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Fingertip Injury

Kim A Bjorklund, Dahlia M Rice, Ashley N Amalfi
BACKGROUND: Pediatric digital necrosis resulting in revision amputation is a devastating outcome following digital dressing application. METHODS: We report a series of 4 pediatric patients (age: 21 months-11 years) who presented for surgical consultation related to digital ischemia and irreversible necrosis following the application of Coban digital dressings. A review of the literature demonstrated that such injuries had not previously been described. RESULTS: In our case series, Coban dressing was utilized as a deterrent for thumb sucking, fingertip tuft fractures with nail bed lacerations, and a phalanx fracture secondary to crush injury...
April 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
M Tarallo, P Fino, D Ribuffo, D Casella, M Toscani, C Spalvieri, W Lattanzi, G Di Taranto
BACKGROUND: Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. This prospective study compares the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid (LAF). METHODS: 40 consecutive patients with a fingertip injury were dichotomized into group A (control group: conservative approach) and B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStemEvo®kit), allowing the nonenzymatic separation of LAF, which was then injected at injured site...
March 29, 2018: Plastic and Reconstructive Surgery
Fei Wu, Xiaofang Shen, Kyle R Eberlin, Zhibo Sun, Xiao Zhou, Mingyu Xue
PURPOSE: The purpose of this study was to evaluate outcomes for patients sustaining a distal fingertip amputation who underwent replantation witharteriovenous anastomosis for venous drainage over a one year period at our institution. This technique has been utilized when insufficient veins are identified in the amputated part for standard veno-venous anastomosis. METHODS: A retrospective study was performed on patients presenting from 2013 to 2014. Guillotine, crush, and avulsion/degloving injuries were included if they underwent fingertip (Tamai Zone I) replantation with arterial anastomosis for vascular inflow and arteriovenous anastomosis for venous drainage...
March 27, 2018: Injury
Sang Wook Lee, Billy C Vermillion, Shashwati Geed, Alexander W Dromerick, Derek G Kamper
Neurological injuries often cause degraded motor control. While rehabilitation efforts typically focus on movement kinematics, abnormal muscle activation patterns are often the primary source of impairment. Muscle-based therapies are likely more effective than joint-based therapy. In this paper, we examined the feasibility of biomimetic input mimicking the action of human musculotendons in altering hand muscle coordination. Twelve healthy subjects produced a submaximal isometric dorsal fingertip force, while a custom actuator provided assistance mirroring the actions of either the extrinsic extensor or the intrinsic muscles of the index finger...
March 2018: IEEE Transactions on Neural Systems and Rehabilitation Engineering
Hyung-Sup Shim, Byung Yeun Kwon, Bommie F Seo, Ho Kwon, Sung-No Jung
BACKGROUND: The treatment of choice for fingertip amputation is replantation to restore function and aesthetics. The purpose of this study was to compare the success rates and salvage periods between patients with Tamai's zone I amputation injuries treated with bony fixation and suture fixation. METHODS: Fifty-five patients with Tamai's zone I amputations with bony involvement were included in this study. The patients were allocated randomly to two groups treated by bony fixation with Kirschner (K-)wire and suture fixation, respectively...
February 22, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Xianghong Lou, Haijun Zhu, Hang Xue, Yuxiong Weng, Jianghai Chen
BACKROUND: Fingertip injuries are common in both adults and children. Many operative and non-operative management techniques have been reported to restore the function and cosmetic shape of fingertips after injuries. Although these methods may be used for different indications in clinical settings, few of them can treat all kinds of fingertip injuries. In addition, there is controversy as to whether the surgical approach or the conservative approach is the optimal management for fingertip injuries...
March 5, 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
F Unglaub, M F Langer, J M Unglaub, L P Müller, P Hahn, C K Spies, S Löw
Due to the exposure of the hands in the daily routine, defect wounds of the hand are common. The injury severity varies and ranges from small fingertip defects to large soft tissue lesions with exposed tendons, nerves and vessels. The complete extent of the soft tissue defect is often only recognizable after meticulous debridement. A considerable variety of techniques for defect coverage are available to the surgeon but the actual challenge is to select the most appropriate procedure which will result in the smallest possible residual defect...
April 2018: Der Unfallchirurg
Connor P Dolan, Lindsay A Dawson, Ken Muneoka
Regeneration Biology is the study of organisms with endogenous regenerative abilities, whereas Regenerative Medicine focuses on engineering solutions for human injuries that do not regenerate. While the two fields are fundamentally different in their approach, there is an obvious interface involving mammalian regeneration models. The fingertip is the only part of the human limb that is regeneration-competent and the regenerating mouse digit tip has emerged as a model to study a clinically relevant regenerative response...
