78,"body":"surgery. And during surgery, our"},{"speaker":"Chris Dy","startTime":522.55,"endTime":526.78,"body":"fantastic trauma colleague went"},{"speaker":"Chris Dy","startTime":526.78,"endTime":531.34,"body":"ahead and exposed the radial"},{"speaker":"Chris Dy","startTime":526.78,"endTime":531.34,"body":"nerve to look at it, because"},{"speaker":"Chris Dy","startTime":531.34,"endTime":535.0,"body":"they were plating the, plating"},{"speaker":"Chris Dy","startTime":531.34,"endTime":535.0,"body":"the humerus. And that was"},{"speaker":"Chris Dy","startTime":535.0,"endTime":537.79,"body":"incredibly helpful information"},{"speaker":"Chris Dy","startTime":535.0,"endTime":537.79,"body":"because he told me the radial"},{"speaker":"Chris Dy","startTime":537.79,"endTime":541.57,"body":"nerve was in complete"},{"speaker":"Chris Dy","startTime":537.79,"endTime":541.57,"body":"discontinuity at the level of"},{"speaker":"Chris Dy","startTime":541.57,"endTime":546.94,"body":"the kind of just distal to the"},{"speaker":"Chris Dy","startTime":541.57,"endTime":546.94,"body":"so called spiral group. And that"},{"speaker":"Chris Dy","startTime":546.94,"endTime":550.45,"body":"allows us a lot of, you know, to"},{"speaker":"Chris Dy","startTime":546.94,"endTime":550.45,"body":"accelerate the decision making"},{"speaker":"Chris Dy","startTime":550.45,"endTime":553.27,"body":"process. You don't have to sit"},{"speaker":"Chris Dy","startTime":550.45,"endTime":553.27,"body":"around waiting, wondering"},{"speaker":"Chris Dy","startTime":553.27,"endTime":556.57,"body":"whether their nerve was intact"},{"speaker":"Chris Dy","startTime":553.27,"endTime":556.57,"body":"or not. But long story short, we"},{"speaker":"Chris Dy","startTime":556.57,"endTime":561.61,"body":"get to the OR, and we expose the"},{"speaker":"Chris Dy","startTime":556.57,"endTime":561.61,"body":"nerve. And the nerve is"},{"speaker":"Chris Dy","startTime":562.09,"endTime":564.46,"body":"obviously in complete"},{"speaker":"Chris Dy","startTime":562.09,"endTime":564.46,"body":"discontinuity, but then we've"},{"speaker":"Chris Dy","startTime":564.46,"endTime":566.44,"body":"got two ends of the nerve and"},{"speaker":"Chris Dy","startTime":564.46,"endTime":566.44,"body":"I'm trying to figure out how"},{"speaker":"Chris Dy","startTime":566.44,"endTime":570.1,"body":"much to cut back. And we talked"},{"speaker":"Chris Dy","startTime":566.44,"endTime":570.1,"body":"in the last episode about the"},{"speaker":"Chris Dy","startTime":570.1,"endTime":572.86,"body":"challenges of assessing an"},{"speaker":"Chris Dy","startTime":570.1,"endTime":572.86,"body":"injured nerve and how much to"},{"speaker":"Chris Dy","startTime":572.86,"endTime":577.51,"body":"cut back. And obviously, you can"},{"speaker":"Chris Dy","startTime":572.86,"endTime":577.51,"body":"always cut more. So we started"},{"speaker":"Chris Dy","startTime":577.54,"endTime":581.41,"body":"bread loafing and I was"},{"speaker":"Chris Dy","startTime":577.54,"endTime":581.41,"body":"surprised how good the fascicles"},{"speaker":"Chris Dy","startTime":581.41,"endTime":585.58,"body":"look despite kind of a woody"},{"speaker":"Chris Dy","startTime":581.41,"endTime":585.58,"body":"appearance on part of it. And"},{"speaker":"Chris Dy","startTime":585.58,"endTime":589.48,"body":"that kind of leads us to a gap"},{"speaker":"Chris Dy","startTime":585.58,"endTime":589.48,"body":"in our knowledge as surgeons is,"},{"speaker":"Chris Dy","startTime":589.48,"endTime":592.99,"body":"you know, how do we assess"},{"speaker":"Chris Dy","startTime":589.48,"endTime":592.99,"body":"injured nerves? And how do you"},{"speaker":"Chris Dy","startTime":593.02,"endTime":596.29,"body":"you know, when you're looking at"},{"speaker":"Chris Dy","startTime":593.02,"endTime":596.29,"body":"cut nerve ends, and trying to"},{"speaker":"Chris Dy","startTime":596.29,"endTime":599.32,"body":"figure out you know, I'm trying"},{"speaker":"Chris Dy","startTime":596.29,"endTime":599.32,"body":"not to put too long of a graft,"},{"speaker":"Chris Dy","startTime":599.32,"endTime":601.75,"body":"but I need to be in good nerve,"},{"speaker":"Chris Dy","startTime":599.32,"endTime":601.75,"body":"how do you go through that"},{"speaker":"Chris Dy","startTime":601.75,"endTime":603.88,"body":"process of cutting back? And"},{"speaker":"Chris Dy","startTime":601.75,"endTime":603.88,"body":"that kind of thing?"},{"speaker":"Charles Goldfarb","startTime":604.03,"endTime":606.58,"body":"The temporal"},{"speaker":"Charles Goldfarb","startTime":604.03,"endTime":606.58,"body":"component is certainly super"},{"speaker":"Charles Goldfarb","startTime":606.58,"endTime":609.34,"body":"important. And so I don't it"},{"speaker":"Charles Goldfarb","startTime":606.58,"endTime":609.34,"body":"sounds as though you went to the"},{"speaker":"Charles Goldfarb","startTime":609.34,"endTime":613.93,"body":"OR, immediately with this case,"},{"speaker":"Charles Goldfarb","startTime":609.34,"endTime":613.93,"body":"or certainly within a very short"},{"speaker":"Charles Goldfarb","startTime":613.93,"endTime":614.2,"body":"time."},{"speaker":"Chris Dy","startTime":615.28,"endTime":616.24,"body":"Within a few weeks."},{"speaker":"Charles Goldfarb","startTime":616.54,"endTime":618.34,"body":"Yeah. And"},{"speaker":"Charles Goldfarb","startTime":616.54,"endTime":618.34,"body":"that's, that's really"},{"speaker":"Charles Goldfarb","startTime":618.34,"endTime":622.21,"body":"interesting, because I don't"},{"speaker":"Charles Goldfarb","startTime":618.34,"endTime":622.21,"body":"know that well, I do know that"},{"speaker":"Charles Goldfarb","startTime":622.21,"endTime":626.2,"body":"it will not have fully declared"},{"speaker":"Charles Goldfarb","startTime":622.21,"endTime":626.2,"body":"itself by that time. And so you"},{"speaker":"Charles Goldfarb","startTime":626.2,"endTime":630.73,"body":"have more experience with"},{"speaker":"Charles Goldfarb","startTime":626.2,"endTime":630.73,"body":"assessing nerve viability, we'd"},{"speaker":"Charles Goldfarb","startTime":630.73,"endTime":634.63,"body":"love to have more information"},{"speaker":"Charles Goldfarb","startTime":630.73,"endTime":634.63,"body":"than simple appearance and feel,"},{"speaker":"Charles Goldfarb","startTime":634.81,"endTime":641.14,"body":"I do use bulging fascicles as my"},{"speaker":"Charles Goldfarb","startTime":634.81,"endTime":641.14,"body":"primary indicator. And I, you"},{"speaker":"Charles Goldfarb","startTime":641.14,"endTime":645.61,"body":"know, cut from distal to"},{"speaker":"Charles Goldfarb","startTime":641.14,"endTime":645.61,"body":"proximal, I think in the setting"},{"speaker":"Charles Goldfarb","startTime":645.61,"endTime":648.91,"body":"of a radial nerve, it's probably"},{"speaker":"Charles Goldfarb","startTime":645.61,"endTime":648.91,"body":"a little less important to work"},{"speaker":"Charles Goldfarb","startTime":648.91,"endTime":651.31,"body":"for every millimeter, because"},{"speaker":"Charles Goldfarb","startTime":648.91,"endTime":651.31,"body":"you're already going to be"},{"speaker":"Charles Goldfarb","startTime":651.31,"endTime":654.34,"body":"talking about a longer recovery"},{"speaker":"Charles Goldfarb","startTime":651.31,"endTime":654.34,"body":"period, and you're talking about"},{"speaker":"Charles Goldfarb","startTime":654.34,"endTime":656.74,"body":"a bigger gap, presumably, so"},{"speaker":"Charles Goldfarb","startTime":654.34,"endTime":656.74,"body":"probably a little less"},{"speaker":"Charles Goldfarb","startTime":656.74,"endTime":660.67,"body":"important. But it's visual for"},{"speaker":"Charles Goldfarb","startTime":656.74,"endTime":660.67,"body":"me primarily."},{"speaker":"Chris Dy","startTime":662.16,"endTime":665.16,"body":"So how would you if"},{"speaker":"Chris Dy","startTime":662.16,"endTime":665.16,"body":"you were to look at this gap,"},{"speaker":"Chris Dy","startTime":665.25,"endTime":668.37,"body":"and you've got, you know, you've"},{"speaker":"Chris Dy","startTime":665.25,"endTime":668.37,"body":"got your extruding fascicles on"},{"speaker":"Chris Dy","startTime":668.37,"endTime":671.28,"body":"both ends, and say, you've got a"},{"speaker":"Chris Dy","startTime":668.37,"endTime":671.28,"body":"reasonable length gap, three or"},{"speaker":"Chris Dy","startTime":671.28,"endTime":674.88,"body":"four centimeters? Tell me how"},{"speaker":"Chris Dy","startTime":671.28,"endTime":674.88,"body":"you were trained, and how you"},{"speaker":"Chris Dy","startTime":675.27,"endTime":678.12,"body":"very occasionally very rarely"},{"speaker":"Chris Dy","startTime":675.27,"endTime":678.12,"body":"will go harvest the sural nerve."},{"speaker":"Charles Goldfarb","startTime":679.35,"endTime":681.27,"body":"Yeah, I'm"},{"speaker":"Charles Goldfarb","startTime":679.35,"endTime":681.27,"body":"grateful that you're my partner."},{"speaker":"Charles Goldfarb","startTime":681.27,"endTime":683.88,"body":"Because I don't have to do that"},{"speaker":"Charles Goldfarb","startTime":681.27,"endTime":683.88,"body":"all that much anymore. Sural"},{"speaker":"Charles Goldfarb","startTime":683.88,"endTime":687.72,"body":"nerve harvest is not my favorite"},{"speaker":"Charles Goldfarb","startTime":683.88,"endTime":687.72,"body":"thing to do. You know, it's"},{"speaker":"Charles Goldfarb","startTime":687.72,"endTime":690.6,"body":"interesting, because with a"},{"speaker":"Charles Goldfarb","startTime":687.72,"endTime":690.6,"body":"radial nerve, I would assume you"},{"speaker":"Charles Goldfarb","startTime":690.6,"endTime":693.12,"body":"would have put the patient in a"},{"speaker":"Charles Goldfarb","startTime":690.6,"endTime":693.12,"body":"lateral position which would"},{"speaker":"Charles Goldfarb","startTime":693.12,"endTime":696.09,"body":"ease both your exposure and your"},{"speaker":"Charles Goldfarb","startTime":693.12,"endTime":696.09,"body":"harvest, or you could certainly"},{"speaker":"Charles Goldfarb","startTime":696.09,"endTime":700.32,"body":"argue for a prone position as"},{"speaker":"Charles Goldfarb","startTime":696.09,"endTime":700.32,"body":"well, with the arm over an arm"},{"speaker":"Charles Goldfarb","startTime":700.32,"endTime":703.05,"body":"board, either way, I think would"},{"speaker":"Charles Goldfarb","startTime":700.32,"endTime":703.05,"body":"give me good access, and you"},{"speaker":"Charles Goldfarb","startTime":703.05,"endTime":707.37,"body":"wouldn't be struggling for the"},{"speaker":"Charles Goldfarb","startTime":703.05,"endTime":707.37,"body":"sural nerve harvest. While I do"},{"speaker":"Charles Goldfarb","startTime":707.37,"endTime":711.21,"body":"believe that transverse"},{"speaker":"Charles Goldfarb","startTime":707.37,"endTime":711.21,"body":"incisions for sural nerve"},{"speaker":"Charles Goldfarb","startTime":711.21,"endTime":714.6,"body":"harvests are acute, I have"},{"speaker":"Charles Goldfarb","startTime":711.21,"endTime":714.6,"body":"typically not proceeded in that"},{"speaker":"Charles Goldfarb","startTime":714.6,"endTime":719.04,"body":"direction, I typically make a"},{"speaker":"Charles Goldfarb","startTime":714.6,"endTime":719.04,"body":"longitudinal incision, find the"},{"speaker":"Charles Goldfarb","startTime":719.04,"endTime":722.91,"body":"nerve distally, isolate it. And"},{"speaker":"Charles Goldfarb","startTime":719.04,"endTime":722.91,"body":"then depending obviously, on"},{"speaker":"Charles Goldfarb","startTime":722.91,"endTime":728.25,"body":"what I need, you know, take the"},{"speaker":"Charles Goldfarb","startTime":722.91,"endTime":728.25,"body":"nerve. I know you do a tran-,"},{"speaker":"Charles Goldfarb","startTime":728.28,"endTime":730.71,"body":"you do the acute transverse"},{"speaker":"Charles Goldfarb","startTime":728.28,"endTime":730.71,"body":"incisions, as I recall."