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Hunt TJ, Powlan FJ, Renfro KN, Polmear M, Macias RA, Dunn JC, Wells ME. Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers. Mil Med 2024; 189:988-994. [PMID: 36734106 DOI: 10.1093/milmed/usad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. MATERIALS AND METHODS The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. RESULTS The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. CONCLUSIONS Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics.
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Affiliation(s)
- Tyler J Hunt
- Jack Hughston Memorial Hospital, Phenix City, AL 36867, USA
| | - Franklin J Powlan
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Kayleigh N Renfro
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Michael Polmear
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Reuben A Macias
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Matthew E Wells
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
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Kuwahara Y, Hara T, Kurahashi T, Takeshige H, Urata S, Oguchi T. Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap Using Nail Bed Graft for Fingertip Amputation with Replantation. Plast Reconstr Surg 2024; 153:1086-1092. [PMID: 37253041 DOI: 10.1097/prs.0000000000010760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. METHODS Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. RESULTS Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). CONCLUSION In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | | | - Shiro Urata
- From Orthopedic Surgery, Anjo Kosei Hospital
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Park SO, Kim DK, Ahn HC, Kim YH. Fingertip coverage with uni-pedicled volar rotational advancement flap with large Z-plasty: a report on 112 cases. J Orthop Surg Res 2023; 18:553. [PMID: 37525140 PMCID: PMC10391884 DOI: 10.1186/s13018-023-04047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Simple and safe fingertip reconstruction methods involve the use of local neurovascular islands flaps that can preserve functional length and sensitivity, and reconstruction with skin of the same texture. However, techniques involving flaps have numerous drawbacks and do not satisfy all the requirements for fingertip reconstruction. A particular problem is the persistence of contracture deformity due to lack of full flap advancement. We present a new technique using uni-pedicled volar rotational advancement flap with large Z-plasty, and describe the results of long-term follow-up. METHODS From October 1993 to December 2009, 112 fingers of 98 patients were covered with uni-pedicled volar rotational advancement flap with large Z-plasty after sustaining various types of injuries or finger pulp avulsion. A longitudinal incision was made along the lateral border of the digit and a large neurovascular volar flap was elevated just above the pulleys and flexor tendon sheath. To release tension, a large Z-plasty was applied at the metacarpophalangeal joint or interphalangeal joint crease. The final patient outcomes were reviewed retrospectively. RESULTS All fingertip injuries were treated without flap necrosis. Partial wound dehiscence was observed in two patients and average static two-point discrimination was 5.2 mm. There were no postoperative contracture deformities, joint stiffness, paresthesia, or hypersensitivity. Most patients were left with acceptable scarring and were free of postoperative pain and cold intolerance during the long-term follow-up. CONCLUSIONS Our novel technique provides durable, completely sensate, and well-vascularized coverage of the fingertip with minimal discomfort to patients.
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Affiliation(s)
- Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, 222 Wangsimniro, Seongdong-gu, Seoul, 04763, Korea.
| | - Dae Kwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, 222 Wangsimniro, Seongdong-gu, Seoul, 04763, Korea
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, CHA University Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, 222 Wangsimniro, Seongdong-gu, Seoul, 04763, Korea
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Mohsen I, Mahmoud M, Shaheen A. Modified Bilateral V-Y Rotation Advancement Flap for Coverage of Fingertip Amputations. J Hand Surg Asian Pac Vol 2022; 27:1013-1020. [PMID: 36550086 DOI: 10.1142/s2424835522500977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The use of homodigital antegrade flow flaps is an appealing option for coverage of fingertip injuries with exposed bone as it provides good padding, sensation and colour match with no need for splinting or secondary procedure for flap separation. V-Y flaps presented by Atasoy and Kutler have limited ability of distal advancement. We used two separate V flaps each based on a separate neuro-vascular bundle to allow better advancement while keeping good vascularity and sensation. Methods: We used a modified bilateral V-Y rotation advancement flap for coverage of fourteen fingertip injuries with bone exposed in 11 adult patients. Time to complete healing and return to work was recorded. Range of motion of injured finger as well as fingertip sensation using two-point discrimination were assessed and compared to non-injured contralateral finger 6 months after surgery. Fingertip hypersensitivity, cold intolerance and hooked nail deformity were assessed as well. Results: All flaps survived, and all patients resumed their activities after a mean period of 5 weeks. The mean two-point discrimination was 3.9 mm and was comparable to non-injured side. All patients regained full range of motion and were satisfied by the result. Two cases suffered from hypersensitivity that resolved at 3 months post-operative. Hooked nail deformity and cold intolerance were not recorded in our study. Conclusions: This modified bilateral V-Y rotation advancement flap technique presents a simple and single step procedure that provides good padding of fingertip with cosmetically pleasant contour and normal sensation. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Ibrahim Mohsen
- Department of Orthopedic Surgery, Fayoum University Hospital, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mostafa Mahmoud
- Department of Orthopedic Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Shaheen
- Department of Orthopedic Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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Syrnioti G, Ayyat M, Jean C, Ahmad H, Ahmad N. Nail Reconstruction With Nail Bed Graft From Big Toe: A Case Report. Cureus 2022; 14:e27884. [PMID: 36110482 PMCID: PMC9462594 DOI: 10.7759/cureus.27884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
Abstract
Fingertip injuries with loss of the nail bed can lead to permanent deformities or absent nail formation. This is a case report of a 17-year-old female who sustained a blunt injury to the left second index finger with nail avulsion. The patient underwent nail reconstruction with a split-thickness graft from the sterile matrix of the left great toe. Postoperatively both the donor and the recipient sites appear to be healing appropriately. Since nail reconstruction with toe graft is rarely performed, this case is of particular interest due to its excellent postoperative outcomes.
