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Facca S, Liverneaux PA. Response to the correspondence about the article "Semi-occlusive dressing versus surgery in fingertip injuries: A randomized controlled trial". Hand Surg Rehabil 2024; 43:101670. [PMID: 38395196 DOI: 10.1016/j.hansur.2024.101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, Strasbourg 67200, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, Strasbourg 67000, France
| | - Philippe A Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, Strasbourg 67200, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, Strasbourg 67000, France.
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Lemsanni M, Najeb Y, Chaouqui Y, Elkasseh M, Zoukal S. Fingertip injuries managed by a thenar flap: Follow-up and long-term outcomes of 32 cases. Hand Surg Rehabil 2021; 40:484-490. [PMID: 33895423 DOI: 10.1016/j.hansur.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
While various techniques are used for the reconstruction of fingertip injuries, the main goals remain the same: preserve finger length, sensation, and function. The thenar flap is a well-described technique and simple procedure in fingertip amputations. This study aimed to evaluate the long-term functional and esthetic outcomes along with patient satisfaction of thenar flaps done for fingertip defects. Thenar flaps used in 32 patients operated between January 2010 and December 2016 were analyzed retrospectively to assess sensory recovery, range of motion, cold intolerance, pain relief, appearance, patient satisfaction, and QuickDASH score. All flaps survived, without adverse events. The flap was detached after 10-14 days (mean 12.5 days). The mean follow-up was 31 months (range, 20-45 months). According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 25 patients (78%). The mean static 2-point discrimination was 6.1 mm. There were no functionally significant finger flexion contractures at the final follow-up. Complications such as pain, donor site morbidity and cold intolerance were not encountered. The thenar flap is an excellent technique for coverage of total or subtotal tissue loss of radial-side fingertips that is not accessible to local flaps. It provides good sensory function and appearance when fundamental technical principles (flap design, timing of division, and early mobilization) are respected.
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Affiliation(s)
- M Lemsanni
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco.
| | - Y Najeb
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - Y Chaouqui
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - M Elkasseh
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - S Zoukal
- Epidemiology Laboratory of the Faculty of Medicine and Pharmacy of Casablanca, Rue Tarik Ibnou Ziad, 20250 Casablanca, Morocco
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Ng HJH, Sim J, Tey VHT, Selvaganesh S, Rebosura CKP, Rajaratnam V. Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries. J Hand Surg Asian Pac Vol 2020; 25:199-205. [PMID: 32312214 DOI: 10.1142/s242483552050023x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Fingertip amputation injuries are common hand injuries amongst all ages. If occurring as a result of workplace accidents, these injuries has the potential to lead to significant socioeconomic costs. Non-surgical techniques can treat these injuries with the potential to alleviate the burden of these socioeconomic costs. The aim of our study is to describe an alternative, cost-effective device to manage fingertip amputation injuries, and to present our short-term outcomes with this treatment modality. Methods: A retrospective study of patients with isolated fingertip amputation injuries who received treatment with semi-occlusive dressing and splint cap from 1 February 2018-21 December 2018 was conducted. The semi-occlusive dressing used was UrgoTul. The splint cap is a 3-dimensional thermoplastic splint to cover the semi-occlusive dressing of the injured finger. Results: There were 28 patients and 31 digits. The average age was 39.9 ± 12.7 years. 89.3% were male, 75% were foreign workers, 96.4% were blue-collared workers, 40% had dominant hand injuries and 25.8% had nailbed involvement. The average duration of follow-up was 66 ± 37.4 days and the average duration of hospital leave was 6.5 ± 4 weeks. The splint cap was applied for an average of 18.1 ± 6.2 days. The total time for tissue regrowth was 27.5 ± 8.8 days. 14.8% had residual nail deformities and return of sensation took 31.5 ± 11 days. Grip strength was 82.5% of unaffected hand. The mean range of motion at the distal interphalangeal, proximal interphalangeal and metacarpophalangeal joint was 58.8 ± 21.3°, 86.9 ± 15.5°, 81.4 ± 6.0° respectively, and 63.9 ± 23.6° and 66.3 ± 17.3° at the interphalangeal and metacarpophalangeal joint of the thumb respectively. Cost analysis will be further elaborated in the paper. Conclusions: Fingertip amputation injuries have a potential for regeneration through healing by secondary intention under semi-occlusive dressing conditions. The splint cap provides an easy to fashion, cost-efficient and comfortable addition to semi-occlusive dressings for fingertip injuries.