},{"speaker":"Chris Dy","startTime":731.62,"endTime":734.17,"body":"It depends on who's"},{"speaker":"Chris Dy","startTime":731.62,"endTime":734.17,"body":"doing it. So one of those things"},{"speaker":"Chris Dy","startTime":734.17,"endTime":736.75,"body":"is you know, so for this"},{"speaker":"Chris Dy","startTime":734.17,"endTime":736.75,"body":"particular case, unfortunately,"},{"speaker":"Chris Dy","startTime":736.75,"endTime":740.23,"body":"we had the patient supine,"},{"speaker":"Chris Dy","startTime":736.75,"endTime":740.23,"body":"because there was a possibility,"},{"speaker":"Chris Dy","startTime":740.23,"endTime":742.87,"body":"depending on the gap of just"},{"speaker":"Chris Dy","startTime":740.23,"endTime":742.87,"body":"straight out doing a nerve"},{"speaker":"Chris Dy","startTime":742.87,"endTime":747.4,"body":"transfer. So I wanted the"},{"speaker":"Chris Dy","startTime":742.87,"endTime":747.4,"body":"ability to use a hand table, so"},{"speaker":"Chris Dy","startTime":747.4,"endTime":750.1,"body":"I had them supine, but actually"},{"speaker":"Chris Dy","startTime":747.4,"endTime":750.1,"body":"have their arm up in like a"},{"speaker":"Chris Dy","startTime":750.1,"endTime":752.89,"body":"McConnell arm holder, like a"},{"speaker":"Chris Dy","startTime":750.1,"endTime":752.89,"body":"shoulder scope kind of thing. So"},{"speaker":"Chris Dy","startTime":752.89,"endTime":755.89,"body":"I could bring the arm over the"},{"speaker":"Chris Dy","startTime":752.89,"endTime":755.89,"body":"chest and work laterally and"},{"speaker":"Chris Dy","startTime":755.89,"endTime":760.9,"body":"posteriorly for the approach to"},{"speaker":"Chris Dy","startTime":755.89,"endTime":760.9,"body":"the nerve, which obviously makes"},{"speaker":"Chris Dy","startTime":760.9,"endTime":765.19,"body":"it harder to harvest sural"},{"speaker":"Chris Dy","startTime":760.9,"endTime":765.19,"body":"nerve. I still remember in my"},{"speaker":"Chris Dy","startTime":765.19,"endTime":768.4,"body":"first year of practice, our"},{"speaker":"Chris Dy","startTime":765.19,"endTime":768.4,"body":"partner Marty Boyer coming and"},{"speaker":"Chris Dy","startTime":768.4,"endTime":772.06,"body":"helping me with a Plexus case"},{"speaker":"Chris Dy","startTime":768.4,"endTime":772.06,"body":"and volunteering to go harvest"},{"speaker":"Chris Dy","startTime":772.06,"endTime":775.54,"body":"the sural nerve while the"},{"speaker":"Chris Dy","startTime":772.06,"endTime":775.54,"body":"patient was supine. And you"},{"speaker":"Chris Dy","startTime":775.54,"endTime":778.3,"body":"know, the number of times that I"},{"speaker":"Chris Dy","startTime":775.54,"endTime":778.3,"body":"heard about the crick in the"},{"speaker":"Chris Dy","startTime":778.33,"endTime":782.32,"body":"neck for the following weeks,"},{"speaker":"Chris Dy","startTime":778.33,"endTime":782.32,"body":"you know, I, I'd be rich if I"},{"speaker":"Chris Dy","startTime":782.32,"endTime":786.43,"body":"got a dime for all of them. But"},{"speaker":"Chris Dy","startTime":782.32,"endTime":786.43,"body":"it is hard because somebody is"},{"speaker":"Chris Dy","startTime":786.52,"endTime":789.22,"body":"usually you know, I usually send"},{"speaker":"Chris Dy","startTime":786.52,"endTime":789.22,"body":"a trainee to do it. Because it's"},{"speaker":"Chris Dy","startTime":789.22,"endTime":792.22,"body":"it's actually really good"},{"speaker":"Chris Dy","startTime":789.22,"endTime":792.22,"body":"practice to dissect around the"},{"speaker":"Chris Dy","startTime":792.22,"endTime":795.97,"body":"nerve from a technical"},{"speaker":"Chris Dy","startTime":792.22,"endTime":795.97,"body":"perspective. But you want"},{"speaker":"Chris Dy","startTime":795.97,"endTime":798.25,"body":"somebody there that can help"},{"speaker":"Chris Dy","startTime":795.97,"endTime":798.25,"body":"hold the leg for them if you're"},{"speaker":"Chris Dy","startTime":798.25,"endTime":801.7,"body":"in the supine position. I"},{"speaker":"Chris Dy","startTime":798.25,"endTime":801.7,"body":"usually go with one longitudinal"},{"speaker":"Chris Dy","startTime":801.7,"endTime":805.99,"body":"incision to start between the"},{"speaker":"Chris Dy","startTime":801.7,"endTime":805.99,"body":"Achilles and the lateral"},{"speaker":"Chris Dy","startTime":805.99,"endTime":809.05,"body":"malleolus, probably about three"},{"speaker":"Chris Dy","startTime":805.99,"endTime":809.05,"body":"or four centimeters just to get"},{"speaker":"Chris Dy","startTime":809.05,"endTime":811.69,"body":"your bearings. And then if it's"},{"speaker":"Chris Dy","startTime":809.05,"endTime":811.69,"body":"me, I don't mind doing the"},{"speaker":"Chris Dy","startTime":811.69,"endTime":814.66,"body":"transverse incisions going up"},{"speaker":"Chris Dy","startTime":811.69,"endTime":814.66,"body":"proximally because I'm more"},{"speaker":"Chris Dy","startTime":814.84,"endTime":818.62,"body":"obviously a little more"},{"speaker":"Chris Dy","startTime":814.84,"endTime":818.62,"body":"experienced with it. But if it's"},{"speaker":"Chris Dy","startTime":818.62,"endTime":821.62,"body":"a trainee, I tell him your one"},{"speaker":"Chris Dy","startTime":818.62,"endTime":821.62,"body":"job is to find this nerve and do"},{"speaker":"Chris Dy","startTime":821.62,"endTime":823.81,"body":"it well, because that nerve is"},{"speaker":"Chris Dy","startTime":821.62,"endTime":823.81,"body":"gold. I don't want you getting"},{"speaker":"Chris Dy","startTime":823.81,"endTime":827.08,"body":"acute. I don't want any, you"},{"speaker":"Chris Dy","startTime":823.81,"endTime":827.08,"body":"know, shortcuts on this, because"},{"speaker":"Chris Dy","startTime":827.26,"endTime":829.57,"body":"we're here for one reason. It's"},{"speaker":"Chris Dy","startTime":827.26,"endTime":829.57,"body":"pretty high stakes surgery."},{"speaker":"Charles Goldfarb","startTime":830.65,"endTime":832.81,"body":"Yeah, and it's"},{"speaker":"Charles Goldfarb","startTime":830.65,"endTime":832.81,"body":"great. I mean, it is a good with"},{"speaker":"Charles Goldfarb","startTime":832.81,"endTime":835.39,"body":"the right training, it's a good,"},{"speaker":"Charles Goldfarb","startTime":832.81,"endTime":835.39,"body":"you know, good way to give them"},{"speaker":"Charles Goldfarb","startTime":835.39,"endTime":839.47,"body":"autonomy and expect, you know,"},{"speaker":"Charles Goldfarb","startTime":835.39,"endTime":839.47,"body":"an excellent harvest. Go back,"},{"speaker":"Charles Goldfarb","startTime":839.5,"endTime":843.04,"body":"we're gonna have a whole chat"},{"speaker":"Charles Goldfarb","startTime":839.5,"endTime":843.04,"body":"about nerve transfers, we hope"},{"speaker":"Charles Goldfarb","startTime":843.04,"endTime":845.68,"body":"in the near future. But go back"},{"speaker":"Charles Goldfarb","startTime":843.04,"endTime":845.68,"body":"to what you said. You said you"},{"speaker":"Charles Goldfarb","startTime":845.68,"endTime":848.53,"body":"placed them supine, because"},{"speaker":"Charles Goldfarb","startTime":845.68,"endTime":848.53,"body":"there's a possibility of a nerve"},{"speaker":"Charles Goldfarb","startTime":848.53,"endTime":852.85,"body":"transfer, depending on the gap."},{"speaker":"Charles Goldfarb","startTime":848.53,"endTime":852.85,"body":"Explain what you mean. Does a"},{"speaker":"Charles Goldfarb","startTime":852.85,"endTime":856.24,"body":"small gap in this situation lead"},{"speaker":"Charles Goldfarb","startTime":852.85,"endTime":856.24,"body":"to a nerve transfer, a big gap"},{"speaker":"Charles Goldfarb","startTime":856.27,"endTime":857.83,"body":"leads you- explain what you"},{"speaker":"Charles Goldfarb","startTime":856.27,"endTime":857.83,"body":"mean."},{"speaker":"Chris Dy","startTime":858.11,"endTime":861.05,"body":"Yeah. So for me, it"},{"speaker":"Chris Dy","startTime":858.11,"endTime":861.05,"body":"was you know, if I was able to"},{"speaker":"Chris Dy","startTime":861.05,"endTime":864.26,"body":"get, you know, we knew the nerve"},{"speaker":"Chris Dy","startTime":861.05,"endTime":864.26,"body":"was- in this particular case, we"},{"speaker":"Chris Dy","startTime":864.26,"endTime":867.14,"body":"knew there was discontinuity of"},{"speaker":"Chris Dy","startTime":864.26,"endTime":867.14,"body":"nerve, but we'd have to trim"},{"speaker":"Chris Dy","startTime":867.14,"endTime":870.56,"body":"back. And if we got to a gap"},{"speaker":"Chris Dy","startTime":867.14,"endTime":870.56,"body":"that was I felt reasonable,"},{"speaker":"Chris Dy","startTime":870.56,"endTime":874.82,"body":"somewhere less than five, maybe"},{"speaker":"Chris Dy","startTime":870.56,"endTime":874.82,"body":"six or seven centimeters for a"},{"speaker":"Chris Dy","startTime":874.82,"endTime":879.32,"body":"cable graft. If we were able to"},{"speaker":"Chris Dy","startTime":874.82,"endTime":879.32,"body":"do that, then I would say, all"},{"speaker":"Chris Dy","startTime":879.32,"endTime":881.51,"body":"right, well, let's see what we"},{"speaker":"Chris Dy","startTime":879.32,"endTime":881.51,"body":"can get because we were so early"},{"speaker":"Chris Dy","startTime":881.51,"endTime":885.17,"body":"on, we're only a few weeks from"},{"speaker":"Chris Dy","startTime":881.51,"endTime":885.17,"body":"the injury. And then if we get a"},{"speaker":"Chris Dy","startTime":885.17,"endTime":888.23,"body":"response, we can track it a Tine"},{"speaker":"Chris Dy","startTime":885.17,"endTime":888.23,"body":"s, we see some early wrist"},{"speaker":"Chris Dy","startTime":888.23,"endTime":890.39,"body":"extension, that kind of thing."},{"speaker":"Chris Dy","startTime":888.23,"endTime":890.39,"body":"Great. We don't need to do"},{"speaker":"Chris Dy","startTime":890.39,"endTime":895.82,"body":"anything else. I expect the PIN"},{"speaker":"Chris Dy","startTime":890.39,"endTime":895.82,"body":"to recover, etc. But if I if I"},{"speaker":"Chris Dy","startTime":895.85,"endTime":898.91,"body":"didn't see a good response after"},{"speaker":"Chris Dy","startTime":895.85,"endTime":898.91,"body":"a reasonable length nerve graph,"},{"speaker":"Chris Dy","startTime":898.91,"endTime":903.23,"body":"we could have you know, said, we"},{"speaker":"Chris Dy","startTime":898.91,"endTime":903.23,"body":"still are early on the anterior"},{"speaker":"Chris Dy","startTime":903.23,"endTime":906.44,"body":"forearm is still virgin anatomy,"},{"speaker":"Chris Dy","startTime":903.23,"endTime":906.44,"body":"we can go to a nerve transfer"},{"speaker":"Chris Dy","startTime":906.44,"endTime":909.08,"body":"within a few months, even within"},{"speaker":"Chris Dy","startTime":906.44,"endTime":909.08,"body":"six months or something and"},{"speaker":"Chris Dy","startTime":909.08,"endTime":913.37,"body":"still have a reasonable chance."},{"speaker":"Chris Dy","startTime":909.08,"endTime":913.37,"body":"Now, if that gap was excessively"},{"speaker":"Chris Dy","startTime":913.37,"endTime":916.22,"body":"long, I probably would have just"},{"speaker":"Chris Dy","startTime":913.37,"endTime":916.22,"body":"jumped to the nerve transfers"},{"speaker":"Chris Dy","startTime":916.37,"endTime":918.86,"body":"right then and there. And in"},{"speaker":"Chris Dy","startTime":916.37,"endTime":918.86,"body":"this case, the gap wasn't"},{"speaker":"Chris Dy","startTime":918.86,"endTime":921.98,"body":"excessively long. So it was a,"},{"speaker":"Chris Dy","startTime":918.86,"endTime":921.98,"body":"it was it was kind of an"},{"speaker":"Chris Dy","startTime":921.98,"endTime":925.37,"body":"interesting case, because I had"},{"speaker":"Chris Dy","startTime":921.98,"endTime":925.37,"body":"a nice branch to the lower"},{"speaker":"Chris Dy","startTime":925.37,"endTime":928.01,"body":"lateral head of the triceps that"},{"speaker":"Chris Dy","startTime":925.37,"endTime":928.01,"body":"I transferred into the radial"},{"speaker":"Chris Dy","startTime":928.01,"endTime":931.55,"body":"nerve as well. And that's a"},{"speaker":"Chris Dy","startTime":928.01,"endTime":931.55,"body":"whole different. I don't know,"},{"speaker":"Chris Dy","startTime":931.55,"endTime":934.55,"body":"if the radial nerve decision"},{"speaker":"Chris Dy","startTime":931.55,"endTime":934.55,"body":"making algorithm deserves its"},{"speaker":"Chris Dy","startTime":934.55,"endTime":936.8,"body":"own episode, it probably does."