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Abstract
Following a fingertip amputation, if vessels are present and of adequate condition, microsurgical replantation is the preferred technique for management. Composite grafting has a limited role in the management of fingertip amputations due to its unreliable nature but can be an option when an amputated fingertip is not replantable and the patient desires restoration of fingertip length and aesthetics. When composite grafting is selected as the treatment of choice for a particular patient, there are methods of optimizing the chances of graft revascularization and survival, including early grafting, graft cooling, and a moist wound healing environment.
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Affiliation(s)
- Kate Elzinga
- Section of Plastic Surgery, University of Calgary, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada.
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Medical School, The University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-0340, USA
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Abstract
Fingertip replantation is technically challenging, but in a motivated patient excellent aesthetic and functional outcomes can be achieved. Fingertip microanatomy by zone is described to facilitate the classification and treatment of these injuries. In this article, we outline our preferred techniques for fingertip replantation and review the current body of evidence surrounding indications, techniques, and outcomes while highlighting opportunities for future study.
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Affiliation(s)
- Amelia C Van Handel
- Division of Plastic & Reconstructive Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Suite 1150, St Louis, MO 63110, USA
| | - Mitchell A Pet
- Division of Plastic & Reconstructive Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Suite 1150, St Louis, MO 63110, USA.
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Abstract
Fingertip injuries in the military are common and often hinder the fighting force and support personnel. Injuries range from small subungual hematomas to proximal finger amputations. Treatment modalities are dictated by injury patterns, anatomic considerations, and the need to return to duty. Nail bed injuries should be repaired when possible and exposed bone or tendon is treated with appropriate soft tissue coverage. If soft tissue coverage is unobtainable, revision amputation should be performed with attention given to maintaining as much finger length as possible. Antibiotics may not be required, however they are often utilized in the deployed setting.
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Affiliation(s)
- Matthew E Wells
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79902, USA; Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, 4801 Alberta Avenue, El Paso, TX 79905, USA.
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79902, USA; Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, 4801 Alberta Avenue, El Paso, TX 79905, USA
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery, Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223, USA
| | - Leon J Nesti
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79902, USA; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Modified Oblique Triangular Neurovascular Island Flap Technique to Prevent the Development of Hooked Nail Deformity. Tech Hand Up Extrem Surg 2020; 25:201-205. [PMID: 33370085 DOI: 10.1097/bth.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hooked fingernail deformity can develop after any type of fingertip amputation. A more proximal amputation is associated with a higher probability of developing hooked fingernails. Proximal fingertip amputations with very short remaining nail beds are recommended for revision amputation with nail bed ablation. This procedure eliminates the possibility that the patient may have a functional nail. When the nail matrix is still retained, an oblique triangular neurovascular island flap may preserve the nail and digit length. At our institution, the modified oblique triangular neurovascular island flap is routinely used for patients who underwent fingertip amputation with a retained nail bed. These modifications may aid in preventing the development of hooked nail deformity and creating a round pulp contour without the need for fixation, composite grafts, or distant soft tissue transfer.