March 2018: Stem Cells Translational Medicine
M-L Abi-Chahla, J-M Alet, T Fabre, P Pelissier
Defects on the palmar surface of the fingers are an important part of hand emergencies, especially fingertip wounds. Luckily, many coverage methods are available. We will review the anatomy of this area and the thought process for treating these defects. We will also propose an algorithm that can be used to select the best technique based on the type of injury present.
February 2018: Hand Surgery and Rehabilitation
H Peters-Sengers, J H E Houtzager, M B A Heemskerk, M M Idu, R C Minnee, R W Klaasen, S E Joor, J A M Hagenaars, P M Rebers, J J Homan van der Heide, J I Roodnat, F J Bemelman
Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2 > 60% or SpO2 < 60%, and minutes of SBP > 80 mmHg or SBP < 80 mmHg...
January 30, 2018: American Journal of Transplantation
Bryan Bean, Shane Cook, Bryan J Loeffler, R Glenn Gaston
High-pressure water injection injuries of the hand are uncommon, and there is limited literature to guide their treatment. The ideal management of these injuries, whether nonoperative with close observation or early surgical debridement, remains unknown. The authors retrospectively identified a cohort of patients with high-pressure water injection injuries to the hand during a 16-year period. Data collected included demographics, location of injection, hand dominance, type of treatment, need for additional surgery, and complications...
March 1, 2018: Orthopedics
Narayanamurthy Sundaramurthy, Surya Rao Rao Venkata Mahipathy, Alagar Raja Durairaj
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...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Leandro Azevedo de Figueiredo, Rafael de Souza Ribeiro, Antonio Leão Bandeira de Melo, André Luiz Lima, Bernardo Barcellos Terra, Fernando Carvalho Ventim
Objective: Report the results of treatment of fingertip injuries and describe this reproducible and low cost surgical technique, which utilizes a polypropylene prosthesis that temporarily replaces the nail and is placed on the area of injury, providing protection and encouragement for healing by secondary intention. Method: This study evaluated 22 patients with traumatic injuries of the fingertips in the period from January 2012 to December 2015. All procedures were performed by the same surgeon...
November 2017: Revista Brasileira de Ortopedia
Alexander George, Reena Alexander, C Manju
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...
November 2017: Indian Journal of Orthopaedics
Vishal Thanik, Ajul Shah, David Chiu
Fingertip amputation is the most common amputation encountered by hand surgeons. Treatment decisions are multifactorial, based on mechanism, level of injury, tissue loss, associated injuries, and patient preference, among others. In this article, we present use of the thenar flap in combination with bone graft and split-thickness nail bed graft to address the tripartite loss of distal phalanx, soft tissue, and nail bed. This method allows for a full-length and functional reconstructed fingertip that is aesthetically satisfactory and does not require microsurgical techniques...
December 2017: Journal of Hand Surgery
Mostafa Mahmoud, Motaz Elian, Abdalah Seif Elnasr
Injuries to flexor tendons in zone I has always been challenging during repair. Over the time several techniques were developed and modified to achieve the highest repair strength and thus the best functional outcome. These techniques vary from pull-out sutures with internal and external fixation to the use of bone anchors. All techniques were accompanied with advantages and disadvantages as well as postoperative morbidities related to certain techniques. In the present technique we introduce a subperiosteal pull-out suturing technique...
December 2017: Techniques in Hand & Upper Extremity Surgery
Valeriy Shubinets, River M Elliott
The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation...
January 2018: Journal of Hand Surgery
Dimitrios K Antonopoulos, Andreas F Mavrogenis, Panayiotis D Megaloikonomos, Evanthia Mitsiokapa, George Georgoudis, Christos Th Vottis, George K Antonopoulos, Panayiotis J Papagelopoulos, Spyridon Pneumatikos, Sarantis G Spyridonos
STUDY DESIGN: Prospective controlled study. INTRODUCTION: Previous studies evaluated the effectiveness of sensory reeducation (SR) after peripheral nerve injury and repair. However, evidence for long-term clinical usefulness of SR is inconclusive. PURPOSE OF THE STUDY: The purpose of this study is to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without SR at long term...
November 4, 2017: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Kunal Sindhu, Steven F DeFroda, Andrew P Harris, Joseph A Gil
BACKGROUND: Hand and finger injuries account for approximately 4.8 million visits to emergency departments each year. These injuries can cause a great deal of distress for both patients and providers and are often initially encountered in urgent care clinics, community hospitals, and level one trauma centers. Tip amputation injuries vary widely in mechanism, ranging from sharp lacerations to crush injuries that present with varying degrees of contamination. The severity of damage to soft tissue, bone, arteries and nerves is dependent upon the mechanism and guides treatment decision-making...
December 2017: Injury
Deok Hyeon Ryu, Si Young Roh, Jin Soo Kim, Dong Chul Lee, Kyung Jin Lee
BACKGROUND: Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. METHODS: A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016...
January 2018: Archives of Plastic Surgery
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