},{"speaker":"Chris Dy","startTime":934.55,"endTime":936.8,"body":"Because there's a lot of"},{"speaker":"Chris Dy","startTime":936.8,"endTime":937.67,"body":"controversy there."},{"speaker":"Charles Goldfarb","startTime":938.35,"endTime":939.91,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":938.35,"endTime":939.91,"body":"absolutely, we're gonna, I'm"},{"speaker":"Charles Goldfarb","startTime":939.91,"endTime":943.0,"body":"gonna stay away from saying"},{"speaker":"Charles Goldfarb","startTime":939.91,"endTime":943.0,"body":"tendon transfers rule the world."},{"speaker":"Charles Goldfarb","startTime":943.3,"endTime":945.82,"body":"Alright, so let's say you've"},{"speaker":"Charles Goldfarb","startTime":943.3,"endTime":945.82,"body":"harvested-"},{"speaker":"Chris Dy","startTime":945.82,"endTime":947.77,"body":"It's ok, as long as"},{"speaker":"Chris Dy","startTime":945.82,"endTime":947.77,"body":"long as you don't need to take"},{"speaker":"Chris Dy","startTime":948.01,"endTime":950.71,"body":"because you can't extend your"},{"speaker":"Chris Dy","startTime":948.01,"endTime":950.71,"body":"fingers independently. So that's"},{"speaker":"Chris Dy","startTime":950.71,"endTime":952.93,"body":"fine, you know, lower your"},{"speaker":"Chris Dy","startTime":950.71,"endTime":952.93,"body":"expectations."},{"speaker":"Charles Goldfarb","startTime":954.52,"endTime":956.95,"body":"Alright, I'm"},{"speaker":"Charles Goldfarb","startTime":954.52,"endTime":956.95,"body":"gonna ignore that and move on."},{"speaker":"Charles Goldfarb","startTime":957.16,"endTime":961.66,"body":"So we have our sural nerve"},{"speaker":"Charles Goldfarb","startTime":957.16,"endTime":961.66,"body":"graft? How do you make the"},{"speaker":"Charles Goldfarb","startTime":961.66,"endTime":967.54,"body":"determination of how many cables"},{"speaker":"Charles Goldfarb","startTime":961.66,"endTime":967.54,"body":"you use? Is there a is it simply"},{"speaker":"Charles Goldfarb","startTime":967.54,"endTime":972.16,"body":"based on overlap on the proximal"},{"speaker":"Charles Goldfarb","startTime":967.54,"endTime":972.16,"body":"end of the radial nerve? Do you"},{"speaker":"Charles Goldfarb","startTime":972.16,"endTime":975.25,"body":"try to put as many cables as you"},{"speaker":"Charles Goldfarb","startTime":972.16,"endTime":975.25,"body":"can, based on the amount of"},{"speaker":"Charles Goldfarb","startTime":975.25,"endTime":978.61,"body":"nerve you have? Certainly you"},{"speaker":"Charles Goldfarb","startTime":975.25,"endTime":978.61,"body":"don't want to skimp, just talk"},{"speaker":"Charles Goldfarb","startTime":978.61,"endTime":979.93,"body":"through how you think about"},{"speaker":"Charles Goldfarb","startTime":978.61,"endTime":979.93,"body":"that."},{"speaker":"Chris Dy","startTime":981.16,"endTime":983.71,"body":"Yeah, I think some of"},{"speaker":"Chris Dy","startTime":981.16,"endTime":983.71,"body":"that obviously, depends on the"},{"speaker":"Chris Dy","startTime":983.71,"endTime":987.01,"body":"diameter of the nerve you're"},{"speaker":"Chris Dy","startTime":983.71,"endTime":987.01,"body":"working with. And I posted a"},{"speaker":"Chris Dy","startTime":987.01,"endTime":990.82,"body":"case to Twitter, some pictures"},{"speaker":"Chris Dy","startTime":987.01,"endTime":990.82,"body":"recently that showed me using"},{"speaker":"Chris Dy","startTime":990.88,"endTime":995.53,"body":"the nerve cutting or neuro tone"},{"speaker":"Chris Dy","startTime":990.88,"endTime":995.53,"body":"set from a company called ASSI,"},{"speaker":"Chris Dy","startTime":995.53,"endTime":997.54,"body":"I have no conflicts of interest,"},{"speaker":"Chris Dy","startTime":995.53,"endTime":997.54,"body":"I think they're the only ones"},{"speaker":"Chris Dy","startTime":997.54,"endTime":1002.37,"body":"that make it. And it essentially"},{"speaker":"Chris Dy","startTime":997.54,"endTime":1002.37,"body":"it, it sizes the nerve and then"},{"speaker":"Chris Dy","startTime":1002.37,"endTime":1005.79,"body":"you can, it has a slit where you"},{"speaker":"Chris Dy","startTime":1002.37,"endTime":1005.79,"body":"can put a scalpel in and cut"},{"speaker":"Chris Dy","startTime":1005.79,"endTime":1008.55,"body":"through that. Now I don't love"},{"speaker":"Chris Dy","startTime":1005.79,"endTime":1008.55,"body":"the scalpel on the blade that"},{"speaker":"Chris Dy","startTime":1008.55,"endTime":1010.92,"body":"comes with it. So I actually end"},{"speaker":"Chris Dy","startTime":1008.55,"endTime":1010.92,"body":"up using that to help hold the"},{"speaker":"Chris Dy","startTime":1010.92,"endTime":1015.3,"body":"nerve and then I will still cut"},{"speaker":"Chris Dy","startTime":1010.92,"endTime":1015.3,"body":"over a tongue depressor. But"},{"speaker":"Chris Dy","startTime":1015.3,"endTime":1018.09,"body":"while you're doing that, that"},{"speaker":"Chris Dy","startTime":1015.3,"endTime":1018.09,"body":"helps you size, the diameter of"},{"speaker":"Chris Dy","startTime":1018.12,"endTime":1020.82,"body":"the nerve. And that can help you"},{"speaker":"Chris Dy","startTime":1018.12,"endTime":1020.82,"body":"figure out how many cables to"},{"speaker":"Chris Dy","startTime":1020.82,"endTime":1023.52,"body":"use. And then there's a nice"},{"speaker":"Chris Dy","startTime":1020.82,"endTime":1023.52,"body":"technique, I think it was"},{"speaker":"Chris Dy","startTime":1023.52,"endTime":1026.43,"body":"described in a paper out of"},{"speaker":"Chris Dy","startTime":1023.52,"endTime":1026.43,"body":"University of North Carolina,"},{"speaker":"Chris Dy","startTime":1027.15,"endTime":1032.58,"body":"using those to help shape your"},{"speaker":"Chris Dy","startTime":1027.15,"endTime":1032.58,"body":"sural graphs when you cable"},{"speaker":"Chris Dy","startTime":1032.58,"endTime":1036.36,"body":"them. So not only can it help"},{"speaker":"Chris Dy","startTime":1032.58,"endTime":1036.36,"body":"you figure out how many cables"},{"speaker":"Chris Dy","startTime":1036.36,"endTime":1040.35,"body":"you need, but then also helps"},{"speaker":"Chris Dy","startTime":1036.36,"endTime":1040.35,"body":"you shape the graft so that it's"},{"speaker":"Chris Dy","startTime":1040.38,"endTime":1042.39,"body":"easier to handle once it's back"},{"speaker":"Chris Dy","startTime":1040.38,"endTime":1042.39,"body":"on the field."},{"speaker":"Charles Goldfarb","startTime":1043.95,"endTime":1047.46,"body":"Okay, and"},{"speaker":"Charles Goldfarb","startTime":1043.95,"endTime":1047.46,"body":"describe your suturing"},{"speaker":"Charles Goldfarb","startTime":1047.46,"endTime":1052.05,"body":"technique, when you do perform a"},{"speaker":"Charles Goldfarb","startTime":1047.46,"endTime":1052.05,"body":"cable graft. How many sutures"},{"speaker":"Charles Goldfarb","startTime":1052.05,"endTime":1054.75,"body":"you let's say you have three"},{"speaker":"Charles Goldfarb","startTime":1052.05,"endTime":1054.75,"body":"cables, which might be more than"},{"speaker":"Charles Goldfarb","startTime":1054.75,"endTime":1057.12,"body":"you would need. Let's say you"},{"speaker":"Charles Goldfarb","startTime":1054.75,"endTime":1057.12,"body":"have three cables for this"},{"speaker":"Charles Goldfarb","startTime":1057.12,"endTime":1060.54,"body":"radial nerve, you have plenty of"},{"speaker":"Charles Goldfarb","startTime":1057.12,"endTime":1060.54,"body":"length, tell me what you do"},{"speaker":"Charles Goldfarb","startTime":1060.54,"endTime":1061.05,"body":"next."},{"speaker":"Chris Dy","startTime":1062.41,"endTime":1065.92,"body":"So probably a first"},{"speaker":"Chris Dy","startTime":1062.41,"endTime":1065.92,"body":"good technical pearl that I was"},{"speaker":"Chris Dy","startTime":1065.92,"endTime":1069.1,"body":"taught is that you know, when"},{"speaker":"Chris Dy","startTime":1065.92,"endTime":1069.1,"body":"you're measuring your gap, the"},{"speaker":"Chris Dy","startTime":1069.1,"endTime":1072.55,"body":"last thing you want to do is go"},{"speaker":"Chris Dy","startTime":1069.1,"endTime":1072.55,"body":"size your your cable graft and"},{"speaker":"Chris Dy","startTime":1072.55,"endTime":1077.68,"body":"then be short. So we measure"},{"speaker":"Chris Dy","startTime":1072.55,"endTime":1077.68,"body":"your gap, add 20% and then you"},{"speaker":"Chris Dy","startTime":1077.68,"endTime":1081.97,"body":"know use that 20% to make your"},{"speaker":"Chris Dy","startTime":1077.68,"endTime":1081.97,"body":"cables. I like to use you know,"},{"speaker":"Chris Dy","startTime":1081.97,"endTime":1086.83,"body":"put them in those neuro tone"},{"speaker":"Chris Dy","startTime":1081.97,"endTime":1086.83,"body":"holding devices. And then put a"},{"speaker":"Chris Dy","startTime":1086.83,"endTime":1090.13,"body":"little fibrin glue or TISSEEL"},{"speaker":"Chris Dy","startTime":1086.83,"endTime":1090.13,"body":"again, like we said last time"},{"speaker":"Chris Dy","startTime":1090.13,"endTime":1095.26,"body":"it's an off label use for nerve"},{"speaker":"Chris Dy","startTime":1090.13,"endTime":1095.26,"body":"but that helps then the nerve"},{"speaker":"Chris Dy","startTime":1095.26,"endTime":1098.08,"body":"graft to handle a little bit"},{"speaker":"Chris Dy","startTime":1095.26,"endTime":1098.08,"body":"easier and actually forms a nice"},{"speaker":"Chris Dy","startTime":1098.08,"endTime":1101.02,"body":"little sealed epineurium type"},{"speaker":"Chris Dy","startTime":1098.08,"endTime":1101.02,"body":"thing that you can use for"},{"speaker":"Chris Dy","startTime":1101.02,"endTime":1104.05,"body":"handling and putting your"},{"speaker":"Chris Dy","startTime":1101.02,"endTime":1104.05,"body":"sutures in. After you've sealed"},{"speaker":"Chris Dy","startTime":1104.05,"endTime":1108.46,"body":"both ends with some of the glue,"},{"speaker":"Chris Dy","startTime":1104.05,"endTime":1108.46,"body":"you obviously have to cut it"},{"speaker":"Chris Dy","startTime":1108.46,"endTime":1111.85,"body":"back again so that you're not"},{"speaker":"Chris Dy","startTime":1108.46,"endTime":1111.85,"body":"you know, you so that you're"},{"speaker":"Chris Dy","startTime":1111.88,"endTime":1114.97,"body":"coapting fascicles to fascicles"},{"speaker":"Chris Dy","startTime":1111.88,"endTime":1114.97,"body":"and so you have the fresh end."},{"speaker":"Chris Dy","startTime":1115.54,"endTime":1119.62,"body":"And then I usually use a 9-0"},{"speaker":"Chris Dy","startTime":1115.54,"endTime":1119.62,"body":"nylon, and for the reasons that"},{"speaker":"Chris Dy","startTime":1119.62,"endTime":1123.22,"body":"we stated in the last episode."},{"speaker":"Chris Dy","startTime":1119.62,"endTime":1123.22,"body":"And I will use probably about"},{"speaker":"Chris Dy","startTime":1123.67,"endTime":1127.39,"body":"four to five, three to four"},{"speaker":"Chris Dy","startTime":1123.67,"endTime":1127.39,"body":"depending on you know the size"},{"speaker":"Chris Dy","startTime":1127.39,"endTime":1131.98,"body":"of the nerve but spaced apart"},{"speaker":"Chris Dy","startTime":1127.39,"endTime":1131.98,"body":"and used and applied in a manner"},{"speaker":"Chris Dy","startTime":1131.98,"endTime":1135.04,"body":"so that nothing extrudes and"},{"speaker":"Chris Dy","startTime":1131.98,"endTime":1135.04,"body":"that's where the microscope"},{"speaker":"Chris Dy","startTime":1135.04,"endTime":1137.59,"body":"comes in handy. But honestly,"},{"speaker":"Chris Dy","startTime":1135.04,"endTime":1137.59,"body":"there are cases where the scope"},{"speaker":"Chris Dy","startTime":1137.65,"endTime":1140.41,"body":"is a little bit difficult to get"},{"speaker":"Chris Dy","startTime":1137.65,"endTime":1140.41,"body":"in at the angle that you need."