Twenty years' experience of limb replantation--review of 293 upper extremity replants.
Explore the source record for details and available documents.
Adult↗
SEARCH · Search PubMed
Results for “Finger Injuries”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Hydrogen washout technique in monitoring vascular status after replantation surgery.
The hydrogen washout technique was applied to an experimental model of microvascular repair to evaluate its potential use in determining blood flow after microvascular surgery. Three blood flow measurements were obtained in each of 10 rat hindlimbs with the hydrogen washout technique: a control, a reading with arterial flow disrupted, and a final reading after standard microvascular repair of only the saphenous artery. After repair, flow rate was 0.115 ml/minute/ml compared to 0.008 ml/minute/ml for the disrupted reading (p less than .01). The practical clinical applicability of the hydrogen washout technique for evaluating blood flow in the fingertip was tested on five human volunteers. Ischemia in the upper extremity was produced with a pneumatic tourniquet. The hydrogen washout technique and the Doppler pulse monitor were used simultaneously to evaluate circulation in the small finger. Hydrogen uptake occurred simultaneously with return of clinical signs of tissue perfusion during gradual tourniquet deflation. The Doppler pulse returned while clinical signs of ischemia remained. The use of hydrogen washout in monitoring three patients following microvascular surgery has shown it to be accurate in predicting survival. It has, thus far, proven itself to be easily repeatable and reliable both intraoperatively and postoperatively.
Adult↗
True aneurysm of digital artery.
Explore the source record for details and available documents.
Adult↗
A staged technique for the repair of the traumatic boutonniere deformity.
A step-by-step approach to the systematic management of chronic boutonniere deformity due to trauma is presented. If surgical intervention is necessary, the problem should be approached one step at a time. The following stages are described: stage I, tendolysis of the extensor tendon and freeing of the transverse retinacular ligament; stage II, sectioning of the transverse retinacular ligament; stage III, tendon lengthening of the lateral bands over the middle phalanx; and stage IV, repair of the central extensor tendon. After managing 23 patients according to this plan, we have concluded that it is frequently unnecessary to automatically go through all four stages in treating chronic traumatic boutonniere deformity. We found that 17 patients were successfully managed by some combination of stages I, II, and III, and six patients received adequate treatment with stages I, II, and IV.
Adolescent↗
The use of lateral V-Y advancement flaps for fingertip reconstruction.
An operation is described that is based on anatomical studies showing the pattern of the fibrous septa and neurovascular bundles of the distal phalanx. Lateral V-Y advancement flaps are outlined with the dorsal incisions going sharply to the bone. With palmar retraction of each flap, dense fibrous bands on its underside are sharply divided. The palmar incision is made through skin only. The nerves, vessels, and adipose tissue of this pedicle are preserved while the fibrous septa are carefully divided. This technique permits 10 to 14 mm advancement of each flap. Complete division of the dorsal pedicle permits great mobility of the flap without functionally diminishing circulation or innervation. This procedure is particularly useful in traumatic fingertip amputations with the palmar and transverse oblique deformities. Elective remodeling of irregular fingertips has also been aided by this operation.
Amputation, Traumatic↗
An evaluation of the two-stage flexor tendon reconstruction technique.
The performance of 43 two-stage flexor tendon reconstructions in 39 patients was reviewed. Results were graded by comparing the preoperative passive motion of the proximal and distal interphalangeal joints after stage one to the active motion of these same joints after stage two. The procedures returned 16% excellent, 23% good, 26% fair, and 35% poor results with three graft ruptures. Following the tenolysis of 20 grafts (47%) the results for the entire group were improved to 27% excellent, 28% good, 30% fair, and 16% poor. Stage reconstruction, including tenolysis, was felt to be the best available method for restoration of digital function following flexor tendon loss in the badly scarred digit.
Adolescent↗
A free total toe phalanx transplant to a finger: a case report.
A six-year-old boy sustained traumatic loss of the index finger middle phalanx of his right hand and one year after the accident the proximal phalanx of the fourth toe was transplanted to the index finger as a free graft. Four years after the operation x-ray films demonstrate acceptance of the graft and satisfactory function of the finger.
Amputation, Traumatic↗
Successful revascularization of an incompletely amputated finger with serious venous congestion--a case report.
Explore the source record for details and available documents.
Adult↗
The pseudosynovial sheath--its characteristics in a primate model.
The characteristics and long-term fate of the pseudosynovial sheath formed in response to a gliding tendon implant were examined. A primate model was chosen to reproduce the human clinical situation. Hunter passive gliding implants were implanted in 32 digits of eight Macque monkeys. Surgical syndactylism was created to the adjacent active digits to provide passive range of motion of the digits. No implanted digits demonstrated progressive flexion contractures. Radiographs revealed passive excursion of the implants of an average of 2.5 cm. Biopsies were taken at various time intervals and locations for histological examination. The pseudosynovial sheath has three descriptive layers: an intima, media, and adventitia. This sheath becomes mature and stable at 8 weeks. The intima cells contain a glycosaminoglycan substance and have a secretory capacity. The media cells have large amounts of collagen and provide structural and vascular support. The adventitia is a highly vascular structure composed of loose fibrous tissues that demonstrates clefts that may represent gliding planes. The pseudosynovial sheath was found to be a morphologically stable structure that showed no propensity for longitudinal contracture. The sheath appears to have the characteristics necessary to provide a good bed for a tendon graft.