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Effects of hyperbaric oxygen on graft survival outcomes in composite grafting for amputated fingertip injury. Arch Plast Surg 2020; 47:444-450. [PMID: 32971596 PMCID: PMC7520242 DOI: 10.5999/aps.2020.00381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fingertip injuries are the most common type of traumatic injury treated at emergency departments and require prompt and adequate interventions for favorable wound survival outcomes. Hyperbaric oxygen (HBO2) therapy is well known for its many positive effects on wound healing. We hypothesized that treatment with HBO2 would improve the graft survival outcomes of amputated fingertip injuries treated with composite grafts. METHODS This retrospective observational study included fingertip amputations that were treated between January 2013 and December 2017. A conventional group and an HBO2 therapy group were statistically compared to evaluate the effect of HBO2 treatment. Graft survival was categorized as either success or failure. RESULTS Among 55 cases (digits), 34 digits were conventionally treated, while 21 digits were treated with HBO2. No statistically significant differences were observed between the groups with regard to general characteristics. Among patients with guillotine-type injuries, the composite graft success rate was statistically significantly higher in the group that received HBO2 therapy than in the conventional group (P=0.0337). Overall, the HBO2 group also demonstrated a statistically significantly shorter healing time than the conventional group (P=0.0075). As such, HBO2 treatment facilitates composite graft survival in cases of fingertip injury. CONCLUSIONS HBO2 treatment was associated with an increased composite graft survival rate in guillotine-type fingertip injuries and reduced the time required for grafts to heal.
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Li M, Chen Z, Yang Y, Ma L, Zhang Z. Split-Thickness Nail Bed Flap Graft in the Management of Distal Partial Defect of the Nail Bed Combined With Soft Tissue. J Hand Surg Am 2020; 45:879.e1-879.e10. [PMID: 32299689 DOI: 10.1016/j.jhsa.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/12/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We report a surgical procedure for the management of nail bed injuries combined with soft tissue defects. METHODS We reviewed the records of patients with a nail bed injury combined with a soft tissue defect, who were surgically treated at our hospital from 2015 through 2018. According to the Allen classification, 5 patients were characterized as type 2 and 3 were characterized as type 3. Two also had partial defects of the distal phalanx. In all cases, we created a split-thickness nail bed flap of the great toe to reconstruct the nail bed injury. All patients underwent supervised postoperative rehabilitation. We reviewed patients' medical records for the Michigan Hand Outcomes Questionnaire, 2-point discrimination, and postoperative healing in the donor area. RESULTS Both the nails and flaps of all patients survived. No complications were observed after surgery. The nail was completely attached to the nail bed. In addition, there were no deformities, and the nail plate appearance was close to normal. A nail with an unsatisfactory appearance was noted in one patient. The shape, texture, and elasticity of the flaps of all patients were acceptable. All patients were capable of normal pinching, gripping, and grasping. Twelve months after the operation, 3 of 8 patients had 2-point discrimination of 6 mm or less. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire. The toenail of the donor site grew well, and no deformity or pain with walking was noted. CONCLUSIONS We demonstrate that this approach is a safe means of repairing a nail bed injury combined with a soft tissue defect. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Muwei Li
- Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China
| | - Zhiying Chen
- Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China
| | - Yanjun Yang
- Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China
| | - Lifeng Ma
- Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China
| | - Ziqing Zhang
- Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China.
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Jampani R, Takkallapally V. Back to Fine Work with Fine Surgery. J Lifestyle Med 2020; 10:126-129. [PMID: 32995341 PMCID: PMC7502890 DOI: 10.15280/jlm.2020.10.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
Generation Z of this millennial period has a very active lifestyle. Generation Z is demographic cohort with date of birth between mid-1990s to late 2010. In recent times men and women are very active and they balance their work and recreation. They have focus in their occupation and same way they have passion towards biking, diving and sports. We present a case of software engineer who has sustained an injury while pursuing his passion of bike driving on a weekend holiday. He sustained a crush injury to fingers of dominant right-hand index and middle finger. We had a comprehensive preoperative and postoperative plan and executed the plan well so that he could go back to his occupation of software engineer where he has to use his fingers over keyboard and mouse so that he can earn his livelihood. Treating an injury has to include patient’s occupation, his passion,his needs and demands. Crux of any management must include patient demands rather than surgeon’s passion of doing a fancy procedure.
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Affiliation(s)
- Ravitheja Jampani
- Department of Orthopaedic Surgery, Sankalpa Cstar Hopsitals, Khammam, Vijayawada, India
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Neustein TM, Payne SH, Seiler JG. Treatment of Fingertip Injuries. JBJS Rev 2020; 8:e0182. [PMID: 32539263 DOI: 10.2106/jbjs.rvw.19.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The goal of care when treating fingertip injuries is to minimize the risk of infection while maximizing function, tactile sensation, digit length, pulp padding, and appearance. This outcome can be achieved with careful soft-tissue coverage and, if possible, nail-bed preservation. When replantation for a fingertip amputation is not possible for anatomic or logistical reasons, local or regional flap reconstruction can be a useful alternative to gain early soft-tissue coverage and allow more functional rehabilitation. Reviewing current fingertip soft-tissue coverage procedures and demonstrating key anatomic and technical points with cadaveric dissections provides a foundation for the incorporation of these techniques into practice.