},{"speaker":"Chris Dy","startTime":1141.19,"endTime":1144.58,"body":"So I'll do the repair the"},{"speaker":"Chris Dy","startTime":1141.19,"endTime":1144.58,"body":"grafting potentially under like"},{"speaker":"Chris Dy","startTime":1144.58,"endTime":1147.37,"body":"three, five loops, and then look"},{"speaker":"Chris Dy","startTime":1144.58,"endTime":1147.37,"body":"at it on the scope just to make"},{"speaker":"Chris Dy","startTime":1147.37,"endTime":1149.2,"body":"sure I like everything that I'm"},{"speaker":"Chris Dy","startTime":1147.37,"endTime":1149.2,"body":"seeing."},{"speaker":"Charles Goldfarb","startTime":1150.53,"endTime":1152.87,"body":"So you're"},{"speaker":"Charles Goldfarb","startTime":1150.53,"endTime":1152.87,"body":"putting at least one suture, one"},{"speaker":"Charles Goldfarb","startTime":1152.87,"endTime":1157.46,"body":"9-0 suture for each cable?"},{"speaker":"Charles Goldfarb","startTime":1152.87,"endTime":1157.46,"body":"Right? I mean, I guess-"},{"speaker":"Chris Dy","startTime":1157.46,"endTime":1159.05,"body":"Yeah, I mean, the"},{"speaker":"Chris Dy","startTime":1157.46,"endTime":1159.05,"body":"whole thing, the whole thing,"},{"speaker":"Chris Dy","startTime":1159.05,"endTime":1162.2,"body":"basically, once you've glued it"},{"speaker":"Chris Dy","startTime":1159.05,"endTime":1162.2,"body":"all together, and then cut it"},{"speaker":"Chris Dy","startTime":1162.2,"endTime":1166.13,"body":"back to extruding fascicles on"},{"speaker":"Chris Dy","startTime":1162.2,"endTime":1166.13,"body":"your graft. It handles like, you"},{"speaker":"Chris Dy","startTime":1166.13,"endTime":1169.73,"body":"know, a single peripheral nerve."},{"speaker":"Chris Dy","startTime":1166.13,"endTime":1169.73,"body":"So then I usually spaced the"},{"speaker":"Chris Dy","startTime":1169.73,"endTime":1171.98,"body":"sutures about 60 to 80 degrees"},{"speaker":"Chris Dy","startTime":1169.73,"endTime":1171.98,"body":"apart."},{"speaker":"Charles Goldfarb","startTime":1172.85,"endTime":1175.73,"body":"Okay, and then"},{"speaker":"Charles Goldfarb","startTime":1172.85,"endTime":1175.73,"body":"you suture and do you add more"},{"speaker":"Charles Goldfarb","startTime":1176.42,"endTime":1179.15,"body":"TISSEEL over each end?"},{"speaker":"Chris Dy","startTime":1179.18,"endTime":1182.21,"body":"Yeah, I will. I know"},{"speaker":"Chris Dy","startTime":1179.18,"endTime":1182.21,"body":"there are some places where you"},{"speaker":"Chris Dy","startTime":1182.21,"endTime":1185.96,"body":"rely completely on the glue. I"},{"speaker":"Chris Dy","startTime":1182.21,"endTime":1185.96,"body":"don't love that idea. But I will"},{"speaker":"Chris Dy","startTime":1185.99,"endTime":1189.8,"body":"I will apply additional glue on"},{"speaker":"Chris Dy","startTime":1185.99,"endTime":1189.8,"body":"top only after you've taken the"},{"speaker":"Chris Dy","startTime":1189.8,"endTime":1190.43,"body":"picture so."},{"speaker":"Charles Goldfarb","startTime":1193.07,"endTime":1197.0,"body":"And what, and"},{"speaker":"Charles Goldfarb","startTime":1193.07,"endTime":1197.0,"body":"what's your ideal tension, so"},{"speaker":"Charles Goldfarb","startTime":1197.0,"endTime":1202.19,"body":"you have the ability to put this"},{"speaker":"Charles Goldfarb","startTime":1197.0,"endTime":1202.19,"body":"in sloppy somewhat tense"},{"speaker":"Charles Goldfarb","startTime":1202.19,"endTime":1204.35,"body":"obviously don't want it too"},{"speaker":"Charles Goldfarb","startTime":1202.19,"endTime":1204.35,"body":"tense so talk through that"},{"speaker":"Charles Goldfarb","startTime":1204.35,"endTime":1204.86,"body":"process."},{"speaker":"Chris Dy","startTime":1206.31,"endTime":1210.75,"body":"So I will I, I tried"},{"speaker":"Chris Dy","startTime":1206.31,"endTime":1210.75,"body":"to position the extremity in the"},{"speaker":"Chris Dy","startTime":1210.75,"endTime":1214.14,"body":"manner in which I think the"},{"speaker":"Chris Dy","startTime":1210.75,"endTime":1214.14,"body":"nerve will be under maximum"},{"speaker":"Chris Dy","startTime":1214.17,"endTime":1218.1,"body":"tension potentially. So for this"},{"speaker":"Chris Dy","startTime":1214.17,"endTime":1218.1,"body":"particular case, I extended the"},{"speaker":"Chris Dy","startTime":1218.1,"endTime":1222.63,"body":"elbow. So that was potentially"},{"speaker":"Chris Dy","startTime":1218.1,"endTime":1222.63,"body":"all the way out. So I had it in"},{"speaker":"Chris Dy","startTime":1222.63,"endTime":1226.53,"body":"the arm holder extended it out,"},{"speaker":"Chris Dy","startTime":1222.63,"endTime":1226.53,"body":"so that was at max tension. And"},{"speaker":"Chris Dy","startTime":1226.53,"endTime":1229.77,"body":"then at this level the wrist"},{"speaker":"Chris Dy","startTime":1226.53,"endTime":1229.77,"body":"doesn't really matter and the"},{"speaker":"Chris Dy","startTime":1229.77,"endTime":1231.57,"body":"shoulder doesn't really matter"},{"speaker":"Chris Dy","startTime":1229.77,"endTime":1231.57,"body":"because we were basically at the"},{"speaker":"Chris Dy","startTime":1231.57,"endTime":1236.28,"body":"distal third of the humerus. And"},{"speaker":"Chris Dy","startTime":1231.57,"endTime":1236.28,"body":"then it's hard to say the just"},{"speaker":"Chris Dy","startTime":1236.28,"endTime":1238.98,"body":"the right amount but you if you"},{"speaker":"Chris Dy","startTime":1236.28,"endTime":1238.98,"body":"think it's too much, it's"},{"speaker":"Chris Dy","startTime":1238.98,"endTime":1244.02,"body":"probably too much. The there's"},{"speaker":"Chris Dy","startTime":1238.98,"endTime":1244.02,"body":"the you know, the 8-0 nylon"},{"speaker":"Chris Dy","startTime":1244.62,"endTime":1247.23,"body":"dogma, you know, if it can hold"},{"speaker":"Chris Dy","startTime":1244.62,"endTime":1247.23,"body":"with 8-0 nylon, it's probably"},{"speaker":"Chris Dy","startTime":1247.23,"endTime":1251.01,"body":"Okay, that was examined in a"},{"speaker":"Chris Dy","startTime":1247.23,"endTime":1251.01,"body":"good paper from Jeff Greenberg's"},{"speaker":"Chris Dy","startTime":1251.01,"endTime":1254.73,"body":"group that looked at you know,"},{"speaker":"Chris Dy","startTime":1251.01,"endTime":1254.73,"body":"8-0 nylon versus 9-0 nylon and"},{"speaker":"Chris Dy","startTime":1254.73,"endTime":1259.62,"body":"9-0 nylon has more favorable"},{"speaker":"Chris Dy","startTime":1254.73,"endTime":1259.62,"body":"characteristics in terms of you"},{"speaker":"Chris Dy","startTime":1259.62,"endTime":1261.93,"body":"know, the amount of tension and"},{"speaker":"Chris Dy","startTime":1259.62,"endTime":1261.93,"body":"strain it can handle. So I"},{"speaker":"Chris Dy","startTime":1261.93,"endTime":1265.26,"body":"usually use the 9-0 nylon as my"},{"speaker":"Chris Dy","startTime":1261.93,"endTime":1265.26,"body":"quote, test. If it comes"},{"speaker":"Chris Dy","startTime":1265.26,"endTime":1267.9,"body":"together easily with a 9-0"},{"speaker":"Chris Dy","startTime":1265.26,"endTime":1267.9,"body":"nylon. I'm good to go."},{"speaker":"Charles Goldfarb","startTime":1268.98,"endTime":1272.82,"body":"Perfect."},{"speaker":"Charles Goldfarb","startTime":1268.98,"endTime":1272.82,"body":"Perfect. Okay. I'm ready to"},{"speaker":"Charles Goldfarb","startTime":1272.82,"endTime":1274.77,"body":"pivot to a different nerve"},{"speaker":"Charles Goldfarb","startTime":1272.82,"endTime":1274.77,"body":"topic."},{"speaker":"Chris Dy","startTime":1276.48,"endTime":1277.8,"body":"You're so excited"},{"speaker":"Chris Dy","startTime":1276.48,"endTime":1277.8,"body":"right now."},{"speaker":"Charles Goldfarb","startTime":1277.92,"endTime":1279.78,"body":"Any any final"},{"speaker":"Charles Goldfarb","startTime":1277.92,"endTime":1279.78,"body":"cable graft?"},{"speaker":"Chris Dy","startTime":1279.0,"endTime":1285.09,"body":"I think I think that's"},{"speaker":"Chris Dy","startTime":1279.0,"endTime":1285.09,"body":"probably it. I mean, I think the"},{"speaker":"Chris Dy","startTime":1285.09,"endTime":1289.92,"body":"the natural decision right now"},{"speaker":"Chris Dy","startTime":1285.09,"endTime":1289.92,"body":"in 2021, is what's the role of"},{"speaker":"Chris Dy","startTime":1289.95,"endTime":1292.77,"body":"an allograft? Because that is"},{"speaker":"Chris Dy","startTime":1289.95,"endTime":1292.77,"body":"something where you would save a"},{"speaker":"Chris Dy","startTime":1292.77,"endTime":1297.24,"body":"lot of time. And you know,"},{"speaker":"Chris Dy","startTime":1292.77,"endTime":1297.24,"body":"potential donor site morbidity,"},{"speaker":"Chris Dy","startTime":1297.36,"endTime":1300.54,"body":"and that's an acellular"},{"speaker":"Chris Dy","startTime":1297.36,"endTime":1300.54,"body":"processed nerve allograft in the"},{"speaker":"Chris Dy","startTime":1300.54,"endTime":1304.11,"body":"states that's manufactured, not"},{"speaker":"Chris Dy","startTime":1300.54,"endTime":1304.11,"body":"manufactured, but processed, I"},{"speaker":"Chris Dy","startTime":1304.11,"endTime":1308.43,"body":"guess, by a company called"},{"speaker":"Chris Dy","startTime":1304.11,"endTime":1308.43,"body":"Axogen. And I don't know how"},{"speaker":"Chris Dy","startTime":1308.43,"endTime":1311.46,"body":"widely available it is overseas."},{"speaker":"Chris Dy","startTime":1308.43,"endTime":1311.46,"body":"But I mean, what's your thought"},{"speaker":"Chris Dy","startTime":1311.46,"endTime":1315.54,"body":"on using an acellular processed"},{"speaker":"Chris Dy","startTime":1311.46,"endTime":1315.54,"body":"nerve allograft in 2021, Chuck?"},{"speaker":"Charles Goldfarb","startTime":1316.53,"endTime":1321.21,"body":"Well, as a, I"},{"speaker":"Charles Goldfarb","startTime":1316.53,"endTime":1321.21,"body":"guess, I would say, in the realm"},{"speaker":"Charles Goldfarb","startTime":1321.21,"endTime":1323.52,"body":"of nerves, I would consider"},{"speaker":"Charles Goldfarb","startTime":1321.21,"endTime":1323.52,"body":"myself a bread and butter hand"},{"speaker":"Charles Goldfarb","startTime":1323.52,"endTime":1327.06,"body":"surgeon. And so I certainly"},{"speaker":"Charles Goldfarb","startTime":1323.52,"endTime":1327.06,"body":"treat nerve injuries, I perform"},{"speaker":"Charles Goldfarb","startTime":1327.06,"endTime":1330.24,"body":"nerve repairs. When things get"},{"speaker":"Charles Goldfarb","startTime":1327.06,"endTime":1330.24,"body":"too complex, I rely on my"},{"speaker":"Charles Goldfarb","startTime":1330.24,"endTime":1335.04,"body":"partners who have a passion and"},{"speaker":"Charles Goldfarb","startTime":1330.24,"endTime":1335.04,"body":"more expertise on this. I was"},{"speaker":"Charles Goldfarb","startTime":1335.04,"endTime":1341.07,"body":"raised, I was raised really,"},{"speaker":"Charles Goldfarb","startTime":1335.04,"endTime":1341.07,"body":"without nerve conduits, or"},{"speaker":"Charles Goldfarb","startTime":1341.13,"endTime":1344.79,"body":"allografts. But I guess early in"},{"speaker":"Charles Goldfarb","startTime":1341.13,"endTime":1344.79,"body":"my career, nerve conduits were"},{"speaker":"Charles Goldfarb","startTime":1344.79,"endTime":1348.87,"body":"coming of age, and were very"},{"speaker":"Charles Goldfarb","startTime":1344.79,"endTime":1348.87,"body":"popular. And I have to say, my"},{"speaker":"Charles Goldfarb","startTime":1348.87,"endTime":1351.66,"body":"personal experience with"},{"speaker":"Charles Goldfarb","startTime":1348.87,"endTime":1351.66,"body":"conduits was not great. And I"},{"speaker":"Charles Goldfarb","startTime":1351.66,"endTime":1354.21,"body":"didn't get the recovery that I"},{"speaker":"Charles Goldfarb","startTime":1351.66,"endTime":1354.21,"body":"hoped for. But really, that's"},{"speaker":"Charles Goldfarb","startTime":1354.21,"endTime":1358.05,"body":"all that's all we had to choose"},{"speaker":"Charles Goldfarb","startTime":1354.21,"endTime":1358.05,"body":"from. And so now, I think"},{"speaker":"Charles Goldfarb","startTime":1358.08,"endTime":1363.42,"body":"allografts do make a lot of"},{"speaker":"Charles Goldfarb","startTime":1358.08,"endTime":1363.42,"body":"sense, they do feel good to work"},{"speaker":"Charles Goldfarb","startTime":1363.42,"endTime":1366.69,"body":"with. And I think the results"},{"speaker":"Charles Goldfarb","startTime":1363.42,"endTime":1366.69,"body":"have been satisfying for me. My"},{"speaker":"Charles Goldfarb","startTime":1366.69,"endTime":1370.71,"body":"most common use of allograft is"},{"speaker":"Charles Goldfarb","startTime":1366.69,"endTime":1370.71,"body":"a digital nerve. A digital nerve"},{"speaker":"Charles Goldfarb","startTime":1370.71,"endTime":1373.62,"body":"that I can't primarily repair."