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PubMed1994

Fingertip replantation: pre-osteosynthesis vein graft technique.

Since 1985 we have been performing replantation of amputated fingertips using a pre-osteosynthesis vein graft technique. First, we locate an artery and vein at the distal part of the fingertip and perform a vein graft. After this, we perform osteosynthesis. Since there is sufficient vessel length, the anastomosis technique becomes easier than with the method previously used. In our department, between 1985 and 1990 we performed 11 Zone I replantations. Ten fingers survived and one failed. There were good results in seven cases and three had fair results. The pre-osteosynthesis vein graft technique is a reliable technique for amputated fingertip replantation.

Adolescent↗
PubMed1994

Transpositional microsurgery in multiple digital amputations.

In 34 of the 62 patients treated for complete multiple digital amputations, the severed part was not replanted in its anatomical position, but in the place of the most useful stump. This procedure is defined as transpositional digital microsurgery and refers to the transposition and replantation of any digit to another stump which plays a more significant role in the function of the hand. Twenty-eight patients had transposition of a digit, while six patients underwent thumb transposition. All except six of the transposed digits survived, while all of the thumbs survived the surgical procedure. The cosmetic appearance of the hand with a transposed digit or thumb was acceptable to the patients. Two-point discrimination was assessed to be 10-14 mm for the transposed digits, and the functional ability of the transplanted digit was comparable to digits which were replanted in their anatomical position. In conclusion, transpositional digital microsurgery remains a useful alternative for the treatment of multiple digit amputations, particularly in patients with severely damaged non-replantable amputated parts.

Adult↗
PubMed1994

Digital reconstruction by free microvascular transfer of two fingers as a unit from the contralateral paralyzed hand.

The ideal reconstruction for damaged or missing fingers has yet to be achieved. While toe transfer offers an excellent option for reconstruction of the thumb, this type of reconstruction often falls short in replacement of other digits of the hand. Microsurgical transfer of a finger or fingers from the opposite hand offers an option, but is rarely performed due to the morbidity in the donor hand. The case of a patient with a paralyzed, but otherwise normal, opposite hand presents a unique opportunity to repair the contralateral damaged but innervated hand. This case report deals with such a patient in whom two fingers were moved from a paralyzed hand to replace two traumatically missing digits in his previously normal hand. Technical considerations will be discussed and the result at 33 months will be presented.

Adult↗
PubMed1995

Natural history of digital replantation: a 12-year prospective study.

UNLABELLED: The purpose of the study was to evaluate the fate of the digital arterial anastomoses, resting total digit blood flow, and cold-induced discomfort following digital replantation with two repaired arteries. The evaluation was done with a Doppler ultrasound of the anastomoses, temperature recording from the finger pulp at room temperature, and a questionnaire regarding the patient's impression of cold-induced discomfort. At the 2-year follow-up all anastomoses were patent, but in two of the six patients one anastomosis was occluded at the 12-year follow-up. The replanted digits generally showed lower skin temperatures compared with controls at the 2-year follow-up but these had normalized 10 years later, even in digits with one of the two repaired arteries occluded. The number of patients with severe cold-induced discomfort was unchanged during the observation period. CONCLUSION: The digital flow continues to increase after the first 2 years after replantation and may reach normal levels at room temperature; however, cold-induced discomfort is not normalized. Total blood flow improvement is not affected by late arterial occlusion.

Adolescent↗
PubMed1995

Evaluation of the effectiveness of sensory reeducation following digital replantation and revascularization.

Sensory recovery following digital replantation plays an important role in the restoration of hand function. Twelve patients with twenty-four replanted or revascularized digits were randomly selected to enter a program of sensory reeducation, and another 15 patients with 22 replanted or revascularized digits were selected as controls who did not receive sensory reeducation. A moving two-point discrimination and a Semmes-Weinstein pressure threshold test were evaluated for monitoring the sensory recovery. The period of sensory reeducation was 18.83 weeks on average, and the mean follow-up time was 11.94 months. The group that received sensory reeducation significantly improved to a better degree of moving two-point discrimination and Semmes-Weinstein threshold level by both univariate and multiple regression analysis. We suggest that sensory reeducation should be an integral part of the postoperative rehabilitation protocol following digital replantation and revascularization.