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Affiliation(s)
- Thomas M Neustein
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Composite grafts for fingertip amputations: A systematic review protocol. Int J Surg Protoc 2019; 16:1-4. [PMID: 31897441 PMCID: PMC6921220 DOI: 10.1016/j.isjp.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background There is much debate in the hand surgery literature as to the management of fingertip amputations. Much research continues to be published in this area. Methods of reattachment include microsurgical and non-microsurgical (composite graft) replantation. The role of composite grafts lacks clarity in terms of outcomes, success rates and complications. Hence there is a need for an evidence synthesis, which can guide patient selection, the consent process and determine graft survival rates and functional outcomes to optimise patient outcomes. Methods Search of the databases OVID MEDLINE, PubMed, EMBASE, SCOPUS, The Cochrane Library and clinical trial registries from inception using terms "fingertip" "digital tip" "digit" "finger" "thumb" "amputation" "replantation" "reattachment" "reimplantation" and "composite graft" as key terms with "AND" selected as a Boolean operator, limited to humans will be conducted by two independent researchers. The patient population will include adults and children. Studies will be included if they report: (1) primary data; (2) outcomes of 'composite grafts' or 'nonmicrosurgical replantations'; (3) graft survival, (4) 5 or more cases. Articles will be excluded if surgical techniques involve: (1) composite graft pocketing, or (2) microsurgical replantation or (3) additional flaps (pulp or local). Full exclusion and inclusion criteria are described within this protocol. Data extraction will include; demographic details, patient comorbidities, amputation nature and level, functional, and aesthetic outcomes, complications and need for secondary procedures. All data extracted will be cross-checked, and discrepancies resolved through consensus. Dissemination This review will be published in a peer-reviewed journal and will be presented at national and international conferences to inform the practice of other clinicians.
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Shah S, Garg R, Uppal S, Mittal R, Thakur B, Rafique S. Modified mid palmar flap for middle finger tip injuries: A review of 12 cases. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/jotr.jotr_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jain A, Walker FS, Ugrappa S, Makkad S, Ugrappa VK. Three-part mould technique for fabrication of hollow thumb prosthesis: A case report. Prosthet Orthot Int 2016; 40:756-762. [PMID: 26578073 DOI: 10.1177/0309364615612636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this article is to describe a technique which helps in fabrication of glove-type hollow thumb prosthesis using three-part mould technique. CASE DESCRIPTION AND METHODS Patient reported to the Department of Private dental clinic, Delhi, India with a chief complaint of missing partial left thumb and wanted to get it replaced. A complete clinical hand examination was carried out, which revealed a residual stump of 1 cm length. After ensuring the medical conditions to be normal, fabrication of hollow thumb prosthesis was planned using three-part mould technique. FINDINGS AND OUTCOMES The prosthesis delivered to the patient was highly retentive because of its glove-type retention and lighter weight; feedback from the patient regarding retention was excellent. The prosthesis was aesthetically pleasing because of its excellent colour matching with the skin, and each and every part of the prosthesis could be colour customized because of easy retrieval of the third part of the mould, as well. CONCLUSION A technique of hollow thumb prosthesis has been described in this article which helps in reduction in weight, easy packing of silicone material into the mould and easy colour customization at the knuckles area of the dorsal and ventral aspect of the prosthesis. CLINICAL RELEVANCE This three-part mould technique helps to fabricate hollow prosthesis which increases retainability and at the same time allows easy packing of silicone material and easy colour customization at the knuckles area of the prosthesis.
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Affiliation(s)
| | - Fraser S Walker
- West of Scotland Regional Maxillofacial Prosthetics Service, Southern General Hospital, Glasgow, UK
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Lee YJ, Kim HY, Rha EY, Lee JY, Han HH. Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo. J Plast Reconstr Aesthet Surg 2016; 69:1574-1576. [DOI: 10.1016/j.bjps.2016.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Rinkevich Y, Maan ZN, Walmsley GG, Sen SK. Injuries to appendage extremities and digit tips: A clinical and cellular update. Dev Dyn 2016; 244:641-50. [PMID: 25715837 DOI: 10.1002/dvdy.24265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/12/2015] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The regrowth of amputated appendage extremities and the distal tips of digits represent models of tissue regeneration in multiple vertebrate taxa. In humans, digit tip injuries, including traumatic amputation and crush injuries, are among the most common type of injury to the human hand. Despite clinical reports demonstrating natural regeneration of appendages in lower vertebrates and human digits, current treatment options are suboptimal, and are complicated by the anatomical complexities and functions of the different tissues within the digits. RESULTS In light of these challenges, we focus on recent advancements in understanding appendage regeneration from model organisms. We pay special attention to the cellular programs underlying appendage regeneration, where cumulative data from salamanders, fish, frogs, and mice indicate that regeneration occurs by the actions of lineage-restricted precursors. We focus on pathologic states and the interdependency that exists, in both humans and animal models, between the nail organ and the peripheral nerves for successful regeneration. CONCLUSIONS The increased understanding of regeneration in animal models may open new opportunities for basic and translational research aimed at understanding the mechanisms that support limb regeneration, as well as amelioration of limb abnormalities and pathologies.