},{"speaker":"Charles Goldfarb","startTime":1370.71,"endTime":1373.62,"body":"And I've been very happy with"},{"speaker":"Charles Goldfarb","startTime":1373.62,"endTime":1377.55,"body":"the outcomes of those, I haven't"},{"speaker":"Charles Goldfarb","startTime":1373.62,"endTime":1377.55,"body":"really used allografts for other"},{"speaker":"Charles Goldfarb","startTime":1377.55,"endTime":1381.3,"body":"more complicated reasons. And"},{"speaker":"Charles Goldfarb","startTime":1377.55,"endTime":1381.3,"body":"like much of what we all do for"},{"speaker":"Charles Goldfarb","startTime":1381.3,"endTime":1384.69,"body":"me, I if I'm questioning the"},{"speaker":"Charles Goldfarb","startTime":1381.3,"endTime":1384.69,"body":"role of an allograft versus a"},{"speaker":"Charles Goldfarb","startTime":1384.69,"endTime":1387.51,"body":"sural nerve cable graft, for"},{"speaker":"Charles Goldfarb","startTime":1384.69,"endTime":1387.51,"body":"example, the case we just"},{"speaker":"Charles Goldfarb","startTime":1387.51,"endTime":1390.27,"body":"discussed, I go back to what"},{"speaker":"Charles Goldfarb","startTime":1387.51,"endTime":1390.27,"body":"what I want done with me, and"},{"speaker":"Charles Goldfarb","startTime":1390.27,"endTime":1393.9,"body":"for me, the data, especially on"},{"speaker":"Charles Goldfarb","startTime":1390.27,"endTime":1393.9,"body":"mixed nerves, and especially on"},{"speaker":"Charles Goldfarb","startTime":1393.9,"endTime":1396.39,"body":"bigger nerves is just not"},{"speaker":"Charles Goldfarb","startTime":1393.9,"endTime":1396.39,"body":"compelling enough for allograft."},{"speaker":"Charles Goldfarb","startTime":1396.39,"endTime":1398.79,"body":"So I would use a cable graft. So"},{"speaker":"Charles Goldfarb","startTime":1396.39,"endTime":1398.79,"body":"that's-"},{"speaker":"Chris Dy","startTime":1398.91,"endTime":1399.87,"body":"Ok, I agree with that."},{"speaker":"Charles Goldfarb","startTime":1400.29,"endTime":1402.06,"body":"Yeah. So share"},{"speaker":"Charles Goldfarb","startTime":1400.29,"endTime":1402.06,"body":"me, share your thoughts don't"},{"speaker":"Charles Goldfarb","startTime":1402.06,"endTime":1403.08,"body":"don't let me put words in your"},{"speaker":"Charles Goldfarb","startTime":1402.06,"endTime":1403.08,"body":"mouth."},{"speaker":"Chris Dy","startTime":1404.2,"endTime":1406.12,"body":"I mean, I think the"},{"speaker":"Chris Dy","startTime":1404.2,"endTime":1406.12,"body":"for the digital nerves in"},{"speaker":"Chris Dy","startTime":1406.12,"endTime":1409.24,"body":"particular, I think allograft"},{"speaker":"Chris Dy","startTime":1406.12,"endTime":1409.24,"body":"has supplanted any sort of role"},{"speaker":"Chris Dy","startTime":1409.24,"endTime":1413.23,"body":"for conduits. And I think"},{"speaker":"Chris Dy","startTime":1409.24,"endTime":1413.23,"body":"literature published by multiple"},{"speaker":"Chris Dy","startTime":1413.23,"endTime":1417.34,"body":"groups, including those that are"},{"speaker":"Chris Dy","startTime":1413.23,"endTime":1417.34,"body":"not beholden to, to industry"},{"speaker":"Chris Dy","startTime":1417.91,"endTime":1421.75,"body":"demonstrates that. So I think"},{"speaker":"Chris Dy","startTime":1417.91,"endTime":1421.75,"body":"the role for a conduit or"},{"speaker":"Chris Dy","startTime":1421.75,"endTime":1426.04,"body":"connector in 2021 is much less."},{"speaker":"Chris Dy","startTime":1421.75,"endTime":1426.04,"body":"I know, there are a lot of folks"},{"speaker":"Chris Dy","startTime":1426.04,"endTime":1430.39,"body":"who would like to use connectors"},{"speaker":"Chris Dy","startTime":1426.04,"endTime":1430.39,"body":"and conduits to take pressure or"},{"speaker":"Chris Dy","startTime":1430.39,"endTime":1433.99,"body":"take, remove some of the tension"},{"speaker":"Chris Dy","startTime":1430.39,"endTime":1433.99,"body":"from the repair site itself. I"},{"speaker":"Chris Dy","startTime":1433.99,"endTime":1436.51,"body":"personally do not buy that"},{"speaker":"Chris Dy","startTime":1433.99,"endTime":1436.51,"body":"argument, because I think that"},{"speaker":"Chris Dy","startTime":1436.51,"endTime":1440.65,"body":"the introduction of the"},{"speaker":"Chris Dy","startTime":1436.51,"endTime":1440.65,"body":"connector or the wrap actually"},{"speaker":"Chris Dy","startTime":1440.65,"endTime":1444.58,"body":"increases the amount of scar"},{"speaker":"Chris Dy","startTime":1440.65,"endTime":1444.58,"body":"formation that is present. So"},{"speaker":"Chris Dy","startTime":1444.58,"endTime":1447.34,"body":"and that's, again, a very nerdy"},{"speaker":"Chris Dy","startTime":1444.58,"endTime":1447.34,"body":"discussion that we can have, but"},{"speaker":"Chris Dy","startTime":1447.34,"endTime":1450.73,"body":"I don't buy it. I will say, you"},{"speaker":"Chris Dy","startTime":1447.34,"endTime":1450.73,"body":"know, I should say, obviously,"},{"speaker":"Chris Dy","startTime":1450.73,"endTime":1454.09,"body":"for disclosure of conflicts of"},{"speaker":"Chris Dy","startTime":1450.73,"endTime":1454.09,"body":"interest, I don't have any"},{"speaker":"Chris Dy","startTime":1454.09,"endTime":1457.45,"body":"consulting agreements with"},{"speaker":"Chris Dy","startTime":1454.09,"endTime":1457.45,"body":"Axogen, I have done some"},{"speaker":"Chris Dy","startTime":1457.45,"endTime":1460.54,"body":"occasional ad hoc consulting for"},{"speaker":"Chris Dy","startTime":1457.45,"endTime":1460.54,"body":"them in a think tank capacity"},{"speaker":"Chris Dy","startTime":1460.54,"endTime":1465.07,"body":"and that the compensation went"},{"speaker":"Chris Dy","startTime":1460.54,"endTime":1465.07,"body":"directly to the American"},{"speaker":"Chris Dy","startTime":1465.1,"endTime":1467.65,"body":"Foundation for Surgery of the"},{"speaker":"Chris Dy","startTime":1465.1,"endTime":1467.65,"body":"Hand. So that just want to put"},{"speaker":"Chris Dy","startTime":1467.65,"endTime":1470.86,"body":"that out there. But I don't"},{"speaker":"Chris Dy","startTime":1467.65,"endTime":1470.86,"body":"think that the literature in"},{"speaker":"Chris Dy","startTime":1470.86,"endTime":1477.64,"body":"2021 supports the use of"},{"speaker":"Chris Dy","startTime":1470.86,"endTime":1477.64,"body":"processed nerve allografts for a"},{"speaker":"Chris Dy","startTime":1477.64,"endTime":1482.59,"body":"mixed or a motor nerve. At least"},{"speaker":"Chris Dy","startTime":1477.64,"endTime":1482.59,"body":"in my practice, I think that"},{"speaker":"Chris Dy","startTime":1482.59,"endTime":1486.31,"body":"there are some emerging stuff"},{"speaker":"Chris Dy","startTime":1482.59,"endTime":1486.31,"body":"out there. But I'm still a bit"},{"speaker":"Chris Dy","startTime":1486.31,"endTime":1486.88,"body":"skeptical."},{"speaker":"Charles Goldfarb","startTime":1488.47,"endTime":1490.57,"body":"Is there any"},{"speaker":"Charles Goldfarb","startTime":1488.47,"endTime":1490.57,"body":"role for conduits in your"},{"speaker":"Charles Goldfarb","startTime":1490.57,"endTime":1491.38,"body":"practice today?"},{"speaker":"Chris Dy","startTime":1493.39,"endTime":1495.61,"body":"Now, I don't like I"},{"speaker":"Chris Dy","startTime":1493.39,"endTime":1495.61,"body":"don't use it. I mean, you know,"},{"speaker":"Chris Dy","startTime":1495.61,"endTime":1498.13,"body":"if I have a gap, I'm either"},{"speaker":"Chris Dy","startTime":1495.61,"endTime":1498.13,"body":"going to do an autograft or if"},{"speaker":"Chris Dy","startTime":1498.13,"endTime":1501.4,"body":"it's a digital nerve an"},{"speaker":"Chris Dy","startTime":1498.13,"endTime":1501.4,"body":"allograft. And I don't I don't"},{"speaker":"Chris Dy","startTime":1501.4,"endTime":1504.52,"body":"see how it really takes tension"},{"speaker":"Chris Dy","startTime":1501.4,"endTime":1504.52,"body":"off of the repair. I mean, I"},{"speaker":"Chris Dy","startTime":1504.52,"endTime":1507.43,"body":"understand the theoretical"},{"speaker":"Chris Dy","startTime":1504.52,"endTime":1507.43,"body":"arguments. But I think that the"},{"speaker":"Chris Dy","startTime":1508.0,"endTime":1512.44,"body":"potential introduction of scar"},{"speaker":"Chris Dy","startTime":1508.0,"endTime":1512.44,"body":"and an inflammatory reaction"},{"speaker":"Chris Dy","startTime":1512.56,"endTime":1516.43,"body":"from that collagen substances is"},{"speaker":"Chris Dy","startTime":1512.56,"endTime":1516.43,"body":"it's real. I mean, we've seen"},{"speaker":"Chris Dy","startTime":1516.43,"endTime":1519.79,"body":"that in our partner, David"},{"speaker":"Chris Dy","startTime":1516.43,"endTime":1519.79,"body":"Brogan's work in the lab. And"},{"speaker":"Chris Dy","startTime":1519.79,"endTime":1523.54,"body":"anecdotally, you talk to many"},{"speaker":"Chris Dy","startTime":1519.79,"endTime":1523.54,"body":"surgeons who have a lot of gray"},{"speaker":"Chris Dy","startTime":1523.54,"endTime":1526.33,"body":"hair and less hair. That's what"},{"speaker":"Chris Dy","startTime":1523.54,"endTime":1526.33,"body":"that's what they believe to."},{"speaker":"Charles Goldfarb","startTime":1527.92,"endTime":1530.86,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":1527.92,"endTime":1530.86,"body":"tell me how you and that, you"},{"speaker":"Charles Goldfarb","startTime":1530.86,"endTime":1534.91,"body":"know, cost is an issue, I"},{"speaker":"Charles Goldfarb","startTime":1530.86,"endTime":1534.91,"body":"constantly go back to. Tell me"},{"speaker":"Charles Goldfarb","startTime":1534.91,"endTime":1540.34,"body":"how you reconcile cost with a"},{"speaker":"Charles Goldfarb","startTime":1534.91,"endTime":1540.34,"body":"digital nerve allograft repair"},{"speaker":"Charles Goldfarb","startTime":1540.49,"endTime":1543.85,"body":"versus harvesting another"},{"speaker":"Charles Goldfarb","startTime":1540.49,"endTime":1543.85,"body":"alternative, whether it be the"},{"speaker":"Charles Goldfarb","startTime":1543.85,"endTime":1546.49,"body":"post interosseous nerve, or the"},{"speaker":"Charles Goldfarb","startTime":1543.85,"endTime":1546.49,"body":"medial antebrachial cutaneous"},{"speaker":"Charles Goldfarb","startTime":1546.49,"endTime":1548.53,"body":"nerve. How do you how do you"},{"speaker":"Charles Goldfarb","startTime":1546.49,"endTime":1548.53,"body":"reconcile that?"