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Hand replantation

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https://www.readbyqxmd.com/read/28413903/digital-revascularization-and-replantation-using-the-wide-awake-hand-surgery-technique
#1
Jkf Wong, C H Lin, N J Chang, H C Chen, Y T Lin, C C Hsu
The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the 'wide-awake' anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis...
April 1, 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28340658/a-global-view-of-digital-replantation-and-revascularization
#2
REVIEW
Jin Bo Tang, Zeng Tao Wang, Jing Chen, Jason Wong
Survival rates of digital replantation vary in different regions and countries, and Asian surgeons see more challenging cases and have developed some unique methods. Replantation of multiple digits in one or both hands can follow a structure-by-structure method or a digit-by-digit method. For replanting all 10 digits, 3 or 4 teams should be organized. Flow-through flaps, often venous flaps, can be taken from the distal forearm or lower extremity to repair defects of soft tissues and arteries. A pedicled digital artery flap from the adjacent digit can also repair tissue defects and supply blood to the replanted digit...
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28329874/long-term-health-related-quality-of-life-outcomes-in-digital-replantation-versus-revision-amputation
#3
Oren Tessler, Matthew J Bartow, Marie P Tremblay-Champagne, Alex M Lin, Geneviève Landes, Sarah Sebbag, Andreas Nikolis
Background Earlier, digit viability judged the success of digital replantation. Now, utility health-related quality of life (HRQOL) measures can better assess the impact of digital replantation. Methods Overall, 264 digital injury patients were sent a regimen of utility measures: Disabilities of the Arm, Shoulder and Hand (DASH) score, European Quality of Life 5 Dimensions, visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG). Overall, 51 patients responded completely to all of these-36 replantation patients and 15 revision amputation patients...
March 22, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28251838/is-hyperbaric-oxygen-therapy-indispensable-for-saving-mutilated-hand-injuries
#4
I-Han Chiang, Yuan-Sheng Tzeng, Shun-Cheng Chang
Mutilated hand injuries are a profound challenge to the plastic surgeon, and such injuries often lead to limb loss and severe functional impairment. Hyperbaric oxygen therapy (HBOT) appears to counteract tissue hypoxia and stimulate acute wound healing. This study was performed to evaluate the efficacy of HBOT as an adjunctive therapy in patients with a mutilated hand injury. Between January 2006 and December 2014, 45 patients with a mutilated hand injury were enrolled. After reconstruction or revascularisation, patients underwent 120 minutes of HBOT with oxygen at 2·5 atmospheres absolute while breathing 100% oxygen...
March 1, 2017: International Wound Journal
https://www.readbyqxmd.com/read/28216826/assessment-of-hand-function-after-successful-replantation-of-upper-limb-at-arm
#5
V Koteswara Rao Rayidi, Venkata Bhargava Velde, Narsimha Rao, N Ram Babu, Laxman Sambari
In upper arm replantation, a successful anastomosis guarantees the viability and good quality repair determines the overall function of the hand. There is paucity of successful arm replantation case reports in the literature. This is a case report of a successful arm replantation in a four year child with a near total functional outcome. We have used different scores to assess the functional outcome.
September 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/28187720/long-term-outcome-following-upper-extremity-replantation-after-major-traumatic-amputation
#6
G Mattiassich, F Rittenschober, L Dorninger, J Rois, R Mittermayr, R Ortmaier, M Ponschab, K Katzensteiner, L Larcher
BACKGROUND: Amputations in general and amputations of upper extremities, in particular, have a major impact on patients' lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. METHODS: Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011...
February 10, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28179478/magnetic-resonance-spectroscopy-of-current-hand-amputees-reveals-evidence-for-neuronal-level-changes-in-former-sensorimotor-cortex
#7
Carmen M Cirstea, In-Young Choi, Phil Lee, Huiling Peng, Christina L Kaufman, Scott H Frey
Deafferentation is accompanied by large-scale functional reorganization of maps in the primary sensory and motor areas of the hemisphere contralateral to injury. Animal models of deafferentation suggest a variety of cellular-level changes including depression of neuronal metabolism and even neuronal death. Whether similar neuronal changes contribute to patterns of reorganization within the contralateral sensorimotor cortex of chronic human amputees is uncertain. We used functional MRI-guided proton magnetic resonance spectroscopy to test the hypothesis that unilateral deafferentation is associated with lower levels of N-acetylaspartate (NAA, a putative marker of neuronal integrity) in the sensorimotor hand territory located contralateral to the missing hand in chronic amputees (n = 19) compared with the analogous hand territory of age- and sex-matched healthy controls (n = 28)...
