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PubMedDate not supplied

Bilateral digital artery thrombosis: a case report.

Blunt arterial trauma can cause digital arterial occlusion, and vein grafts may be required to restore adequate digital blood flow, as in the case of this 55-year-old man who developed thrombosis of both the radial and ulnar digital arteries of the ring finger.

Arterial Occlusive Diseases↗
PubMed1982

Recovery of sensation in replanted digits--time of recovery and degree of two-point discrimination.

Even if good motor function returns in a replanted digit, if no useful sensation returns, the digit cannot be considered fully functional. In such cases sensory reconstruction with nerve grafts may be necessary, but it is difficult to determine the optimal time for such surgery. Therefore, we studied 37 replanted digits in which the palmar digital nerves had been severed bilaterally and anastomosed at the replantation procedure. Our findings indicate a correlation between the time at which sensation returned to the digits and the degree of two-point discrimination (2PD) that returned. In digits in which sensation returned less than four months after replantation, a 2PD of less than 15 mm returned in more than 50% of cases, but when more than four months passed before the return of sensation, a useful degree of 2PD seldom returned. We believe, therefore, that if the recovery of sensation in a replanted digit has not been satisfactory by four months after replantation, reconstructive surgery should be considered.

Adult↗
PubMed1984

Clinical and experimental studies of bone union in reimplantation of digits: a preliminary report on ischemic interval.

The relationship between ischemic interval and bone union in reimplantation of digits was studied clinically and experimentally. In 32 reimplanted digits, the cases in which the bone union delayed had a longer ischemic interval. In experimental study of rats, bone union of the group of which ischemic interval was 12 hours was definitively delayed in comparison with that of the control group.

Adult↗
PubMed1984

Automatic milking apparatus for the insufficient venous drainage of the replanted digit.

An automatic milking apparatus composed of a finger attachment and a pump to push out the air was devised in order to perform the forced drainage from replanted digits with insufficient venous drainage. Seven replanted digits with insufficient venous drainage after replantation were applied, and remarkable improvement was found in five digits. An interesting case is reported in which a replanted digit without venous anastomosis survived as a consequence of applying the milking apparatus. The advantages of our milking apparatus are also discussed.

Amputation, Traumatic↗
PubMed1988

The venous flow augmentation pump: a solution to venous congestion.

Venous congestion is a well-recognized cause of failure of survival of replanted digits. When re-exploration of a venous congested digit is not possible, an alternate solution is presented. A description of the venous flow augmentation pump is provided, along with a preliminary case report of its successful use.

Aged↗
PubMed1990

Microvascular anastomoses in replanted fingers: do they stay open?

Replantation of fingers is a well established procedure following traumatic amputation. Several studies have documented the functional results of replanted digits. Studies have not documented the long-term (greater than 5 yrs) patency of the microvascular anastomosis in the replanted digit. Duplex imaging, a combination of B-mode ultrasound and bidirectional Doppler ultrasound has been shown to visualize vessels 1 mm in diameter. Color enhancement of the ultrasound image is now possible. We evaluated 18 patients with 24 replanted fingers to assess vascular patency. A minimum of five years follow-up was required for inclusion in the study group. Examination showed a patent anastomosis in every case and a Digital-Brachial Index within normal limits in 71% of the digits. Microvascular anastomoses in vessels as small as 1 mm in diameter remain open as long as 11 years following completion. The sophisticated techniques of color enhanced Duplex imaging makes long-term evaluation of these procedures possible in a non-invasive and accurate fashion. The use of such imaging modalities will have an important role in the evaluation of replanted digits and microvascular procedures in general.

Adult↗
PubMed1990

Digital replantation in children: a long-term follow-up study.

This paper reports a series of 14 cases of digital replantation in children who had had a total of 17 digits traumatically amputated. All but two digits survived, for an overall success rate of 88%. The length of follow-up was between 3 and 14 years (average 8 years). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 86%. Twelve cases had an excellent result, and one case had a good result. Digital replantation in children is recommended when feasible.

Amputation, Traumatic↗
PubMed1991

Free vascularized whole joint transfer in children.

Reconstruction of the traumatized finger joint with epiphyseal destruction has long been problematic. Since free vascularized whole joint transfer was introduced as a treatment for joint and epiphyseal destruction, this procedure has been selected as an alternative treatment because it may provide a growing epiphysis. We have reviewed our series of 19 joint transfers. Mean age at operation was 6.2 years (range 3 to 12). Average active range of motion was 31 degrees/61 degrees for the group with posttraumatic reconstruction (n = 12) and 21 degrees/43 degrees for the group with reconstruction of a congenital deformity (n = 7), with an overall average of 27 degrees/54 degrees. Average range of motion following transfer of an metatarsophalangeal (MTP) or metacarpophalangeal (MCP) joint to an MCP joint position was 39 degrees/75 degrees (n = 4); proximal interphalangeal (PIP) to PIP transfer was 22 degrees/39 degrees (n = 13); and PIP to MCP transfer was 38 degrees/51 degrees (n = 2). The proximal phalanges in MCP joints transferred to the MCP position grew an average of 7.0 mm, and the middle phalanges of joints transferred to the PIP position grew 4.3 mm. Almost normal growth was observed in all transferred joints except two that showed premature epiphyseal closure. Indications for this procedure and techniques to improve range of motion are described.

Arthroplasty↗
PubMed1991

Replantation of severed fingers: two unique cases.

Two cases of amputated digits are reported. One involved a period of ischemia at freezing temperatures, and the other at unusually high temperatures. Both fingers survived upon replantation. The implications of extreme temperature upon ischemic tissues are discussed.

Adult↗
PubMed1994

Distal phalanx replantation.

Microsurgical replantation has been attempted in the distal phalanx of the digits. Twenty-three complete, single digit amputations are reviewed. The patients' ages ranged from 9 months to 48 years. Viability was 78%. Sensory recovery averaged 7 mm static two-point discrimination. Range of motion in the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb averaged 64 and 51 degrees, respectively. Eight of the 17 successfully replanted digits had mild to moderate atrophy. Eighty-two percent of patients were able to use the replanted digit successfully in their daily work. We feel that distal digital replantation is rewarding. In successful cases, it always preserves acceptable function and good appearance at a price of an average of 2.3 months off work.

Adolescent↗
PubMed1994

Digital amputations and their reconstruction: reconstructive surgery of the fingers.

Reconstructive surgery of the fingers has been greatly modified and improved by the introduction of microsurgery. Fifty-three cases, in the past five years, of hand mutilation due to an amputation and the reconstructive techniques used have been reviewed. In the majority of the secondary reconstructions, three fundamental methods have been combined: (1) medialisation of the digits, (2) prolongation of the digits from "nearby" transpositions (remainders of proximal fingers), and (3) transfers from foot to hand. Beginning with this analysis, a classification of the procedures according to the defect to be reconstructed can be developed. Finally, the results in relation to the procedures applied have been analysed and technical observations that derive from these are pointed out, both for the donor foot as well as for the reconstructed hand.

Amputation, Traumatic↗