},{"speaker":"Chris Dy","startTime":1549.88,"endTime":1552.34,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":1549.88,"endTime":1552.34,"body":"that it depends on obviously,"},{"speaker":"Chris Dy","startTime":1552.37,"endTime":1555.46,"body":"you can, you can make an"},{"speaker":"Chris Dy","startTime":1552.37,"endTime":1555.46,"body":"argument based on economic"},{"speaker":"Chris Dy","startTime":1555.46,"endTime":1558.25,"body":"calculations about the amount of"},{"speaker":"Chris Dy","startTime":1555.46,"endTime":1558.25,"body":"time in the operating room that"},{"speaker":"Chris Dy","startTime":1558.25,"endTime":1561.91,"body":"it takes for, you know, to"},{"speaker":"Chris Dy","startTime":1558.25,"endTime":1561.91,"body":"harvest any sort of nerve graft,"},{"speaker":"Chris Dy","startTime":1561.97,"endTime":1564.88,"body":"and then you can- autograft. And"},{"speaker":"Chris Dy","startTime":1561.97,"endTime":1564.88,"body":"then you could add in the"},{"speaker":"Chris Dy","startTime":1564.88,"endTime":1569.05,"body":"potential donor site morbidity"},{"speaker":"Chris Dy","startTime":1564.88,"endTime":1569.05,"body":"argument, which I think that the"},{"speaker":"Chris Dy","startTime":1569.05,"endTime":1576.97,"body":"more you ask people, maybe it is"},{"speaker":"Chris Dy","startTime":1569.05,"endTime":1576.97,"body":"a real concern. But but I"},{"speaker":"Chris Dy","startTime":1576.97,"endTime":1580.3,"body":"personally have not had many"},{"speaker":"Chris Dy","startTime":1576.97,"endTime":1580.3,"body":"people complain about donor site"},{"speaker":"Chris Dy","startTime":1580.3,"endTime":1583.42,"body":"morbidity, at least from my most"},{"speaker":"Chris Dy","startTime":1580.3,"endTime":1583.42,"body":"harvested site, which is the"},{"speaker":"Chris Dy","startTime":1583.42,"endTime":1586.15,"body":"sural nerve, I do have a very"},{"speaker":"Chris Dy","startTime":1583.42,"endTime":1586.15,"body":"honest conversation with them"},{"speaker":"Chris Dy","startTime":1586.15,"endTime":1589.0,"body":"about it ahead of time, perhaps"},{"speaker":"Chris Dy","startTime":1586.15,"endTime":1589.0,"body":"spend a little more time on it,"},{"speaker":"Chris Dy","startTime":1589.0,"endTime":1592.33,"body":"because I'm concerned about"},{"speaker":"Chris Dy","startTime":1589.0,"endTime":1592.33,"body":"that. But I don't think that the"},{"speaker":"Chris Dy","startTime":1592.33,"endTime":1597.4,"body":"cost from a nerve, processed"},{"speaker":"Chris Dy","startTime":1592.33,"endTime":1597.4,"body":"nerve allograft exceeds, I think"},{"speaker":"Chris Dy","startTime":1597.4,"endTime":1600.58,"body":"it's worth it. In some cases, I"},{"speaker":"Chris Dy","startTime":1597.4,"endTime":1600.58,"body":"should say it that way. But how"},{"speaker":"Chris Dy","startTime":1600.58,"endTime":1602.92,"body":"much do you think it is? I think"},{"speaker":"Chris Dy","startTime":1600.58,"endTime":1602.92,"body":"it's an interesting discussion,"},{"speaker":"Chris Dy","startTime":1602.92,"endTime":1605.08,"body":"because we as surgeons often"},{"speaker":"Chris Dy","startTime":1602.92,"endTime":1605.08,"body":"don't know how much these things"},{"speaker":"Chris Dy","startTime":1605.08,"endTime":1605.44,"body":"cost."},{"speaker":"Charles Goldfarb","startTime":1606.04,"endTime":1607.84,"body":"Well, you're"},{"speaker":"Charles Goldfarb","startTime":1606.04,"endTime":1607.84,"body":"right. I do not know how much"},{"speaker":"Charles Goldfarb","startTime":1607.84,"endTime":1614.11,"body":"these things cost. I want to say"},{"speaker":"Charles Goldfarb","startTime":1607.84,"endTime":1614.11,"body":"it's in the $2,000 range for a"},{"speaker":"Charles Goldfarb","startTime":1614.11,"endTime":1617.05,"body":"typical graft. I don't know what"},{"speaker":"Charles Goldfarb","startTime":1614.11,"endTime":1617.05,"body":"that means, necessarily. I"},{"speaker":"Charles Goldfarb","startTime":1617.05,"endTime":1619.72,"body":"certainly own the cost of things"},{"speaker":"Charles Goldfarb","startTime":1617.05,"endTime":1619.72,"body":"I use frequently. I just don't"},{"speaker":"Charles Goldfarb","startTime":1619.72,"endTime":1621.04,"body":"use our graph frequently enough."},{"speaker":"Chris Dy","startTime":1622.63,"endTime":1623.98,"body":"Yeah, I mean how do"},{"speaker":"Chris Dy","startTime":1622.63,"endTime":1623.98,"body":"you think about it? Because you"},{"speaker":"Chris Dy","startTime":1623.98,"endTime":1627.94,"body":"do a lot of, you ran our"},{"speaker":"Chris Dy","startTime":1623.98,"endTime":1627.94,"body":"Orthopedic Center. And you're,"},{"speaker":"Chris Dy","startTime":1627.97,"endTime":1631.39,"body":"you're the executive vice chair"},{"speaker":"Chris Dy","startTime":1627.97,"endTime":1631.39,"body":"of our department. So costs, on"},{"speaker":"Chris Dy","startTime":1631.39,"endTime":1635.14,"body":"our side is a consideration. I"},{"speaker":"Chris Dy","startTime":1631.39,"endTime":1635.14,"body":"mean, what if I came to you as a"},{"speaker":"Chris Dy","startTime":1635.14,"endTime":1638.5,"body":"new surgeon saying, I only use"},{"speaker":"Chris Dy","startTime":1635.14,"endTime":1638.5,"body":"conduits, I only use allografts?"},{"speaker":"Chris Dy","startTime":1639.22,"endTime":1641.56,"body":"You know, this is my"},{"speaker":"Chris Dy","startTime":1639.22,"endTime":1641.56,"body":"expectation, is that going to be"},{"speaker":"Chris Dy","startTime":1641.56,"endTime":1642.1,"body":"a problem?"},{"speaker":"Charles Goldfarb","startTime":1643.15,"endTime":1645.43,"body":"I think, you"},{"speaker":"Charles Goldfarb","startTime":1643.15,"endTime":1645.43,"body":"know, it is a tough balance,"},{"speaker":"Charles Goldfarb","startTime":1645.43,"endTime":1649.81,"body":"right? We want to be, especially"},{"speaker":"Charles Goldfarb","startTime":1645.43,"endTime":1649.81,"body":"in academics, that's not meant"},{"speaker":"Charles Goldfarb","startTime":1649.81,"endTime":1652.15,"body":"to put us on a different planet"},{"speaker":"Charles Goldfarb","startTime":1649.81,"endTime":1652.15,"body":"than anyone else. But especially"},{"speaker":"Charles Goldfarb","startTime":1652.15,"endTime":1655.18,"body":"in academics, we have to be"},{"speaker":"Charles Goldfarb","startTime":1652.15,"endTime":1655.18,"body":"willing to do different things"},{"speaker":"Charles Goldfarb","startTime":1655.18,"endTime":1659.95,"body":"to advance a field. And we need"},{"speaker":"Charles Goldfarb","startTime":1655.18,"endTime":1659.95,"body":"to be responsive to the"},{"speaker":"Charles Goldfarb","startTime":1659.95,"endTime":1663.34,"body":"literature. And we'll be, we"},{"speaker":"Charles Goldfarb","startTime":1659.95,"endTime":1663.34,"body":"need to be responsive to"},{"speaker":"Charles Goldfarb","startTime":1663.34,"endTime":1666.97,"body":"surgeons who have the right"},{"speaker":"Charles Goldfarb","startTime":1663.34,"endTime":1666.97,"body":"balance, but have a strong case"},{"speaker":"Charles Goldfarb","startTime":1666.97,"endTime":1671.89,"body":"to be made for a particular"},{"speaker":"Charles Goldfarb","startTime":1666.97,"endTime":1671.89,"body":"preference. I think as, it's"},{"speaker":"Charles Goldfarb","startTime":1671.89,"endTime":1676.87,"body":"fortunate that I feel like most"},{"speaker":"Charles Goldfarb","startTime":1671.89,"endTime":1676.87,"body":"of us here are focused enough on"},{"speaker":"Charles Goldfarb","startTime":1676.87,"endTime":1679.84,"body":"cost and do our best to reduce"},{"speaker":"Charles Goldfarb","startTime":1676.87,"endTime":1679.84,"body":"costs so that when a surgeon"},{"speaker":"Charles Goldfarb","startTime":1679.84,"endTime":1682.93,"body":"comes and says, This is what I"},{"speaker":"Charles Goldfarb","startTime":1679.84,"endTime":1682.93,"body":"want to use, and this is why I"},{"speaker":"Charles Goldfarb","startTime":1682.93,"endTime":1687.1,"body":"think it matters, we tend to"},{"speaker":"Charles Goldfarb","startTime":1682.93,"endTime":1687.1,"body":"listen, you know, being in a"},{"speaker":"Charles Goldfarb","startTime":1687.1,"endTime":1690.61,"body":"surgery center environment is"},{"speaker":"Charles Goldfarb","startTime":1687.1,"endTime":1690.61,"body":"very different. It just is more"},{"speaker":"Charles Goldfarb","startTime":1690.64,"endTime":1695.5,"body":"difficult to spend dramatically"},{"speaker":"Charles Goldfarb","startTime":1690.64,"endTime":1695.5,"body":"different amounts of money for"},{"speaker":"Charles Goldfarb","startTime":1695.5,"endTime":1698.59,"body":"different implants, or things"},{"speaker":"Charles Goldfarb","startTime":1695.5,"endTime":1698.59,"body":"like allografts, I think."},{"speaker":"Chris Dy","startTime":1700.03,"endTime":1702.28,"body":"So along those lines,"},{"speaker":"Chris Dy","startTime":1700.03,"endTime":1702.28,"body":"if you're using an autograft"},{"speaker":"Chris Dy","startTime":1702.28,"endTime":1705.76,"body":"Chuck, what are your go tos for,"},{"speaker":"Chris Dy","startTime":1702.28,"endTime":1705.76,"body":"you know, do you like to use"},{"speaker":"Chris Dy","startTime":1705.76,"endTime":1708.55,"body":"medial antebrachial cutaneous,"},{"speaker":"Chris Dy","startTime":1705.76,"endTime":1708.55,"body":"because it's in the field? Do"},{"speaker":"Chris Dy","startTime":1708.55,"endTime":1711.31,"body":"you like to use PIN, AIN, you"},{"speaker":"Chris Dy","startTime":1708.55,"endTime":1711.31,"body":"kind of mentioned that earlier?"},{"speaker":"Charles Goldfarb","startTime":1712.09,"endTime":1713.83,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":1712.09,"endTime":1713.83,"body":"was swayed a little bit by I"},{"speaker":"Charles Goldfarb","startTime":1713.83,"endTime":1717.25,"body":"think Jim Higgins wrote the"},{"speaker":"Charles Goldfarb","startTime":1713.83,"endTime":1717.25,"body":"article years ago about the size"},{"speaker":"Charles Goldfarb","startTime":1717.25,"endTime":1721.12,"body":"and the fascicle density of the"},{"speaker":"Charles Goldfarb","startTime":1717.25,"endTime":1721.12,"body":"post interosseous nerve for"},{"speaker":"Charles Goldfarb","startTime":1721.12,"endTime":1725.41,"body":"digital nerves. And I have to"},{"speaker":"Charles Goldfarb","startTime":1721.12,"endTime":1725.41,"body":"say, I have used it and I'll"},{"speaker":"Charles Goldfarb","startTime":1725.41,"endTime":1728.56,"body":"probably will use it again, I"},{"speaker":"Charles Goldfarb","startTime":1725.41,"endTime":1728.56,"body":"think the danger of using the"},{"speaker":"Charles Goldfarb","startTime":1728.56,"endTime":1732.34,"body":"post interosseous nerve is that"},{"speaker":"Charles Goldfarb","startTime":1728.56,"endTime":1732.34,"body":"it's not appropriate in my"},{"speaker":"Charles Goldfarb","startTime":1732.34,"endTime":1736.12,"body":"experience for proximal digital"},{"speaker":"Charles Goldfarb","startTime":1732.34,"endTime":1736.12,"body":"nerves. So at the palmar digital"},{"speaker":"Charles Goldfarb","startTime":1736.12,"endTime":1739.0,"body":"crease, for example, the"},{"speaker":"Charles Goldfarb","startTime":1736.12,"endTime":1739.0,"body":"proximal aspect of the proximal"},{"speaker":"Charles Goldfarb","startTime":1739.0,"endTime":1742.24,"body":"phalanx, but possibly from the"},{"speaker":"Charles Goldfarb","startTime":1739.0,"endTime":1742.24,"body":"PRP joint distally it can be"},{"speaker":"Charles Goldfarb","startTime":1742.24,"endTime":1747.37,"body":"perfect. So I don't certainly"},{"speaker":"Charles Goldfarb","startTime":1742.24,"endTime":1747.37,"body":"don't want to cable, the PIN. So"},{"speaker":"Charles Goldfarb","startTime":1747.37,"endTime":1750.64,"body":"I think in my experience it's"},{"speaker":"Charles Goldfarb","startTime":1747.37,"endTime":1750.64,"body":"not been robust enough to use"},{"speaker":"Charles Goldfarb","startTime":1750.64,"endTime":1752.35,"body":"proximally. What about yourself?"