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Affiliation(s)
- Yuval Rinkevich
- Institute for Stem Cell Biology and Regenerative Medicine, Departments of Pathology and Developmental Biology, Stanford University School of Medicine, Stanford, California
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Chen HY, Hsu CC, Lin YT, Yeh JT, Lin CH, Lin CH. Functional and aesthetic outcomes of the fingertips after nail lengthening using the eponychial flap. J Plast Reconstr Aesthet Surg 2015; 68:1438-46. [DOI: 10.1016/j.bjps.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/07/2015] [Accepted: 06/08/2015] [Indexed: 11/16/2022]
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Simkin J, Sammarco MC, Dawson LA, Tucker C, Taylor LJ, Van Meter K, Muneoka K. Epidermal closure regulates histolysis during mammalian (Mus) digit regeneration. ACTA ACUST UNITED AC 2015; 2:106-19. [PMID: 27499872 PMCID: PMC4895321 DOI: 10.1002/reg2.34] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 12/15/2022]
Abstract
Mammalian digit regeneration progresses through consistent stages: histolysis, inflammation, epidermal closure, blastema formation, and finally redifferentiation. What we do not yet know is how each stage can affect others. Questions of stage timing, tissue interactions, and microenvironmental states are becoming increasingly important as we look toward solutions for whole limb regeneration. This study focuses on the timing of epidermal closure which, in mammals, is delayed compared to more regenerative animals like the axolotl. We use a standard wound closure device, Dermabond (2-octyl cyanoacrylate), to induce earlier epidermal closure, and we evaluate the effect of fast epidermal closure on histolysis, blastema formation, and redifferentiation. We find that fast epidermal closure is reliant upon a hypoxic microenvironment. Additionally, early epidermal closure eliminates the histolysis stage and results in a regenerate that more closely replicates the amputated structure. We show that tools like Dermabond and oxygen are able to independently influence the various stages of regeneration enabling us to uncouple histolysis, wound closure, and other regenerative events. With this study, we start to understand how each stage of mammalian digit regeneration is controlled.
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Affiliation(s)
- Jennifer Simkin
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA; Department of Biology University of Kentucky Lexington Kentucky 40506 USA
| | - Mimi C Sammarco
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA
| | - Lindsay A Dawson
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA; Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas 77843 USA
| | - Catherine Tucker
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA
| | - Louis J Taylor
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA
| | - Keith Van Meter
- Department of Medicine Louisiana State University Health Sciences Center New Orleans Louisiana 70112 USA
| | - Ken Muneoka
- Division of Developmental Biology, Department of Cell and Molecular Biology Tulane University New Orleans Louisiana 70118 USA; Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas 77843 USA
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Ha N, Chang A, Sullivan J, Leonello D. Non-operative management of fingertip injuries with an intravenous dressing. J Wound Care 2015; 24:276, 278-9. [DOI: 10.12968/jowc.2015.24.6.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N.B. Ha
- Royal Adelaide Hospital Department of Orthopaedics and Trauma Adelaide, South Australia, AUSTRALIA 5000
| | - A.C. Chang
- Royal Adelaide Hospital Department of Orthopaedics and Trauma Adelaide, South Australia, AUSTRALIA 5000
| | - J.S. Sullivan
- Royal Adelaide Hospital Department of Orthopaedics and Trauma Adelaide, South Australia, AUSTRALIA 5000
| | - D.T. Leonello
- Royal Adelaide Hospital Department of Orthopaedics and Trauma Adelaide, South Australia, AUSTRALIA 5000
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Abstract
BACKGROUND Fingertip injuries are common in the pediatric population. Composite grafting is a frequently used technique for distal amputations in children given the reported success rate. We sought to study the early clinical results of composite grafting for fingertip injuries in the pediatric population. METHODS A retrospective review was performed over a 5-year period at a tertiary care pediatric hospital to identify those patients who underwent composite grafting of fingertip injuries. Patients were included if they were 18 years old or younger and sustained an injury distal to the distal interphalangeal joint (or thumb interphalangeal joint). Demographic information was recorded. Graft viability was characterized as no take, partial take, or complete take. The number of secondary procedures and number and duration of follow-up appointments were recorded. Hypothesis testing was done using ordinal logistic regression analysis. RESULTS Thirty-nine patients underwent fingertip composite grafting. The mean age was 5.9 years (1-18 years); there were 24 males (61.5 %) and 15 females (38.5 %). Thirteen patients had no graft take (33.3 %), 23 patients had partial take (59.0 %), and three patients had complete take (7.7 %). Only four patients underwent secondary revision (10 %). The median number of follow-up appointments was 3 and the average follow-up time was 4.5 months. Age did not appear to have a statistically significant influence on graft take. CONCLUSIONS Fingertip composite grafts rarely take completely even in young children. Despite poor viability, however, most patients will have at least partial graft take and do not undergo additional reconstructive procedures.
