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At least 955 records · Page 53Linked to original sources
PubMed1990

Arteriovenous shunt in digit replantation.

From May 1958 to May 1987, 331 digits were replanted successfully with an overall survival rate of 86.2%. Complete success in replantation of amputated fingers requires an accurate anastomoses of both arteries and veins. However, anastomosis between arteries may not be possible in some patients. Since reports that a thumb amputated at the interphalangeal joint area could be successfully replanted by an arteriovenous shunt on the palmar side, we did arteriovenous shunts in four such cases. Two replantations were successful; necrosis developed in the other two patients.

Adult↗
PubMed1991

Reverse forearm flap based on an "exteriorized" pedicle.

Soft tissue coverage after multiple digital amputations was achieved with a reverse forearm flap based on an "exteriorized" vascular pedicle. The length of exposed radial artery pedicle was calculated to permit full range of motion of the involved digits before flap division and inset. No complications of the exposed vascular pedicle were noted.

Adult↗
PubMed1991

Vascularized single toe joint transfer to the hand.

We report a retrospective review of our series of thirty-one single joints harvested from the toe in twenty-six patients and transferred to the metacarpophalangeal or proximal interphalangeal joint of the finger. Twenty-six transfers were done in traumatic cases and five in congenital. Follow-up averaged 22.6 months. Average range of motion was from 17.1 degrees to 44.3 degrees, with an arc of 27.2 degrees. The congenital group had an average motion ranging from 14.4 degrees to 27.2 degrees and an arc of 12.8 degrees. The traumatic group's motion was from 17.6 degrees to 47.6 degrees and an arc of 30.0 degrees. Complication rates were significant, with fifty percent of the patients experiencing one or more complications. Although vascularized joint transfer is a demanding procedure, it provides a reasonable alternative to arthrodesis and with further refinement in technique may become a reliable treatment option.

Adolescent↗
PubMed1991

Biomechanical and functional testing of plate fixation devices for proximal phalangeal fractures.

Functional testing in fresh cadaver digits of a dorsally applied mini-H plate, a mini-straight plate, and a laterally applied mini-condylar plate demonstrated that all three significantly reduce (p less than 0.2) simulated active PIP joint flexion. The mini-condylar plate, however, provided the least reduction of any of the three plates. Biomechanical testing of the same three plates on proximal phalanx after osteotomy in apex palmar and apex dorsal direction bending showed all three plates to provide rigidity less than the intact bone.

Biomechanical Phenomena↗
PubMed1991

Effects of cold exposure on the circulation of replanted fingers during the early postoperative period.

The replanted finger after a complete amputation is an excellent model for the study of many aspects of vascular physiology. In the present clinical study, 10 patients were investigated to evaluate the incidence of cold-induced vasospasm in replanted digits during the early postoperative period. The results indicate that cold-induced vasospasm is not a risk factor in the early postoperative phase after digital-replantation surgery. It is concluded that cold-induced spasm of the digital arteries is primarily a central, nerve-mediated reflex.

Adult↗
PubMed1991

Free vascularized deep peroneal neurocutaneous flap for repair of digital nerve defect involving severe finger damage.

A free vascularized deep peroneal nerve graft seems to be the most suitable method for repairing digital nerve defects involving severe finger damage. We report a patient in which this graft was used as a neurocutaneous flap. The advantages of this method are its excellent vascularity, minimal functional disturbance to the donor foot, and the possibility of versatile application.

Finger Injuries↗
PubMed1977

Traumatic amputation of digits: the fate of remaining blood. An experimental and clinical study.

Experimental studies on rabbit ears amputated by either a clean sharp division or severed by a crushing blow showed that twice as much blood remained in the crush group. Microthrombi and tissue thrombi were seen in this group only. A review of 142 digital replantations performed over a 10 year period showed 126 survivals. Ninety-three were complete amputations and 80 of these survived; 49 were incomplete amputations and 46 survived after revascularization attemps. Of 74 clear amputations, 68 survived; of 68 crush-type amputations, 58 survived. Circulatory disturbances occurred in 36 replanted digits; 16 could not be salvaged. The primary cause of complications was venous obstruction. In 80 digital replantations done from January, 1974, to December, 1975, success was obtained in 75 (93.75 percent). Irrigation of vessels of the severed part is done only in cases of double level amputation, severely crushed or those due to avulsion. Heparin, low molecular weight dextran, urokinase, and antibiotics are given for several days after operation.

Amputation, Traumatic↗
PubMed1978

Temperature monitoring in digital replantation.

Postoperative monitoring of replanted and revascularized digits with skin temperature probes was performed on the 20 patients admitted to the Duke University Medical Center Orthopaedic Replantation Service from April to July, 1977. Using multiple probes, temperatures were recorded for the replanted digit, a control digit on the same hand, and the dressing which represented the ambient temperature. In addition, the following simultaneous clinical inspections were performed on the digits: capillary refill, skin color, turgor, audibility of arterial Doppler tones, and amplitude of pulp pressure tracing. Temperatures of the replanted digits were in the range of 26.0 degrees to 35.0 degrees C. Control temperatures remained relatively stable, in the range of 33.0 degrees to 35.0 degrees C. From the authors' experience the patterns of temperature change which signaled changes in perfusion of the replanted digit and possible poor prognosis were (1) the temperature of the replanted digit dropping more than 2.5 degrees C while the control temperature stayed constant; (2) the temperature of the replanted digit dropping below 30.0 degrees C for longer than 1 hour; and (3) the control temperature dropping below 30.0 degrees C with no correctable cause found.

Adolescent↗
PubMed1978

Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique.

A linkage of Kirschner wires activated by a single rubber band creates a force couple across a fracture-dislocated proximal interphalangeal joint. The method dynamically achieves concentric joint reduction, which is maintained through a full active range-of-joint flexion and extension. Two case reports accompany a description of the technique.

Adolescent↗
PubMed1978

Chronic fracture-subluxation of the proximal interphalangeal joint.

Reported methods of treatment of chronic fracture-subluxations of the proximal interphalangeal joint require wide dissection and prolonged immobilization and often result in limited motion. Open reduction with minimal dissection, immobilization for 11 days to allow soft-tissue healing, and the early institution of active flexion exercises protected by an extension block splint was done in four patients. The long-term results demonstrate restoration of a stable joint with satisfactory motion and minimal subjective complaints.

Adult↗
PubMed1978

Intraosseous wiring of the digital skeleton.

One hundred cases of osteosynthesis done by the use of intraosseous wiring are presented. Two techniques of wiring are described, one used in transverse fractures and arthrodeses in which an additional Kirschner wire is employed, the other in which No. 0 monofilament wire can be placed perpendicular to the line of osteosynthesis. Forty-seven fractures were treated and there was union in all cases; 53 arthrodeses were performed, with failure in five, due, it is believed, to a failure to observe the essential elements of the technique, namely the need to obtain congruous bone ends and to maintain all internal fixation until there is clinical evidence of union. Overall, 83.2% of the maximum attainable total active range of motion was achieved in the 100 cases.

Adolescent↗