},{"speaker":"Chris Dy","startTime":1753.59,"endTime":1756.35,"body":"I agree with that. I"},{"speaker":"Chris Dy","startTime":1753.59,"endTime":1756.35,"body":"mean, I think that anybody who's"},{"speaker":"Chris Dy","startTime":1756.35,"endTime":1759.68,"body":"listening as a trainee, or"},{"speaker":"Chris Dy","startTime":1756.35,"endTime":1759.68,"body":"anybody who's interested I love"},{"speaker":"Chris Dy","startTime":1759.68,"endTime":1763.4,"body":"that paper that Higgins wrote I"},{"speaker":"Chris Dy","startTime":1759.68,"endTime":1763.4,"body":"think it was 2012 JHS, but it's"},{"speaker":"Chris Dy","startTime":1763.4,"endTime":1765.95,"body":"great because it tells you how"},{"speaker":"Chris Dy","startTime":1763.4,"endTime":1765.95,"body":"many fascicles are in each of"},{"speaker":"Chris Dy","startTime":1765.95,"endTime":1769.28,"body":"the donors. Size matches it to"},{"speaker":"Chris Dy","startTime":1765.95,"endTime":1769.28,"body":"the digital nerve based on the"},{"speaker":"Chris Dy","startTime":1769.28,"endTime":1773.54,"body":"location, excellent. It's a"},{"speaker":"Chris Dy","startTime":1769.28,"endTime":1773.54,"body":"great paper in terms of using"},{"speaker":"Chris Dy","startTime":1774.98,"endTime":1778.94,"body":"tables and illustrations to"},{"speaker":"Chris Dy","startTime":1774.98,"endTime":1778.94,"body":"drive a point home. So check"},{"speaker":"Chris Dy","startTime":1778.94,"endTime":1784.01,"body":"that paper out if you haven't. I"},{"speaker":"Chris Dy","startTime":1778.94,"endTime":1784.01,"body":"have been underwhelmed by the"},{"speaker":"Chris Dy","startTime":1784.01,"endTime":1786.77,"body":"AIN and PIN when I have tried to"},{"speaker":"Chris Dy","startTime":1784.01,"endTime":1786.77,"body":"use them as donor nerves. I"},{"speaker":"Chris Dy","startTime":1786.77,"endTime":1790.01,"body":"don't love them. They tend to"},{"speaker":"Chris Dy","startTime":1786.77,"endTime":1790.01,"body":"shrivel up they're smaller than"},{"speaker":"Chris Dy","startTime":1790.01,"endTime":1792.29,"body":"when you harvest, they get"},{"speaker":"Chris Dy","startTime":1790.01,"endTime":1792.29,"body":"shorter than when you harvest"},{"speaker":"Chris Dy","startTime":1792.29,"endTime":1797.45,"body":"them. I don't love medial"},{"speaker":"Chris Dy","startTime":1792.29,"endTime":1797.45,"body":"antebrachial and medial brachial"},{"speaker":"Chris Dy","startTime":1797.45,"endTime":1799.7,"body":"just because I have that you"},{"speaker":"Chris Dy","startTime":1797.45,"endTime":1799.7,"body":"know concern ingrained in my"},{"speaker":"Chris Dy","startTime":1799.7,"endTime":1803.75,"body":"head about painful neuroma"},{"speaker":"Chris Dy","startTime":1799.7,"endTime":1803.75,"body":"formation. But it is convenient"},{"speaker":"Chris Dy","startTime":1803.75,"endTime":1806.18,"body":"because it's in the field. And"},{"speaker":"Chris Dy","startTime":1803.75,"endTime":1806.18,"body":"if you have the right amount of"},{"speaker":"Chris Dy","startTime":1806.18,"endTime":1809.33,"body":"length that you need, it works"},{"speaker":"Chris Dy","startTime":1806.18,"endTime":1809.33,"body":"pretty well. I go to is still"},{"speaker":"Chris Dy","startTime":1809.33,"endTime":1810.41,"body":"sural for most things."},{"speaker":"Charles Goldfarb","startTime":1810.5,"endTime":1812.06,"body":"For most"},{"speaker":"Charles Goldfarb","startTime":1810.5,"endTime":1812.06,"body":"things. That was my next"},{"speaker":"Charles Goldfarb","startTime":1812.06,"endTime":1813.98,"body":"question. Yes, if you're not"},{"speaker":"Charles Goldfarb","startTime":1812.06,"endTime":1813.98,"body":"going to use an autograft,"},{"speaker":"Charles Goldfarb","startTime":1813.98,"endTime":1817.43,"body":"you'll go to sural. Let's"},{"speaker":"Charles Goldfarb","startTime":1813.98,"endTime":1817.43,"body":"conclude with one brief"},{"speaker":"Charles Goldfarb","startTime":1817.43,"endTime":1823.19,"body":"discussion on digital nerve"},{"speaker":"Charles Goldfarb","startTime":1817.43,"endTime":1823.19,"body":"repair. Talk me through briefly."},{"speaker":"Charles Goldfarb","startTime":1823.25,"endTime":1827.75,"body":"Let's say you have a sharp"},{"speaker":"Charles Goldfarb","startTime":1823.25,"endTime":1827.75,"body":"laceration, you're in the"},{"speaker":"Charles Goldfarb","startTime":1827.75,"endTime":1831.08,"body":"hospital, the patient comes in"},{"speaker":"Charles Goldfarb","startTime":1827.75,"endTime":1831.08,"body":"and you take them to the OR"},{"speaker":"Charles Goldfarb","startTime":1831.08,"endTime":1834.23,"body":"right away, maybe not the most"},{"speaker":"Charles Goldfarb","startTime":1831.08,"endTime":1834.23,"body":"common scenario we have. But I'm"},{"speaker":"Charles Goldfarb","startTime":1834.23,"endTime":1837.14,"body":"setting you up for the ability"},{"speaker":"Charles Goldfarb","startTime":1834.23,"endTime":1837.14,"body":"to perform a primary repair,"},{"speaker":"Charles Goldfarb","startTime":1837.2,"endTime":1840.05,"body":"just talk me through how you"},{"speaker":"Charles Goldfarb","startTime":1837.2,"endTime":1840.05,"body":"would think through a mid"},{"speaker":"Charles Goldfarb","startTime":1840.14,"endTime":1844.25,"body":"proximal phalanx digital nerve"},{"speaker":"Charles Goldfarb","startTime":1840.14,"endTime":1844.25,"body":"laceration with an associated"},{"speaker":"Charles Goldfarb","startTime":1844.28,"endTime":1848.09,"body":"artery injury, but the other"},{"speaker":"Charles Goldfarb","startTime":1844.28,"endTime":1848.09,"body":"digital artery is intact. How do"},{"speaker":"Charles Goldfarb","startTime":1848.09,"endTime":1848.84,"body":"you think about that?"},{"speaker":"Chris Dy","startTime":1849.89,"endTime":1851.81,"body":"Well, I mean, if the"},{"speaker":"Chris Dy","startTime":1849.89,"endTime":1851.81,"body":"other digital artery is intact"},{"speaker":"Chris Dy","startTime":1851.81,"endTime":1854.66,"body":"and the finger as well perfused,"},{"speaker":"Chris Dy","startTime":1851.81,"endTime":1854.66,"body":"I tend not to go after the"},{"speaker":"Chris Dy","startTime":1854.66,"endTime":1860.12,"body":"artery, except I will confess"},{"speaker":"Chris Dy","startTime":1854.66,"endTime":1860.12,"body":"that I have, I used maximum MFE,"},{"speaker":"Chris Dy","startTime":1860.12,"endTime":1863.81,"body":"maximum fellow experience, as a"},{"speaker":"Chris Dy","startTime":1860.12,"endTime":1863.81,"body":"rationale for doing the other"},{"speaker":"Chris Dy","startTime":1863.81,"endTime":1866.66,"body":"artery because I mean, it is,"},{"speaker":"Chris Dy","startTime":1863.81,"endTime":1866.66,"body":"it's great micro, you're already"},{"speaker":"Chris Dy","startTime":1866.66,"endTime":1870.5,"body":"got the scope out, you can you"},{"speaker":"Chris Dy","startTime":1866.66,"endTime":1870.5,"body":"know it. The theory is, in"},{"speaker":"Chris Dy","startTime":1870.5,"endTime":1873.44,"body":"theory, in theory, it's good for"},{"speaker":"Chris Dy","startTime":1870.5,"endTime":1873.44,"body":"things like minimizing cold"},{"speaker":"Chris Dy","startTime":1873.44,"endTime":1876.05,"body":"intolerance. But it's really"},{"speaker":"Chris Dy","startTime":1873.44,"endTime":1876.05,"body":"good for our fellows and our"},{"speaker":"Chris Dy","startTime":1876.05,"endTime":1878.84,"body":"residents to get additional"},{"speaker":"Chris Dy","startTime":1876.05,"endTime":1878.84,"body":"experience with arteries,"},{"speaker":"Chris Dy","startTime":1878.84,"endTime":1881.45,"body":"especially when it's not high"},{"speaker":"Chris Dy","startTime":1878.84,"endTime":1881.45,"body":"stakes, and you're going to redo"},{"speaker":"Chris Dy","startTime":1881.45,"endTime":1886.49,"body":"it, redo it, redo it, you know,"},{"speaker":"Chris Dy","startTime":1881.45,"endTime":1886.49,"body":"but I typically will follow"},{"speaker":"Chris Dy","startTime":1886.49,"endTime":1888.77,"body":"similar techniques to what I"},{"speaker":"Chris Dy","startTime":1886.49,"endTime":1888.77,"body":"described earlier, I still use"},{"speaker":"Chris Dy","startTime":1888.8,"endTime":1892.82,"body":"9-0 nylon, I will mobilize the"},{"speaker":"Chris Dy","startTime":1888.8,"endTime":1892.82,"body":"nerve ends as much as I can,"},{"speaker":"Chris Dy","startTime":1892.82,"endTime":1897.41,"body":"without creating too much trauma"},{"speaker":"Chris Dy","startTime":1892.82,"endTime":1897.41,"body":"to the surrounding tissues. And,"},{"speaker":"Chris Dy","startTime":1898.04,"endTime":1901.88,"body":"and if there, if I can repair it"},{"speaker":"Chris Dy","startTime":1898.04,"endTime":1901.88,"body":"primarily with the finger and"},{"speaker":"Chris Dy","startTime":1901.88,"endTime":1905.9,"body":"extension, I will do that. If I"},{"speaker":"Chris Dy","startTime":1901.88,"endTime":1905.9,"body":"cannot repair it primarily with"},{"speaker":"Chris Dy","startTime":1905.9,"endTime":1909.41,"body":"the finger and extension, I do"},{"speaker":"Chris Dy","startTime":1905.9,"endTime":1909.41,"body":"not want my digital nerve being"},{"speaker":"Chris Dy","startTime":1909.41,"endTime":1912.8,"body":"the reason this patient gets"},{"speaker":"Chris Dy","startTime":1909.41,"endTime":1912.8,"body":"stiff. So I will use an"},{"speaker":"Chris Dy","startTime":1912.83,"endTime":1916.43,"body":"allograft usually in this"},{"speaker":"Chris Dy","startTime":1912.83,"endTime":1916.43,"body":"setting. I try to make sure that"},{"speaker":"Chris Dy","startTime":1916.43,"endTime":1919.28,"body":"whoever is consenting the"},{"speaker":"Chris Dy","startTime":1916.43,"endTime":1919.28,"body":"patient, or if it's if it's not"},{"speaker":"Chris Dy","startTime":1919.28,"endTime":1922.85,"body":"me, has talked to the patient"},{"speaker":"Chris Dy","startTime":1919.28,"endTime":1922.85,"body":"explicitly about the possibility"},{"speaker":"Chris Dy","startTime":1922.85,"endTime":1925.85,"body":"of a nerve allograft. What about"},{"speaker":"Chris Dy","startTime":1922.85,"endTime":1925.85,"body":"you? How do you, I mean, this is"},{"speaker":"Chris Dy","startTime":1925.85,"endTime":1928.73,"body":"one of the more common nerve"},{"speaker":"Chris Dy","startTime":1925.85,"endTime":1928.73,"body":"repairs that you would do in"},{"speaker":"Chris Dy","startTime":1928.73,"endTime":1930.32,"body":"terms of being on call and that"},{"speaker":"Chris Dy","startTime":1928.73,"endTime":1930.32,"body":"kind of thing?"},{"speaker":"Charles Goldfarb","startTime":1931.01,"endTime":1934.49,"body":"I'd, not much"},{"speaker":"Charles Goldfarb","startTime":1931.01,"endTime":1934.49,"body":"to add, I think I've learned my"},{"speaker":"Charles Goldfarb","startTime":1934.49,"endTime":1938.03,"body":"lesson over the years to avoid"},{"speaker":"Charles Goldfarb","startTime":1934.49,"endTime":1938.03,"body":"tension at all cost. I don't"},{"speaker":"Charles Goldfarb","startTime":1938.03,"endTime":1940.64,"body":"want to say that I've skimped"},{"speaker":"Charles Goldfarb","startTime":1938.03,"endTime":1940.64,"body":"and, and repaired nerves that I"},{"speaker":"Charles Goldfarb","startTime":1940.64,"endTime":1943.04,"body":"haven't because I've tried not"},{"speaker":"Charles Goldfarb","startTime":1940.64,"endTime":1943.04,"body":"to do that. But when you're in"},{"speaker":"Charles Goldfarb","startTime":1943.04,"endTime":1945.92,"body":"the OR, and it's the middle of"},{"speaker":"Charles Goldfarb","startTime":1943.04,"endTime":1945.92,"body":"the night, or even the middle of"},{"speaker":"Charles Goldfarb","startTime":1945.92,"endTime":1949.01,"body":"the day, and you've mobilized"},{"speaker":"Charles Goldfarb","startTime":1945.92,"endTime":1949.01,"body":"the nerve ends you have good"},{"speaker":"Charles Goldfarb","startTime":1949.01,"endTime":1953.15,"body":"looking fascicles on both"},{"speaker":"Charles Goldfarb","startTime":1949.01,"endTime":1953.15,"body":"proximal and distal stumps, you"},{"speaker":"Charles Goldfarb","startTime":1953.15,"endTime":1957.2,"body":"know you can, it can be it can"},{"speaker":"Charles Goldfarb","startTime":1953.15,"endTime":1957.2,"body":"be tempting to put the nerve"},{"speaker":"Charles Goldfarb","startTime":1957.2,"endTime":1961.07,"body":"together under a, quote, little"},{"speaker":"Charles Goldfarb","startTime":1957.2,"endTime":1961.07,"body":"bit of tension. And that's"},{"speaker":"Charles Goldfarb","startTime":1961.07,"endTime":1963.83,"body":"that's always it's always hard"},{"speaker":"Charles Goldfarb","startTime":1961.07,"endTime":1963.83,"body":"to decide because you're"},{"speaker":"Charles Goldfarb","startTime":1963.83,"endTime":1968.48,"body":"weighing that versus putting in"},{"speaker":"Charles Goldfarb","startTime":1963.83,"endTime":1968.48,"body":"some type of interposition and"},{"speaker":"Charles Goldfarb","startTime":1968.48,"endTime":1971.66,"body":"then requiring the nerve to pass"},{"speaker":"Charles Goldfarb","startTime":1968.48,"endTime":1971.66,"body":"two suture repair points. And so"},{"speaker":"Charles Goldfarb","startTime":1971.66,"endTime":1975.02,"body":"it gets tricky. And I think"},{"speaker":"Charles Goldfarb","startTime":1971.66,"endTime":1975.02,"body":"you're right, I think that it"},{"speaker":"Charles Goldfarb","startTime":1975.02,"endTime":1979.94,"body":"has to be with the finger full"},{"speaker":"Charles Goldfarb","startTime":1975.02,"endTime":1979.94,"body":"extended, if fully extended with"},{"speaker":"Charles Goldfarb","startTime":1979.94,"endTime":1983.9,"body":"9 or 10-0, nylon, you can't have"},{"speaker":"Charles Goldfarb","startTime":1979.94,"endTime":1983.9,"body":"undue tension. And what does"},{"speaker":"Charles Goldfarb","startTime":1983.9,"endTime":1986.45,"body":"that mean? I don't know, I don't"},{"speaker":"Charles Goldfarb","startTime":1983.9,"endTime":1986.45,"body":"know how to quantify it, but you"},{"speaker":"Charles Goldfarb","startTime":1986.45,"endTime":1987.11,"body":"just can't do it."