Cases reported "Amputation, Traumatic"

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1/203. replantation of fingertip amputation by using the pocket principle in adults.

    There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.
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keywords = finger
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2/203. Fingertip reconstruction with flaps and nail bed grafts.

    We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. Split toenail bed grafts were used in 6 cases, full-thickness nail bed grafts from the amputated part in 6, and split nail bed grafts from the injured digit in 2. There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.
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ranking = 0.1875
keywords = finger
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3/203. Ring finger ray amputation: a 25-year follow-up.

    The treatment of class III ring avulsion injuries remains controversial. This case report presents a 25-year follow-up of a class III ring avulsion injury treated with secondary ring finger ray amputation. This case shows long-term excellent functional and cosmetic results of ring finger ray resection without bony transposition.
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ranking = 0.375
keywords = finger
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4/203. carpal tunnel syndrome after distal release of the flexor digitorum profundus and subsequent retraction of the lumbrical muscle into the carpal tunnel.

    We present three patients who had traumatic amputation of a finger or fingers with subsequent retraction of the flexor digitorum profundus and lumbrical muscle leading to the development of carpal tunnel syndrome.
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ranking = 0.125
keywords = finger
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5/203. Successful revascularization of subtotal amputation of a digit in a neonate.

    A successful revascularization was performed in a neonate who sustained a subtotal amputation of the right ring finger with cord scissors while the umbilical cord was being cut. Successful revascularization of the digit was achieved within 5 hours of the injury using standard microsurgical techniques.
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ranking = 0.0625
keywords = finger
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6/203. Transpositional replantation of digits. case reports.

    Heterotopic or transpositional replantation of digits is technically feasible with results similar to those of conventional replantation procedures. Occasionally in multiple digital amputations not all the digits may be replanted in their correct place as a result of complex injuries proximal to the amputation zone or severe damage to important fingers. In these circumstances the amputated digits that are in the best condition as regards undamaged tissue are used for replantation. The primary priority is an optimal functional outcome and the secondary priority the cosmetic outcome. Amputated long digits will always be used to substitute for a non-replantable thumb rather than to replace a long finger. We present 13 cases of successful transpositional digit or joint replantations in traumatic amputations of more than one digit.
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ranking = 0.125
keywords = finger
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7/203. Osseodistraction after traumatic amputation of the little finger in a young musician.

    We lengthened the stump of a traumatically amputated little finger by osseodistraction in a young musician, who required a widened span to enable him to reach the octave on the piano. A mini external distraction device was used. No major complications occurred. The bone lengthening gave a good functional and cosmetic result.
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ranking = 0.3125
keywords = finger
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8/203. Use of the microvascular finger fillet flap.

    This paper reports the authors' experience with the use of microvascular flaps, elevated from severely injured fingers to cover soft-tissue defects of other digits. Two clinical cases are presented and pertinent literature is reviewed.
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ranking = 0.3125
keywords = finger
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9/203. thumb reconstruction with a wrap-around free flap according to the level of amputation.

    In 1980, Morrison and O'Brien reported their experiences with the reconstruction of an amputated thumb using a wrap-around neurovascular free flap from the great toe, but its indication has been limited distal to the metacarpophalangeal (MP) joint (Morrison et al., J hand Surg 5:575-583, 1980). We have performed 37 wrap-around free flaps from the great toe for the reconstruction of thumbs amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. The amputation was distal and proximal to the MP joint in 25 and 12 cases, respectively. Pinching and grasping power, two-point discrimination, and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the results of two-point discrimination was better in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In the 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of 30 degrees flexion and 45 degrees internal rotation. However, in the other six cases in the fixation of 30 degrees flexion and 30 degrees internal rotation, the opposition of the reconstructed thumb to the ring and little fingers was impossible in five cases and only to the little finger in one case. In this study, we concluded that amputation proximal to the MP joint is not an absolute contraindication to the wrap-around free flap procedure for thumb reconstruction. However, for a better functional outcome, we recommend iliac bone block fixation in the position of 30 degrees flexion and 45 degrees internal rotation.
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ranking = 0.25
keywords = finger
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10/203. Biting off more than you can chew: a forensic case report.

    A case is reported where a forefinger is 'amputated' by a human bite. This type of extreme biting injury is uncommon and probably represents tearing by the premolar teeth rather than a clean bite by incisor teeth.
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ranking = 0.0625
keywords = finger
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