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Affiliation(s)
- Hannah Jia Hui Ng
- Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - Jane Sim
- Department of Occupational Therapy, Khoo Teck Puat Hospital, Singapore
| | - Vanessa Hwee Ting Tey
- Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - Sellakuddy Selvaganesh
- Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | | | - Vaikunthan Rajaratnam
- Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
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Abstract
The fingertip is mankind's tactile interface with the physical world, from reading braille, to using touchscreens, to wielding power tools. Its special tissue architecture demands astute evaluation and meticulous surgical or nonsurgical care after injury to return patients to their preinjury level of function. Attentive deliberation of physiologic, vocational, and psychosocial factors could improve the odds of achieving satisfactory results. In this article, we explore these aspects of fingertip injury to provoke readers to examine their practices and philosophies.
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Affiliation(s)
- Patricia Martin-Playa
- Department of Hand and Reconstructive Microsurgery, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Anthony Foo
- Department of Hand and Reconstructive Microsurgery, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Cerny MK, Hopfner U, Kirsch M, Haas EM, Wu F, Giunta R, Machens HG, Duscher D, Erne H, Schilling AF. Occlusive dressing-induced secretomes influence the migration and proliferation of mesenchymal stem cells and fibroblasts differently. Eur J Med Res 2018; 23:60. [PMID: 30585140 DOI: 10.1186/s40001-018-0357-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/15/2018] [Indexed: 01/14/2023] Open
Abstract
Background Fingertip injuries treated with occlusive dressings (ODs) lead to nearly scar-free, functionally, and aesthetically pleasing results. We hypothesized that paracrine factors in the wound fluid (secretome) may influence migration and proliferation of mesenchymal stem cells (MSCs) and fibroblasts and modulate the wound-healing process. Methods We could collect wound fluid samples from 4 fingertip injuries and 7 split skin donor sites at the 5th day during dressing change. Blood serum samples served as controls. The proliferation rate of MSCs and fibroblasts (HS27) was continuously measured through impedance analysis for 60 h and by Alamarblue analysis after 72 h. Cell migration was evaluated continuously for 15 h and confirmed by the in vitro wound-healing assay. Results Migration of MSCs under the influence of both wound fluids was significantly faster than controls from 4 to 6 h after incubation and reversed after 9 h. MSC proliferation in wound fluid groups showed a significant increase at 5 and 10 h and was significantly decreased after 45 h. Fibroblasts in wound fluid groups showed overall a significant increase in migration and a significant decrease in proliferation compared to controls. Conclusion OD-induced secretomes influence MSCs and fibroblasts and thereby possibly modulate wound healing and scar tissue formation.
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Sundaramurthy N, Venkata Mahipathy SRR, Durairaj AR. Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction. Indian J Plast Surg 2018; 50:187-192. [PMID: 29343895 PMCID: PMC5770933 DOI: 10.4103/ijps.ijps_98_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Fingertip injuries that are complicated by pulp loss, bone or tendon exposure will need a flap cover. Cross finger flap is commonly used to cover such defects. However, patients are apprehensive about injuring the uninjured finger as a donor site. Reverse homodigital artery flap (RHAF) can provide reliable vascularised cover to such defects. Aims: This study aims to assess the functional and aesthetic outcomes along with the patient satisfaction of RHAFs done for fingertip defects. Materials and Methods: RHAFs done in 18 patients operated between August 2015 and October 2016 were retrospectively analysed on flap survival, sensory recovery, range of movements, hypersensitivity, cold intolerance, flexion contracture and donor site morbidity. Results: Seventeen of the 18 flaps done survived completely. One flap had partial necrosis of 3 mm that healed conservatively. Middle finger of the right hand was the most commonly injured finger. Touch, pain and pressure sensations recovered in 8–12 weeks. Two-point discrimination was 4.5 mm at 6 months. The deficit of 5° s was present at distal interphalangeal joint during active flexion at 6 months. Cold intolerance and flexion contracture were not seen and 2 instances of hypersensitivity at 2 months got cured conservatively after 4 months. Overall satisfaction of patients was 8/10. Conclusion: RHAF provides single staged well-vascularised cover for fingertip injuries with good sensory recovery without damaging the adjacent uninjured finger. Hence, it can be a reliable flap for fingertip reconstruction in selected cases.