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Rubin G, Orbach H, Rinott M, Wolovelsky A, Rozen N. The use of prophylactic antibiotics in treatment of fingertip amputation: a randomized prospective trial. Am J Emerg Med 2015; 33:645-7. [PMID: 25682579 DOI: 10.1016/j.ajem.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/01/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Fingertip amputation is a common injury. Considerable controversy exists as to whether prophylactic antibiotics are necessary for this injury. Our goal was to compare the rate of infections among subgroups with and without prophylactic antibiotic treatment. The study hypothesis was that infection rates were similar in the 2 groups. METHODS This was a prospective randomized control trial of adult patients presenting with fingertip amputation with bone exposed, requiring surgical treatment. Patients were randomized to 2 groups: group 1 received no antibiotics, and group 2 received 1 g intravenous antibiotics (cefazolin) for 3 days. The 2 groups were matched for age, time to surgery, injury mechanism, and type of surgery. All surgical treatments were performed in the operating room, and all patients were reevaluated in our outpatient clinic after 10 days and again after a month. The primary outcome measure was the rate of infection. RESULTS Fifty-eight patients were initially enrolled in the study; 2 patients withdrew before study completion, 29 subjects were randomized to the no-antibiotic group, and 27 subjects were randomized to the antibiotic group. No statistically significant differences on any baseline values were found between the 2 treatment groups. There was no infection in either group at the end of follow-up. CONCLUSIONS This study suggests that routine prophylactic antibiotics do not reduce the rate of infection after fingertip amputations with bone exposed treated surgically in the operating room.
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Affiliation(s)
- Guy Rubin
- Orthopedic Department, Ha'Emek Medical Center, Afula, Israel; Hand Surgery Unit, Orthopedic Department, Ha'Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel.
| | - Hagay Orbach
- Orthopedic Department, Ha'Emek Medical Center, Afula, Israel
| | - Micha Rinott
- Orthopedic Department, Ha'Emek Medical Center, Afula, Israel; Hand Surgery Unit, Orthopedic Department, Ha'Emek Medical Center, Afula, Israel
| | - Alejandro Wolovelsky
- Orthopedic Department, Ha'Emek Medical Center, Afula, Israel; Hand Surgery Unit, Orthopedic Department, Ha'Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Orthopedic Department, Ha'Emek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
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TORRES FUENTES CARLOSEDUARDO, Hernández Beltrán JA, CASTAÑEDA HERNANDEZ DIEGOALEJANDRO. MANEJO INICIAL DE LAS LESIONES DE PUNTA DE DEDO: GUÍA DE TRATAMIENTO BASADO EN LA EXPERIENCIA EN EL HOSPITAL SAN JOSÉ (91 CASOS). REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v62n3.39603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Xing S, Shen Z, Jia W, Cai Y. Aesthetic and functional results from nailfold recession following fingertip amputations. J Hand Surg Am 2015; 40:1-7. [PMID: 25443165 DOI: 10.1016/j.jhsa.2014.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the aesthetic and functional results of a technique for nail salvage by recessing the nailfold to increase the exposed nail matrix after fingertip amputation. METHODS Thirty cases of fingertip amputation with distal partial nail bed defects underwent nailfold recession and pulp reconstruction. We increased nail bed exposure by recessing a rectangle flap of eponychium and reconstructed the pulp with different local flaps depending on the injury geometry. A 0.3- to 0.4-cm-wide rectangular strip of eponychium was de-epithelialized. The eponychial flap was separated from the nail matrix and slid proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed. RESULTS The flaps survived in all patients. The exposed nail beds were lengthened 0.3 to 0.4 cm and enlarged 38% to 100%. The fingertips had smooth and natural nail plates with inconspicuous scars on both the eponychium and pulp and no deformities. The sensation and mobility of injured and uninjured contralateral fingers did not differ statistically. All patients were satisfied with the appearance and function of the reconstructed fingertips. CONCLUSIONS Nailfold recession combined with different local flaps provided for the aesthetic and functional restoration of the fingertip after amputation with partial nail bed defect.