April 1, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28121876/emergency-department-wait-time-and-treatment-of-traumatic-digit-amputation-do-race-and-insurance-matter
#8
Elham Mahmoudi, Peter R Swiatek, Kevin C Chung
BACKGROUND: Little is known about the association between the quality of trauma care and management of nonfatal injuries. The authors used emergency department wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. They evaluated the association between average hospital emergency department wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. The authors hypothesized that hospitals with shorter emergency department wait times were associated with higher odds of replantation...
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28029391/off-hour-surgery-among-orthopedic-subspecialties-at-an-urban-quaternary-care-level-1-trauma-center
#9
Amanda Lans, Stein J Janssen, David Ring
PURPOSE: We sought to determine and quantify which subspecialties of orthopedic surgeons are operating off hours in an urban, quaternary-care, level 1 trauma center. MATERIALS AND METHODS: We used our clinical registry to identify 43,211 orthopedic surgeries performed between January 2008 and December 2011. Our outcome measures were the number and proportion of off-hour surgeries performed as well as the number and proportion of off-hours per subspecialty. The denominators were the total number of surgeries and the total number of surgical hours worked per subspecialty...
October 28, 2016: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28027844/effect-of-hospital-volume-on-success-of-thumb-replantation
#10
Elham Mahmoudi, Kevin C Chung
PURPOSE: Hospital volume-outcome association has been examined for many high-risk surgical procedures. Little is known about this association for thumb replantation, a complex but essential surgical procedure to restore hand function. We aimed to determine patient and hospital characteristics that are associated with increased probability of replanted thumb survival and to examine volume-outcome association among hospitals that performed thumb replantation. METHODS: We used data from 2008 to 2012 from the National Trauma Data Bank...
February 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28010933/paediatric-fingertip-composite-grafts-do-they-all-go-black
#11
Adrian D Murphy, Cameron P Keating, Anthony Penington, David McCombe, Chris J Coombs
BACKGROUND: Fingertip injuries are amongst the most frequently seen hand injuries in the paediatric population. The present study evaluated the composite graft survival rate in distal digital amputations with respect to injury type, amputation level and time to surgery. METHODS: We performed a retrospective review of patients who underwent composite grafting of fingertip injuries over an 11-year period at a paediatric hospital. All children who underwent non-vascularized replantation of amputated fingertips were included...
February 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27893542/safety-and-suitability-of-finger-replantations-as-a-residency-training-procedure-a-retrospective-cohort-study-with-analysis-of-the-initial-postoperative-outcomes
#12
Dimitra Kotsougiani, Felicitas Ringwald, Caroline A Hundepool, Florian Neubrech, Thomas Kremer, Berthold Bickert, Ulrich Kneser, Christoph Hirche
Finger replantations demand technical excellence in microsurgery and hand trauma care. The objective of this study was to determine whether finger replantations constitute an appropriate and safe procedure for residency training. Additionally, the prognostic risk factors for the need to take a replanted finger back to the operation room and replant failure were analyzed.All patients who underwent finger replantation after complete amputation between 2007 and 2015 were included in a retrospective comparative study...
November 23, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27882250/apical-revascularization-after-delayed-tooth-replantation-an-unusual-case
#13
Marília Pacífico Lucisano, Paulo Nelson-Filho, Lea Assed Bezerra Silva, Raquel Assed Bezerra Silva, Fabricio Kitazono de Carvalho, Alexandra Mussolino de Queiroz
The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed...
2016: Case Reports in Dentistry
https://www.readbyqxmd.com/read/27857526/functional-salvage-of-a-hand-after-unsuccessfull-attempt-of-replantation
#14
Ileana Rodica Matei, Alexandru Valentin Georgescu
Amputation by crush injuries generally represents a contraindication for replantation, and especially when the lesion is caused by the summation of multiple concomitant traumatic mechanisms. We present the case of a 22 year- old female who arrived in our service with a crush/torsion amputation of all long fingers at the metacarpo-phalangeal level of the right hand. After the unsuccessful attempt of replantation, the functional reconstruction of the hand was achieved by using a double free flap transfer: anterolateral thigh perforator flap (ALT) and digital block transfer of second and third toes...