Animals↗
A technique of distraction osteosynthesis in the hand.
Moderate digital lengthening may be accomplished with a step osteotomy that preserves attached sleeves of periosteum. A new external fixation apparatus, the Mini-H-Fixator, allows gradual distraction and solid bone fixation after surgery and facilitates this operation. The advantage of this procedure is that it results in rapid bone formation in the osteotomy gaps, obviating the need for bone grafting.
Adult↗
The "belt loop" technique for the reconstruction of pulleys in the first stage of flexor tendon grafting.
Explore the source record for details and available documents.
Finger Injuries↗
Revascularization of digits after thirty-three hours of warm ischemia time: a case report.
A case of digits revascularized after 33 hours of warm ischemia time is described. Ischemic changes had occurred already with ultimate loss of the distal segments, but most of the fingers survived to provide the patient with adequate function. Although the commonly accepted limit of warm ischemia time has been reported to be within 6 to 12 hours, revascularization of digits can be attempted in selected cases even after an apparent prolonged warm ischemia time.
Adult↗
Update: palmar dislocation of the trapezoid--a case report.
A case is presented of an open palmar dislocation of the trapezoid in conjunction with dorsal dislocations of the carpometacarpal joints of the index and long fingers. Open reduction and a primary limited wrist arthrodesis were performed with good results.
Adult↗
Functional assessment of ray transfer for central digital loss.
Nineteen patients who had ray transposition for central digital loss were evaluated retrospectively with regard to postoperative function and appearance. Pinch and grip recoveries were better in patients with small-to-ring finger transfers than in those with index-to-long finger transfers. Total average pinch recovery measured 83.3% of the nonoperated side. Total grip recovery was 80.2% of the nonoperated side. Average ranges of motion for all transferred digits were 77.6 degrees (metacarpophalangeal joint), 87.6 degrees (proximal interphalangeal joint), and 80.8 degrees (distal interphalangeal joint). Overall results judged by a five-component assessment scale were excellent.
Adolescent↗
Intraosseous nerve transposition for treatment of painful neuromas.
Symptomatic painful neuromas of the sensory nerves are a frequent cause of major impairment of the hand. Numerous techniques and measures have been used for managing this challenging problem. Boldrey first advocated a technique in 1943 in which the nerve end was transposed and implanted into bone and reported the successful use of this method in one patient. In 1981, Hemmy used a similar technique in five patients with no recurrence of pain. To date, no other studies that used this method have been reported. We performed intraosseous transposition of 23 painful neuromas in the hand of 11 patients and were successful in 10 cases.
Adult↗
The stability of internal fixation in the proximal phalanx.
A biomechanical study was performed to assess quantitative differences in the stability obtained with five commonly used types of internal fixation used in proximal phalangeal fractures. The techniques included dorsal plating, dorsal plating combined with an interfragmentary lag screw, two interfragmentary lag screws, tension-band technique, and crossed Kirschner wires. Rigidity and strength in apex palmar bending were determined after oblique osteotomy and fixation of the proximal phalanx. The failure modes for each fixation technique were also observed and described. The results showed that both of the techniques that used interfragmentary lag screws across the oblique osteotomies provided significantly more rigidity than did dorsal plating alone or the wired configurations but that measurements of strength were similar between all techniques tested. Dorsal plates were at a mechanical disadvantage on the compression surface in our apex palmar bend test and consequently provided no more rigidity and strength than did the wired techniques. The tension band technique represented a combination of stiff and flexible intraosseous wires without strict application of tension band principles and provided intermediate rigidity and strength. Rigidity and strength in intact proximal phalanges in the controls were significantly greater than in all techniques tested.
Biomechanical Phenomena↗
Induced vasodilation in the treatment of posttraumatic digital cold intolerance.
Induced vasodilation was used in 10 patients with posttraumatic cold intolerance. Eight of 10 patients improved. Before the treatment program and cold exposure, the injured digits were an average of 1.5 degrees C cooler than the control digits. After cold exposure, the mean temperature difference was 3.2 degrees C. At the conclusion of the study, the temperature differences between the injured and control digits were an average of 0.1 degree C before cold stress and 1.0 degree C after. Associated with this measured improvement was an improvement in cold tolerance. This was maintained 1 year later by 67% of the patients. One year after the completion of this study, nine patients were treated at home on a less controlled program with improvement in 67% of patients.
Adaptation, Physiological↗
Distal replantation.
Explore the source record for details and available documents.
Amputation, Traumatic↗