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Affiliation(s)
- Shuliang Xing
- Department of Plastic, Hand and Aesthetic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zunli Shen
- Department of Plastic, Hand and Aesthetic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Wanxin Jia
- Department of Plastic, Hand and Aesthetic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanxian Cai
- Department of Plastic, Hand and Aesthetic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Injuries to the fingertips are among the most common injuries to the hand and result in approximately 4.8 million emergency department visits per year. Most injuries are lacerations or crushes; amputations represent a small but complex spectrum of injury. Treatments available cover a broad range of techniques with no single recommended reference standard for treatment. Although there is no consensus on how these injuries should be treated, the goals of treatment should include minimization of pain, optimization of healing time, preservation of sensibility and length, prevention of painful neuromas, avoidance or limiting of nail deformity, minimization of time lost from work, and provision of an acceptable cosmetic appearance. In this review we present a variety of options in caring for these injuries to help achieve these goals, and the available data that support the various treatment plans.
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Pediatric thenar flaps: a modified design, case series and review of the literature. J Pediatr Surg 2014; 49:1433-8. [PMID: 25148754 DOI: 10.1016/j.jpedsurg.2013.11.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fingertip injuries are extremely common in children, and severe trauma with pulp loss requires soft-tissue reconstruction to restore length, bulk, and sensibility. The thenar flap is a well-described technique but there are few reports of its use in pediatric patients. METHODS Pediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution. RESULTS Sixteen pediatric patients (eleven male, five female) underwent thenar flap procedures. The average age was 10.8years (1.1-17.8years). The average defect size was 1.5cm×1.5cm (1cm(2)-2cm(2)). Division and inset occurred on average 16days later (12-24days). Average follow-up was 6.8months (4.1-9.6months). The average total active range of motion (TAM) in flexion was 248° (235°-260°) [normal maximum: 260°]. All patients had 85° metacarpophalangeal joint (MCPJ) range of motion (ROM) [normal maximum: 85°]. The average proximal interphalangeal joint (PIPJ) ROM was 103° (95°-110°) [normal maximum: 110°] in flexion, and an average 60° distal interphalangeal (DIPJ) ROM (55°-65°) [normal maximum: 65°] in flexion. Objective sensibility in the flap was ascertained as an average static two-point discrimination of 7mm (6mm-10mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications. CONCLUSIONS The thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring soft-tissue reconstruction.
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Biswas D, Wysocki RW, Fernandez JJ, Cohen MS. Local and regional flaps for hand coverage. J Hand Surg Am 2014; 39:992-1004. [PMID: 24766831 DOI: 10.1016/j.jhsa.2013.09.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 08/26/2013] [Accepted: 09/16/2013] [Indexed: 02/02/2023]
Abstract
Hand surgeons are frequently challenged by the unique requirements of soft tissue coverage of the hand. Whereas many smaller soft tissue defects without involvement of deep structures are amenable to healing by secondary intention or skin grafting, larger lesions and those with exposed tendon, bone, or joint often require vascularized coverage that allows rapid healing without wound contraction. The purpose of this review was to present an overview of local and regional flaps commonly used for soft tissue reconstruction within the hand.
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Affiliation(s)
- Debdut Biswas
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robert W Wysocki
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
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Abstract
Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. Paronychia typically develops following a breakdown in the barrier between the nail plate and the adjacent nail fold and is often caused by bacterial or fungal pathogens; however, noninfectious etiologies, such as chemical irritants, excessive moisture, systemic conditions, and medications, can cause nail changes. Abscesses associated with acute infections may spontaneously decompress or may require drainage and local wound care along with a short course of appropriate antibiotics. Chronic infections have a multifactorial etiology and can lead to nail changes, including thickening, ridging, and discoloration. Large, prospective studies are needed to identify the best treatment regimen for acute and chronic paronychia.
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Mignemi ME, Unruh KP, Lee DH. Controversies in the treatment of nail bed injuries. J Hand Surg Am 2013; 38:1427-30. [PMID: 23751325 DOI: 10.1016/j.jhsa.2013.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Megan E Mignemi
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
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Katz RD. The anterograde homodigital neurovascular island flap. J Hand Surg Am 2013; 38:1226-33. [PMID: 23707019 DOI: 10.1016/j.jhsa.2013.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/11/2013] [Accepted: 03/21/2013] [Indexed: 02/02/2023]
Abstract
The value of the human fingertip is incalculable. More than just aesthetic, the fingertip is an instrument through which we navigate our environment and acquire information. All too often, fingertip reconstruction is either not attempted or attempted without adhering to the fundamental principle of "replacing like with like." Through detailed description and case examples, this article highlights the power and utility of the anterograde homodigital neurovascular island flap in fingertip reconstruction. This single-stage flap can reliably resurface large soft tissue defects with sensate glabrous skin.
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Affiliation(s)
- Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA.