2016: Clujul Medical (1957)
https://www.readbyqxmd.com/read/27833288/algorithmic-surgical-enhancement-of-function-after-finger-revascularisation
#15
Luis Landin, Pedro Bolado, Maria-Angeles Gajete, Alvaro Gonzalez-Miranda, Jorge Bonastre
Secondary surgical procedures can improve the function of revascularised and replanted digits. We describe the case of a patient who underwent multidigit revascularisation and replantation following a saw injury at flexor tendon Zone II. To achieve maximal functional improvement after finger revascularisation, we performed secondary surgical procedures in an order that was determined by following a reconstructive decision procedure that covered late revascularisation, nerve reconstruction, pedicled vascularised joint transfer, staged flexor tendon reconstruction and skin revision...
May 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/27795781/-digital-replantation-results-and-complications-study-of-a-series-of-18-cases
#16
Mohammed El Idrissi, Abdelhalim Elibrahimi, Mohammed Shimi, Abdelmajid Elmrini
Digital amputations are frequent injuries, the majority of them are caused by workplace accidents. Microsurgical techniques are an alternative option to repair these amputations. This study aims to report our experience in digital replantation through the examination of 18 cases. We conducted a retrospective study of 14 patients with total or subtotal fingers amputation between June 2013 and January 2015. All unidigital and multidigital replantations downstream of the distal insertion of superficial flexor tendon as well as all digital replantations upstream of the distal insertion of superficial flexor tendon were included in our study...
2016: Pan African Medical Journal
https://www.readbyqxmd.com/read/27770192/reconstruction-of-totally-degloved-fingers-a-novel-application-of-the-bilobed-spiraled-innervated-radial-artery-superficial-palmar-branch-perforator-flap-design-provides-for-primary-donor-site-closure
#17
Zhenglin Chi, Peng Yang, Dajiang Song, Zan Li, Liang Tang, Weiyang Gao, Yonghuan Song, Tingang Chu
INTRODUCTION: To investigate the results of resurfacing completely degloved digits using bilobed innervated radial artery superficial palmar branch (RASPB) perforator flap in a spiral fashion. METHODS: A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The flap-raising procedure was performed using four fresh cadaver specimen...
October 21, 2016: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/27717838/replantation-or-revascularization-for-the-treatment-of-hand-degloving-injuries
#18
Guangliang Zhang, Jihui Ju, Guangzhe Jin, Linfeng Tang, Yi Fu, Ruixing Hou
PURPOSE: The purpose of this study was to explore effective strategies of replantation or revascularization for the treatment of hand degloving injuries. METHODS: Ten patients who had received replantation or revascularization surgery for hand degloving injury between 2002 and 2014 were included for this study. The average age at the time of surgery was 34.5 years (range 18-49 years). There were nine left and one right hand replantations. The cause of injury was an industrial machine press in all of them...
December 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27712753/secondary-thumb-reconstruction-in-a-mutilated-hand
#19
David Graham, Praveen Bhardwaj, S Raja Sabapathy
The thumb plays an integral role in hand function. Traumatic amputation results in significant morbidity. With loss of the thumb, up to a 40% reduction in hand function may result. Thumb replantation must be attempted when possible. The goals of thumb reconstruction are to replicate normal function as closely as possible, minimize donor site morbidity, and expedite recovery. In the setting of a mutilated hand, the status of the remaining digits must be carefully assessed. Toe transfers, osteoplastic thumb reconstruction, and pollicization are commonly used...
November 2016: Hand Clinics
https://www.readbyqxmd.com/read/27625540/thumb-replantation-using-the-superficial-palmar-branch-of-the-radial-artery
#20
Sang Hyun Cho, Ahmed Suparno Bahar-Moni, Hyun Chul Park
The thumb is the most important part of the hand. If thumb is amputated, all efforts should be made to replant it to preserve hand functions. Good functional outcome can be obtained with successful thumb replantation than with other reconstructive surgery. We present a case of thumb amputation of a 44 -year-old male with severe damage to the soft tissues and bony structures of the radial part of the hand. We performed the replantation anastomosing the superficial palmar branch of the radial artery as donor artery as the proximal part of thumb digital arteries were severely damaged due to crush injury and got favorable result...
August 2016: Journal of Hand and Microsurgery
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