Adult↗
PubMed2005

Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair.

Nerve repair is usually accomplished by direct suture when the two stumps can be approximated without tension. In the presence of a nerve defect, the placement of an autologous nerve graft is the current gold standard for nerve restoration. However, over the last 20 years, an increasing number of research articles reported on the use of non-nervous tubes (tubulization) for repairing nerve defects. The clinical employment of tubes (both biological and synthetic) as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. In addition, tubulization was proposed as an alternative to direct nerve sutures in order to create optimal conditions for nerve regeneration over the short empty space intentionally left between two nerve stumps. This paper outlines recent important advances in this field. Different tubulization techniques proposed so far are described, focusing in particular on studies that reported on the employment of tubes with patients. Our personal clinical experience on tubulization repair of sensory nerve lesions (digital nerves), using both biological and synthetic tubes, is presented, and the clinical results are compared. In our case series, both types of tubes led to good clinical results. Finally, we speculate about the prospects in the clinical application of tubulization for peripheral nerve repair.

Bioprosthesis↗
PubMed2002

Skeletal fixation in digital replantation.

Although the primary objective of replantation is revascularization and ultimately viability of the amputated digit(s), skeletal stabilization is an important cornerstone of the composite repair and reconstructive process. If performed rapidly and securely, anatomic (or near anatomic) fracture reduction and fixation may contribute profoundly to the protection of the revascularization and the repair or reconstruction of nerves, tendons, and integument; reliable fracture healing; functional restoration; and final outcome. Conversely, less than anatomic (or near anatomic) reduction or unreliable and insecure fixation may deter successful early revascularization and, later, good function. This article reviews the various methods of fracture stabilization that may be employed, and their advantages and disadvantages. We believe that anatomic (or near anatomic) fracture reduction, reliable and stable fracture fixation, minimal additional dissection, and early active range-of-motion exercises will have a substantial effect on both viability and functional outcome in digital replantation.

Finger Injuries↗
PubMed1991

False aneurysm of a digital artery. A case report.

Traumatic aneurysms of a digital artery are rare, and only 11 cases have been reported in the literature. This paper describes the aetiology, physical appearances, investigation and management of a false aneurysm of the digital artery of the left little finger.

Adult↗
PubMed1991

Lateral band release for post-traumatic extension contracture of the proximal interphalangeal joint.

In the patient with scarring of just the central band and lateral bands, there is a loss of active and passive flexion of the proximal interphalangeal (PIP) joint because the lateral bands have lost their normal volar shift. Surgical freeing of the lateral bands from the central band using parallel incisions may be required to allow full flexion of the PIP joint. This study reports on 10 patients with post-traumatic extension contracture of the PIP joint treated by lateral band release. All operations were successful, with an average gain in range of motion of 47.5 degrees. This technique is simple, quick, and can be performed effectively on an out-patient basis.

Adult↗
PubMed1978

[Microvascular and microneural repair: technique and results (author's transl)].

Microsurgical technique permits repair of arteries and veins of a diameter of 0.5-2 mm. The success rate rose to 80-90% because of the frequent use of vascular grafts. This led to a high success rate in replantation of amputated parts. But repair of digital vessels is indicated even if the basal circulation is present to improve healing of other structures (tendons, nerves) and so to avoid late ischemic complaints. Free transfer of toes to replace digits in cases of multiple digital loss has its place in reconstructive hand surgery. It became possible because of the satisfactory return of sensibility after nerve repair. Microsurgery of peripheral nerves makes it possible to adapt the surgical technique to intraneural structures (mono-, oligo- or polyfascicular pattern with and without grouping). The results of nerve repair have been improved by the widespread use of nerve grafting. This is also true for cases that, in the past, were regarded as prejudicial to a useful recovery.

Finger Injuries↗
PubMed2000

Operative treatment of mallet finger due to intra-articular fracture of the distal phalanx.

Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial. Thirty-three digits with such fractures were treated by open reduction and internal fixation with Kirschner wires. Of these 33 fractures, 13 were associated with subluxation of the distal phalanx. After an average follow-up period of 29 months, the average loss of extension of the distal phalanx was 4 degrees, and the average flexion of the distal interphalangeal joint was 67 degrees. Radiographs of the distal joint in 27 digits appeared normal, while in the remaining 6 digits, slight degenerative changes were noted. In one there was a minor surgical complication. By using the operative technique described, a congruous reduction of the inta-articular fracture and satisfactory function were achieved.

Adolescent↗
PubMed2005

[Pyrocarbon prosthesis for finger interphalangeal joint replacement. Experience after one year].

The long-term results of finger joint replacement, particularly the proximal interphalangeal (PIP) joint, have mostly been disappointing according to a review of the international literature and our own experiences. The recently developed pyrolytic carbon implants (Ascension Orthopedics, Austin, Texas) for replacing the PIP joint were evaluated retrospectively regarding range of motion, functionality, and relief of pain. In our hospital 17 PIP joints were replaced with pyrolytic carbon implants in 16 patients by an offset stem technique inserted without cement. This study included 13 patients; we excluded three patients because of follow-up <3 months. Prerequisites were adequate collateral ligaments, bone stability, and sufficient or at least reconstructable extensor tendons. The purpose of this study was to evaluate the 1-year outcome (minimum 270, maximum 360 days) regarding range of motion, implant stability based on radiological and clinical parameters, and relief of pain using a pre- and postoperative visual and verbal analogue scale.There was an improved range of motion of the PIP joint from 0-28-51 preoperatively to 0-22-77 postoperatively (average value). On the visual analogue scale (0 no pain, 10 incapacitating pain) we achieved pain relief at rest and in motion of 80%. On the verbal analogue scale there was an improvement of 62%. The results of this study demonstrate that pyrolytic carbon implants reduce pain and are functionally superior to arthrodesis. A precise and individual postoperative protocol is necessary for beneficial results.

Adult↗
PubMed2000

Rapid functional plasticity of the somatosensory cortex after finger amputation.

Recent research indicates that areas of the primary somatosensory (SI) and primary motor cortex show massive cortical reorganization after amputation of the upper arm, forearm or fingers. Most of these studies were carried out months or several years after amputation. In the present study, we describe cortical reorganization of areas in the SI of a patient who underwent amputation of the traumatized middle and ring fingers of his right hand 10 days before cortical magnetic source imaging data were obtained. Somatosensory-evoked magnetic fields (SEF) to mechanical stimuli to the finger tips were recorded and single moving dipoles were calculated using a realistic volume conductor model. Results reveal that the dipoles representing the second and fifth fingers of the affected hand were closer together than the comparable dipoles of the unaffected hand. Our findings demonstrate that neural cell assemblies in SI which formerly represented the right middle and ring fingers of this amputee became reorganized and invaded by neighbouring cell assemblies of the index and little finger of the same hand. These results indicate that functional plasticity occurs within a period of 10 days after amputation.

Afferent Pathways↗
PubMed2001

Measurement of torsion angles of long finger bones using computed tomography.

OBJECTIVE: Rotational dislocation at the fracture site is a complication of long finger bone fractures of the metacarpals and phalanges. To evaluate such deformities, we performed CT of the articular surfaces of these bones to demonstrate the torsion angles. DESIGN: We evaluated 10 pairs of cadaver hands. These were placed flat, with the bones of interest perpendicular to the gantry to acquire axial images. The torsion of the long bone axes was defined as the angle between a tangent positioned parallel to the proximal articular surface and a tangent parallel to the distal articular surface of individual bones. RESULTS: The maximum difference between repeated measurements was 4 degrees. Intraobserver differences measured between right and left hands are less than 3 degrees. CONCLUSION: Side differences in torsion angles exceeding 3 degrees are strongly suspicious of a malrotation after fracture. These measurements might help to plan derotational osteotomy and assess the results of therapy.

Cadaver↗