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Treatment and Outcomes of Fingertip Injuries at a Large Metropolitan Public Hospital. Plast Reconstr Surg 2013; 131:107-112. [DOI: 10.1097/prs.0b013e3182729ec2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Alexanderw Shaw
- Department of Plastic Surgery, Wexham Park Hospital, Slough SL2 4HL
| | - John Findlay
- Department of Trauma and Orthopaedic Surgery, Royal Berkshire Hospital, Reading
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Abstract
Complete or partial fingers are the most commonly encountered forms of partial hand losses. Though finger amputations are commonly due to traumatic injuries, digit loss may also be attributed to congenital malformations and disease. Irrespective of the etiology, the loss of a finger has a considerable functional and psychological impact on an individual. In order to alleviate these problems, partial or complete finger prosthesis may be fabricated. This clinical report portrays a method to fabricate silicone rubber prosthesis for a patient who has a partial finger loss caused due to trauma.
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Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg 2008; 122:105e-117e. [PMID: 18766028 DOI: 10.1097/prs.0b013e3181823be0] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the anatomy of the fingertip. 2. Describe the methods of evaluating fingertip injuries. 3. Discuss reconstructive options for various tip injuries. SUMMARY The fingertip is the most commonly injured part of the hand, and therefore fingertip injuries are among the most frequent injuries that plastic surgeons are asked to treat. Although microsurgical techniques have enabled replantation of even very distal tip amputations, it is relatively uncommon that a distal tip injury will be appropriate for replantation. In the event that replantation is not pursued, options for distal tip soft-tissue reconstruction must be considered. This review presents a straightforward method for evaluating fingertip injuries and provides an algorithm for fingertip reconstruction.
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Strauss EJ, Weil WM, Jordan C, Paksima N. A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries. J Hand Surg Am 2008; 33:250-3. [PMID: 18294549 DOI: 10.1016/j.jhsa.2007.10.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 10/05/2007] [Accepted: 10/10/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively compare the efficacy of 2-octylcyanoacrylate (Dermabond; Ethicon Inc, Somerville, NJ) with standard suture repair in the management of nail bed lacerations. METHODS Forty consecutive patients with acute nail bed lacerations were enrolled in this study. Eighteen patients were randomized to nail bed repair using Dermabond (2-octylcyanoacrylate), and 22 were randomized to standard repair using 6-0 chromic suture. At presentation, demographic information and laceration characteristics were recorded. The time required for nail bed laceration repair with each method was documented, and cosmetic and functional outcomes were assessed at 1, 3, and 6 months after injury. Comparisons between treatment groups were made using unpaired Student's t-tests. RESULTS The Dermabond repair group was composed of 10 males and 8 females with a mean age of 32.3 years. The suture repair group was composed of 17 males and 5 females with a mean age of 29.5 years. The mean follow-up was 5.1 months (range 4-11 months) and 4.8 months (range 4-11 months) for the Dermabond group and suture group, respectively. There was no difference between the two treatment groups with respect to age, comorbidities, and length of follow-up (p>.05). The average time required for nail bed repair using Dermabond was 9.5 minutes, which was significantly less than that required for suture repair (27.8 minutes) (p<.0003). At each follow-up time point, there was no statistical difference in physician-judged cosmesis, patient-perceived cosmetic outcome, pain, or functional ability between the Dermabond and suture treatment cohorts (p>.05). CONCLUSIONS Nail bed repair performed using Dermabond is significantly faster than suture repair, and it provides similar cosmetic and functional results. In the management of acute nail bed lacerations, Dermabond is an efficient and effective repair technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Eric J Strauss
- Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, NY 10016, USA
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Abstract
Distal fingertip amputations present the hand surgeon with a myriad of treatment options. Composite tissue replantation offers the patient the possibility of maintaining digital length and function. The purpose of this study was to determine the efficacy of this treatment modality and to support its use. During a 2.5-year period, 53 patients with 57 digital tip amputations distal to the distal interphalangeal (DIP) joint underwent composite tissue grafting of the tip with minimal defatting. All patients were evaluated in a prospective manner. Specific information regarding the patient and the injury were recorded. The survival rates for amputations distal to the eponychium and between the DIP joint and eponychium were 58% and 43%, respectively. Smoking was the only significant factor that had a strong, independent association with graft loss. Age older than 18 years and alcohol use appeared only initially to have an effect on graft survival because they were so closely linked with smoking. Diabetes mellitus and crush-type injuries may potentially predispose a graft to fail, but a larger sample size is needed to prove this with significance. There were no infections or serious complications, even in those grafts that failed. After reviewing the data, the authors recommend using composite tissue replantation for fingertip amputations distal to the DIP joint in nonsmokers.
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Affiliation(s)
- Jonathan B Heistein
- Ohio State University Hospital, Division of Plastic Surgery, Columbus, OH, USA
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