},{"speaker":"Chris Dy","startTime":1988.76,"endTime":1990.77,"body":"What, so what are your"},{"speaker":"Chris Dy","startTime":1988.76,"endTime":1990.77,"body":"thoughts about scope versus"},{"speaker":"Chris Dy","startTime":1990.77,"endTime":1994.13,"body":"loops? For this particular"},{"speaker":"Chris Dy","startTime":1990.77,"endTime":1994.13,"body":"study, because I know that there"},{"speaker":"Chris Dy","startTime":1994.13,"endTime":1996.41,"body":"are some places where you don't"},{"speaker":"Chris Dy","startTime":1994.13,"endTime":1996.41,"body":"have a microscope available and"},{"speaker":"Chris Dy","startTime":1996.41,"endTime":1999.05,"body":"you're, you're in a surgery"},{"speaker":"Chris Dy","startTime":1996.41,"endTime":1999.05,"body":"center or whatever and you know,"},{"speaker":"Chris Dy","startTime":1999.08,"endTime":2001.21,"body":"your you have your loops, you"},{"speaker":"Chris Dy","startTime":1999.08,"endTime":2001.21,"body":"have the suture, but."},{"speaker":"Charles Goldfarb","startTime":2001.84,"endTime":2003.97,"body":"I made a"},{"speaker":"Charles Goldfarb","startTime":2001.84,"endTime":2003.97,"body":"decision early on to use 3.5"},{"speaker":"Charles Goldfarb","startTime":2003.97,"endTime":2007.99,"body":"loops rather than 2.5 loops. And"},{"speaker":"Charles Goldfarb","startTime":2003.97,"endTime":2007.99,"body":"I think in the outpatient"},{"speaker":"Charles Goldfarb","startTime":2007.99,"endTime":2011.14,"body":"environment, I think it is"},{"speaker":"Charles Goldfarb","startTime":2007.99,"endTime":2011.14,"body":"perfectly appropriate to use"},{"speaker":"Charles Goldfarb","startTime":2011.29,"endTime":2015.82,"body":"loop only repair for digital"},{"speaker":"Charles Goldfarb","startTime":2011.29,"endTime":2015.82,"body":"nerves. However, there is no"},{"speaker":"Charles Goldfarb","startTime":2015.82,"endTime":2020.95,"body":"question in my mind that given a"},{"speaker":"Charles Goldfarb","startTime":2015.82,"endTime":2020.95,"body":"choice between loop repair or"},{"speaker":"Charles Goldfarb","startTime":2021.04,"endTime":2024.28,"body":"microscope repair, the"},{"speaker":"Charles Goldfarb","startTime":2021.04,"endTime":2024.28,"body":"visualization and I do believe"},{"speaker":"Charles Goldfarb","startTime":2024.28,"endTime":2026.11,"body":"the quality of repair is better"},{"speaker":"Charles Goldfarb","startTime":2024.28,"endTime":2026.11,"body":"with a microscope."},{"speaker":"Chris Dy","startTime":2027.8,"endTime":2030.56,"body":"I will say you know"},{"speaker":"Chris Dy","startTime":2027.8,"endTime":2030.56,"body":"your, these cases are"},{"speaker":"Chris Dy","startTime":2030.56,"endTime":2034.07,"body":"challenging in fingers because"},{"speaker":"Chris Dy","startTime":2030.56,"endTime":2034.07,"body":"unlike the scenario you just"},{"speaker":"Chris Dy","startTime":2034.07,"endTime":2037.28,"body":"gave me it usually is not just a"},{"speaker":"Chris Dy","startTime":2034.07,"endTime":2037.28,"body":"digital nerve and an artery,"},{"speaker":"Chris Dy","startTime":2037.34,"endTime":2040.52,"body":"there usually is much more going"},{"speaker":"Chris Dy","startTime":2037.34,"endTime":2040.52,"body":"on. And I think that it's"},{"speaker":"Chris Dy","startTime":2040.52,"endTime":2042.74,"body":"important for us, as hand"},{"speaker":"Chris Dy","startTime":2040.52,"endTime":2042.74,"body":"surgeons to remember that you"},{"speaker":"Chris Dy","startTime":2042.74,"endTime":2046.01,"body":"got to think about the rest of"},{"speaker":"Chris Dy","startTime":2042.74,"endTime":2046.01,"body":"the finger. And yes, selfishly,"},{"speaker":"Chris Dy","startTime":2046.01,"endTime":2049.31,"body":"if I want to, you know, put this"},{"speaker":"Chris Dy","startTime":2046.01,"endTime":2049.31,"body":"patient, immobilize this patient"},{"speaker":"Chris Dy","startTime":2049.31,"endTime":2051.92,"body":"in the dorsal blocking splint"},{"speaker":"Chris Dy","startTime":2049.31,"endTime":2051.92,"body":"for six weeks for my primary"},{"speaker":"Chris Dy","startTime":2051.92,"endTime":2054.65,"body":"nerve repair to heal, it can be"},{"speaker":"Chris Dy","startTime":2051.92,"endTime":2054.65,"body":"great from a nerve repair, but"},{"speaker":"Chris Dy","startTime":2054.65,"endTime":2057.23,"body":"it's going to be awful for the"},{"speaker":"Chris Dy","startTime":2054.65,"endTime":2057.23,"body":"rest of the finger. And that's"},{"speaker":"Chris Dy","startTime":2057.23,"endTime":2059.3,"body":"where i think that you know,"},{"speaker":"Chris Dy","startTime":2057.23,"endTime":2059.3,"body":"where we rely on our therapy"},{"speaker":"Chris Dy","startTime":2059.3,"endTime":2062.78,"body":"colleagues to to get people"},{"speaker":"Chris Dy","startTime":2059.3,"endTime":2062.78,"body":"moving quickly. We need to give"},{"speaker":"Chris Dy","startTime":2062.78,"endTime":2065.75,"body":"them the tools to do that. And"},{"speaker":"Chris Dy","startTime":2062.78,"endTime":2065.75,"body":"if I can do that with you know,"},{"speaker":"Chris Dy","startTime":2065.78,"endTime":2068.6,"body":"a graft, especially with the"},{"speaker":"Chris Dy","startTime":2065.78,"endTime":2068.6,"body":"support of the literature that's"},{"speaker":"Chris Dy","startTime":2068.6,"endTime":2071.21,"body":"out there. I think that that's"},{"speaker":"Chris Dy","startTime":2068.6,"endTime":2071.21,"body":"the right thing to do."},{"speaker":"Charles Goldfarb","startTime":2072.53,"endTime":2074.03,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2072.53,"endTime":2074.03,"body":"that makes all the sense in the"},{"speaker":"Charles Goldfarb","startTime":2074.03,"endTime":2078.95,"body":"world. Alright, so I think we"},{"speaker":"Charles Goldfarb","startTime":2074.03,"endTime":2078.95,"body":"should conclude part two of"},{"speaker":"Charles Goldfarb","startTime":2078.95,"endTime":2082.79,"body":"nerve I can't talk nerve"},{"speaker":"Charles Goldfarb","startTime":2078.95,"endTime":2082.79,"body":"anymore. I'm all nerved out. But"},{"speaker":"Charles Goldfarb","startTime":2082.79,"endTime":2085.1,"body":"I do look forward to coming back"},{"speaker":"Charles Goldfarb","startTime":2082.79,"endTime":2085.1,"body":"and again, hopefully having a"},{"speaker":"Charles Goldfarb","startTime":2085.1,"endTime":2087.29,"body":"little bit of a discussion about"},{"speaker":"Charles Goldfarb","startTime":2085.1,"endTime":2087.29,"body":"nerve transfers and you can"},{"speaker":"Charles Goldfarb","startTime":2087.29,"endTime":2091.73,"body":"educate me. What should, any"},{"speaker":"Charles Goldfarb","startTime":2087.29,"endTime":2091.73,"body":"other Final Thoughts?"},{"speaker":"Chris Dy","startTime":2093.04,"endTime":2095.32,"body":"No, I think that part"},{"speaker":"Chris Dy","startTime":2093.04,"endTime":2095.32,"body":"three nerves is going to be"},{"speaker":"Chris Dy","startTime":2095.32,"endTime":2097.99,"body":"great. We have a couple of great"},{"speaker":"Chris Dy","startTime":2095.32,"endTime":2097.99,"body":"topics we want to cover this"},{"speaker":"Chris Dy","startTime":2097.99,"endTime":2100.15,"body":"month. We're really excited. We"},{"speaker":"Chris Dy","startTime":2097.99,"endTime":2100.15,"body":"have our fellowship interviews"},{"speaker":"Chris Dy","startTime":2100.15,"endTime":2103.06,"body":"for our fellowship coming up"},{"speaker":"Chris Dy","startTime":2100.15,"endTime":2103.06,"body":"next month, so we'll talk a"},{"speaker":"Chris Dy","startTime":2103.06,"endTime":2106.75,"body":"little bit about the process in"},{"speaker":"Chris Dy","startTime":2103.06,"endTime":2106.75,"body":"an upcoming episode. I think"},{"speaker":"Chris Dy","startTime":2106.75,"endTime":2109.0,"body":"both on the applicant side, it's"},{"speaker":"Chris Dy","startTime":2106.75,"endTime":2109.0,"body":"different. It's also pretty"},{"speaker":"Chris Dy","startTime":2109.0,"endTime":2112.81,"body":"different on our side in terms"},{"speaker":"Chris Dy","startTime":2109.0,"endTime":2112.81,"body":"of how we, how we demonstrate"},{"speaker":"Chris Dy","startTime":2112.81,"endTime":2116.83,"body":"what we do here, and also how"},{"speaker":"Chris Dy","startTime":2112.81,"endTime":2116.83,"body":"we, how we interview people. So"},{"speaker":"Chris Dy","startTime":2117.07,"endTime":2119.95,"body":"it'd be great to get comments"},{"speaker":"Chris Dy","startTime":2117.07,"endTime":2119.95,"body":"from anybody that's listening in"},{"speaker":"Chris Dy","startTime":2119.95,"endTime":2122.92,"body":"terms of suggestions for how to"},{"speaker":"Chris Dy","startTime":2119.95,"endTime":2122.92,"body":"do the process. Anybody that's"},{"speaker":"Chris Dy","startTime":2122.92,"endTime":2125.89,"body":"gone through it with residency"},{"speaker":"Chris Dy","startTime":2122.92,"endTime":2125.89,"body":"interviews recently or other"},{"speaker":"Chris Dy","startTime":2125.89,"endTime":2129.28,"body":"fellowships. We'd love to learn"},{"speaker":"Chris Dy","startTime":2125.89,"endTime":2129.28,"body":"because we're all in a brave new"},{"speaker":"Chris Dy","startTime":2129.28,"endTime":2130.06,"body":"world now so."},{"speaker":"Charles Goldfarb","startTime":2130.66,"endTime":2132.49,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2130.66,"endTime":2132.49,"body":"All right. Take care of"},{"speaker":"Charles Goldfarb","startTime":2132.49,"endTime":2134.74,"body":"yourself. Be safe, and we'll"},{"speaker":"Charles Goldfarb","startTime":2132.49,"endTime":2134.74,"body":"talk soon."},{"speaker":"Chris Dy","startTime":2136.12,"endTime":2137.2,"body":"All right, take care."},{"speaker":"Chris Dy","startTime":2136.12,"endTime":2137.2,"body":"Bye."},{"speaker":"Charles Goldfarb","startTime":2138.79,"endTime":2140.77,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2138.79,"endTime":2140.77,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2140.77,"endTime":2141.28,"body":"real soon."},{"speaker":"Chris Dy","startTime":2141.52,"endTime":2144.04,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2141.52,"endTime":2144.04,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2144.28,"endTime":2146.47,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2144.28,"endTime":2146.47,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2146.83,"endTime":2149.68,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2146.83,"endTime":2149.68,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2149.8,"endTime":2153.19,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2149.8,"endTime":2153.19,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2153.19,"endTime":2156.46,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2153.19,"endTime":2156.46,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2157.63,"endTime":2159.76,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2157.63,"endTime":2159.76,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2159.76,"endTime":2160.84,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2160.9,"endTime":2163.12,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2160.9,"endTime":2163.12,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2163.12,"endTime":2163.51,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2163.9,"endTime":2166.18,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2163.9,"endTime":2166.18,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2166.18,"endTime":2170.08,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2166.18,"endTime":2170.08,"body":"upper hand come back next"}]}