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PubMed1979

[Surgery of the hand--a medical duty (author's transl)].

The considerable technical progress in surgery of the hand, especially in the field of microsurgery which made replantation of detached fingers possible, may give the impression that hand surgery is primarily a technical discipline. It is intended to show that besides the technique, surgery of the hand includes many other important factors such as assessing the natural facts and taking into account the biological possibilities. But especially important is concern for the patient. This doctor-patient relationship in hand surgery is decisive for the result.

Adult↗
PubMed1989

[Ultrasonic study of the soft tissues of the hand. III. Traumatic and inflammatory pathology of the flexor tendons of the fingers].

The accuracy of the high-resolution real-time ultrasonic examination of the flexor tendons of the fingers of the hand has been tested on the retrospective study of 27 patients treated surgically. The method is sensitive and specific in the rupture of the tendons (8 cases), except when the latter is partial. Ultrasound enables the discrimination between palmar masses developed extrinsically (8 cases) and those involving the tendons (4 cases). A fluid collection inside the tendon's sheath has been detected in all the 5 cases of tenosynovitis, without false positive. The post-operative follow-up of operated tendons is easier by ultrasound.

Adolescent↗
PubMed1997

Trigger finger: the effect of partial release of the first annular pulley on triggering.

A prospective, randomized study was performed on 19 patients, in whom the proximal, middle, or distal third of the first annular pulley was divided to determine if a specific portion of the first annular pulley was responsible for the clinical triggering associated with restrictive flexor tenosynovitis. In all 19 patients, a partial resection of the first annular pulley resulted in continued clinical triggering with active digital flexion. At this point, a standard complete first annular pulley release was performed, with resolution of clinical triggering of the involved digit in all patients. We conclude that there is no "critical third" of the first annular pulley responsible for clinical digital triggering.

Finger Injuries↗
PubMed1996

A prospective study of rock climbing injuries.

OBJECTIVES: To study the rate, causes, and nature of rock climbing injuries presenting to an accident and emergency (A&E) department. METHODS: Patients presenting with rock climbing injuries to an urban A&E department were studied prospectively for one year. RESULTS: 19 rock climbers presented during the year, at a rate of one per 2774 A&E attendances. Fourteen climbers were injured on outdoor cliffs and five on the local indoor climbing wall, where the safety mats were noted to be in poor condition. Eighteen climbers had been injured during falls, 17 hitting the ground. Twelve of these climbers sustained fractures, four of which were missed on initial attendance. The remaining climber sustained the characteristic A2 pulley finger injury, which was treated conservatively with a good result. CONCLUSIONS: The risks of rock climbing in Britain would be reduced if lead climbers arranged protection at earlier stages of climbs. Sports centres with climbing walls should regularly inspect and repair their safety equipment. It is important for staff in A&E departments to appreciate the large forces involved in any climbing fall, in order that significant injuries are not missed. Those treating injured climbers should also be aware of the specific injuries to which elite climbers are predisposed.

Adult↗
PubMed1990

Operative treatment of the post-traumatic boutonnière deformity. A modification of the direct anatomical repair technique.

We report 20 cases of post-traumatic boutonnière deformity treated by a modification of the direct anatomical repair technique, particularly indicated in late cases which have complete passive motion. A swallow-tailed flap is excised from the fibrous tissue between the two ends of the central slip. The proximal one is then advanced up to the coaptation with the distal edge of the scarred capsular tissue at the insertion on the middle phalanx to which it is sutured in correct tension. Excellent results have been obtained in 72% of cases and good in 5.5%. The 16% of fair results are probably due to the fact that patients didn't use the splint post-operatively and didn't cooperative with physiotherapy.

Adult↗
PubMed2004

Rehabilitation of digital nerve repair: is splinting necessary?

Forty isolated, sharp digital nerve divisions, which had been repaired by microsurgical techniques, were reviewed between 12 and 36 months postoperatively (mean, 20 months). Half of the repairs had been splinted beyond the immediate postoperative period and half had not. Non-splinted patients returned to work significantly quicker than those who were splinted. Splinted patients reported more stiffness and cold intolerance but splinting made no difference to either the measured sensibility or movement of the digit. We would conclude that, after repair of sharp, uncomplicated digital nerve divisions, splinting beyond the immediate postoperative period is at least unnecessary and may be deleterious.

Adolescent↗
PubMed1983

Clinical use of refrigerated flexor tendon allografts to replace a silicone rubber rod.

Thirty-five patients with grades II through V flexor tendon damage in 42 fingers were treated first with a silicone rubber rod prosthesis and later with a flexor tendon allograft. The final results were evaluated by recording the distance each finger lacked in flexing to the distal palmar crease and by recording the total active motion of each finger. By the first measurement, 63% had good flexion, 21% fair, and 16% poor; and 8% had good total active motion, 71% fair, and 21% poor. An allograft can be used successfully in a two-stage reconstruction of flexor tendons, but based on other reports, an autograft may provide somewhat better results.

Adolescent↗
PubMed1984

Toe-to-hand transfers in reconstructive surgery of the hand. Experience with seventy-one cases.