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Affiliation(s)
| | | | - Alagar Raja Durairaj
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College, Kancheepuram, Tamil Nadu, India
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Abstract
BACKGROUND Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips' injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. MATERIALS AND METHODS Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [n = 10 (4.5%)] and general anaesthesia [n = 14 (6.3%)] were used. RESULTS In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. CONCLUSION Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours.
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Affiliation(s)
- Alexander George
- Department of Plastic surgery, Kerala Institute of Medical Sciences, Cochin, Kerala, India
| | - Reena Alexander
- Department of Physiology, Sree Narayana Institute of Medical Sciences, Ernakulum, Kerala, India,Address for correspondence: Dr. Reena Alexander, Department of Physiology, Sree Narayana Institute of Medical Sciences Chalakka, North Kuthiyathodu P.O., Ernakulam Dist, Kerala - 683 594, India. E-mail:
| | - C Manju
- Department of Physiology, Sree Narayana Institute of Medical Sciences, Ernakulum, Kerala, India
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Nanninga GL, de Leur K, van den Boom AL, de Vries MR, van Ginhoven TM. Case report of nail bed injury after blunt trauma; what lies beneath the nail? Int J Surg Case Rep 2015; 15:133-6. [PMID: 26348396 PMCID: PMC4601978 DOI: 10.1016/j.ijscr.2015.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION A stable, mobile and sensate fingertip is of paramount importance to perform daily tasks and sense dangerous situations. Unfortunately, fingertips are easily injured with various extents of soft tissue damage. Delayed and inadequate treatment of nail bed injuries may cause substantial clinical problems. The aim is to increase awareness about nail bed injuries among physicians who often treat these patients. PRESENTATION OF CASE We present a 26-year-old male with blunt trauma to a distal phalanx. Conventional radiographs showed an intra-articular, multi-fragmentary fracture of the distal phalanx. At the outpatient department the nail was removed and revealed a lacerated nail bed, more than was anticipated upon during the first encounter at the emergency department. DISCUSSION Blunt trauma to the fingertip occurs frequently and nail bed injuries are easy to underestimate. An adequate emergency treatment of nail bed injuries is needed to prevent secondary deformities and thereby reduce the risk of secondary reconstruction of the nail bed, which often gives unpredictable results. CONCLUSION However, adequate initial assessment and treatment are important to achieve the functional and cosmetic outcomes. Therefore awareness of physicians at the emergency department is essential.
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Affiliation(s)
| | - Kevin de Leur
- Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | | | - Mark R de Vries
- Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Shen XF, Xue MY, Mi JY, Qiang L, Rui YJ, Chim H. Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects. J Hand Surg Am 2015; 40:1382-8. [PMID: 25953529 DOI: 10.1016/j.jhsa.2015.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/21/2015] [Accepted: 03/25/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations. METHODS Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2.5 × 1.5 cm to 3.0 × 2.0 cm. RESULTS All flaps survived entirely and restored a rounded fingertip contour. Mean static 2-point discrimination was 5 mm (range, 4-6 mm). With the exception of 1 patient with an amputation at the distal interphalangeal joint, the distal interphalangeal joint was preserved in all patients and had 30° to 60° of motion at final follow-up. No patients complained of cold intolerance or residual joint contracture. No hooked nail deformity occurred in patients who had remaining nailbed. CONCLUSIONS The digital artery perforator propeller flap is particularly suited to coverage of a lateral oblique fingertip defect, because only a 90° rotation is required when inset, and the bulk of the flap serves to restore the rounded contour of the fingertip. The skin over the entire dorsal surface of the middle phalanx can be elevated as a flap, providing adequate tissue to resurface the defect and restore a rounded contour to the fingertip. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Thoma A, Vartija LK. Making the V-Y advancement flap safer in fingertip amputations. Can J Plast Surg 2010; 18:e47-e49. [PMID: 22131847 PMCID: PMC3006118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Amputation of the fingertip is a common injury of the upper extremity. Over the years, a variety of reconstructive techniques have been described. For dorsal oblique and transverse amputations, the Atasoy V-Y advancement flap is a popular choice because it preserves finger length, sensation and function. However, closure under tension remains a problem, putting the flap at risk of partial or full necrosis. To avoid this untoward complication, the classic V-Y advancement technique has been modified to allow for a tension-free closure.
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Affiliation(s)
- Achilleas Thoma
- Department of Clinical Epidemiology and Biostatistics, McMaster University
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St Joseph’s Healthcare
- Surgical Outcomes Research Centre
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