Based on a homogeneous series of 71 toe-to-hand transfers performed between February 1975 and December 1982 the same surgeon, the authors have tried to define their present day indications. Technical modifications have been described for the second toe transfer : isolated dorsal approach of the toe with early-stage resection of the second metatarsal bone, utilisation of the plantar metatarsal artery of the second interosseous space, utilisation of the volar vessels for the anastomosis at the recipient site, dorsal subcutaneous tunnel for the venous anastomosis of the hand. Aside from the usual indications for thumb reconstruction (11 cases) and 26 cases of transfers for reconstruction in long finger injuries, the indications for partial transfers have become more and more frequent : pulpar (9 cases), pulp + bone + nail (10 cases), isolated nail (1 case), nail + bone (2 cases), first web space (1 case), double twisted toe (5 cases) and articular (6 cases) transfers.

Adult↗
PubMed2002

[Application of reversed digital artery cross-finger flap with a compound skin pedicle].

OBJECTIVE: To summarize the application of reversed digital artery cross-finger flap with a compound skin pedicle in soft tissue defect of hand. METHODS: From October 1997, 35 fingers of 30 cases, with soft tissue defect at the dorsal side of digital interphalangeal joint and at the fingertips, were repaired by the reversed artery cross-finger flap with a compound skin pedicle, 1.5 cm x 1.0 cm to 2.0 cm x 2.0 cm in size. All of the cases were followed up for 1-6 months and evaluated clinically. RESULTS: All of the flaps survived, with a good texture and no swelling; and there was no adverse side effect on the donor site. CONCLUSION: Reversed digital artery cross-finger flap with a compound skin pedicle is a good option to repair the soft tissue defect of hand.

Arteries↗
PubMedDate not supplied

[2-stage plastic repair of the flexor tendons of the fingers: the indications and technic].

Based on their experiences with treatment of 58 patients with consequences of severe traumas of the hand the authors analyze and substantiate indications for using the method of the two-stages tendoplasty of finger flexors. The technique of implantation of polychlorvinyl rods is described in detail. Relatively high frequency of additional procedures on different anatomical structures of the hand is noted. Special attention is given to intra- and postoperative prophylactics of infectious complications. It was found that time of the second operation should be determined not only by the time of formation of the smooth wall capsule around the implant but also by the degree of liquidation of finger joints contractures.

Finger Injuries↗
PubMed1989

Primary repair of extensor tendons with assisted post-operative mobilisation. A series of 48 cases.

Forty-eight patients with lesions of the extensor apparatus of the hand were treated by primary repair with assisted post operative mobilisation by means of a dynamic extension, low profile splint. They were divided into three groups: 25 simple wounds of the extensor tendons of the fingers; 14 simple wounds of the extensor tendon of the thumb; 9 complex lesions. The mobility of the tendinous suture and the callus displacement were monitored by means of metallic markers implanted at operation. Functional electromyographic study during physiotherapy permitted refinement of the technique of reeducation by a limitation of the range of flexion of the proximal interphalangeal articulations. The results are divided into 4 categories: excellent 33 (60%), good 9 (16.4%), average 4 (7.3%), bad 9 (16.4%). No complications (infection, loosening of suture, reflex sympathetic dystrophy) were detected in this short preliminary series. The proposed technique produced improvement of only minor significance in comparison with traditional methods, when applied to uncomplicated wounds. Significantly improved results were obtained in the group of patients with complex lesions.

Adult↗
PubMed2004

Free dorsoulnar perforator flap transfers for the reconstruction of severely injured digits.

The aim of this study was to investigate the feasibility of transferring the free dorsoulnar perforator flap nourished by the cutaneous perforator branched dorsoulnar artery to reconstruct severely injured fingers under upper arm anesthesia. Between April of 2001 and April of 2002, 13 free dorsoulnar perforator flaps were used in 13 patients. There were 11 men and two women ranging in age from 18 to 64 years, with an average age of 38 years. The affected fingers were one thumb, four index fingers, five middle fingers, two ring fingers, and one little finger. All cases were performed under upper arm anesthesia combined with intravenous local anesthesia. The operative time ranged from 103 to 140 minutes, with an average time of 120 minutes. The flap size ranged from 1 x 3 to 3 x 4 cm, and was transferred from the same forearm of the injured finger. All donor sites were closed primarily without a skin graft. The aim of reconstruction for fingers was to repair a traumatic defect (five cases), partial necrosis following replantation (two cases), and soft-tissue defects resulting from resection of a scar (three cases) and to revascularize ischemic fingers (three cases). All flaps survived completely. After repair of the flow-through circulation of the common digital artery and ischemic finger, a postoperative angiogram showed the vascular patency and hypervascularity of the reconstructed fingers, and the patients' complaints were reduced. The free dorsoulnar perforator flap under regional anesthesia is first reported; it may become one valuable option as a very small flap for the treatment of repairing intercalated or segmental defects as a flow-through flap for soft-tissue defects and ischemic fingers.

Adolescent↗