Cases reported "Amputation, Traumatic"

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1/13. 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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2/13. Amputation of the middle ray in the primary treatment of severe injuries of the central hand.

    Severe injury to the middle finger often compromises both the appearance and function of the hand. This report discusses the use of total middle ray amputation at the time of primary trauma surgery to avoid predictable problems that arise when the ray, or part of it, is retained. Primary ray amputation eliminates the defective middle finger, avoids a gap hand, and reunites the dissociated radial and ulnar segments of the hand to create a useful, three-fingered hand.
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3/13. Ultrasound study of the motion of the residual femur within a trans-femoral socket during daily living activities other than gait.

    This study analyses the residual femur motion of a single amputee within a transfemoral socket during a series of daily living activities. Two simultaneously transmitting, socket mounted transducers were connected to two ultrasound scanners. Displacement measurements of the ultrasound image of the femur were video recorded and measured on "paused" playback. Abduction/adduction and flexion/extension of the residual femur within the socket at any instant during these activities were estimated, knowing the relative positions of the two transducers and the position of the residual femur on the ultrasound image. Consistent motion patterns of the residual femur within the trans-femoral socket were noted throughout each monitored daily living activity of the single amputee studied. Convery and Murray (2000) reported that during level walking, relative to the socket, the residual femur extends 6 degrees and abducts 9 degrees by mid-stance while flexing 6 degrees and adducting 2 degrees by toe-off. Uphill/downhill, turning to the right and stepping up/down altered this reported pattern of femoral motion by approximately 1 degree. During the standing activity from a seated position the femur initially flexed 4 degrees before moving to 7 degrees extension, while simultaneously adducting 6 degrees. During the sitting activity from a standing position the femur moved from 7 degrees extension and 6 degrees adduction to 3 degrees flexion and 1 degree abduction. The activity of single prosthetic support to double support introduced only minor femoral motion whereas during the activity of prosthetic suspension the femur flexed 8 degrees while simultaneously adducting 9 degrees. Additional studies of more amputees are required to validate the motion patterns presented in this investigation.
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4/13. Pollicisation of the index metacarpal based on the first dorsal metacarpal artery.

    We present our experience of two cases in which we carried out pollicisation of the index metacarpal based on the first dorsal metacarpal artery and venae comitans. Both cases were complex severe hand injuries where the initial injury was the result of a firework exploding while held in the hand. In both cases the radial side of the superficial palmar arch was destroyed by the injury. In both cases there was virtually complete loss of the thumb ray and amputation of the index through the base of the proximal phalanx. A useful opposition post has been created from vascularised index metacarpal with free flap soft tissue reconstruction.
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5/13. Bilateral hand reconstruction: report of three cases.

    Although it has been established that a single lost hand can be reconstructed by autogenous bilateral toe transplantation, the problem of how to reconstruct bilateral hand loss still remains. The authors present a novel approach to solve this intricate problem. A big toe free skin-nail flap, along with the second digital ray or second and third digital rays, with a common vascular pedicle, is taken from the donor foot and transferred to the forearm stump by microsurgical technique, thereby creating a hand with two or three digits. Either a piece of the iliac bone or an ulna block cut during the preparation of the forearm stump is used to substitute for the lost first metacarpus and phalanges of the thumb. The operative technique is described. Three patients have undergone this procedure and have had both lost hands reconstructed. Among the six reconstructed hands, two had two digits in each and the others had three digits. One reconstructed hand failed to survive subsequent to vascular thrombosis which might have been due to degeneration and thickening of the vessel wall. Partial failure occurred in another, where the transferred big toe skin-nail flap necrosed and was replaced by a pedicled skin tube. All five surviving hands were followed up for more than one year and showed satisfactory functional recovery.
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6/13. thumb reconstruction by free microvascular transfer of an injured index finger.

    thumb reconstruction for amputation at the metacarpal phalangeal level was accomplished by microneurovascular transfer of the contralateral damaged index finger ray, including metacarpal phalangeal joint. This transfer accomplished a successful thumb restoration and removed a cumbersome index finger amputation stump, improving function in both hands. This case emphasizes the merits of spare part transfer in hand reconstructive surgery made possible by microneurovascular techniques.
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7/13. Cross transposition of short amputation stumps for reconstruction of the thumb.

    Cross transposition of digital rays is illustrated by a case of amputation of the thumb and the middle finger. A remnant of the stump of the middle finger was mobilised and brought on top of the first metacarpal, in order to restore a functional length to the amputated thumb. A cross transposition of the second digital ray to the third was also carried out, closing the gap left by the resection of the third metacarpal.
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8/13. Composite metacarpophalangeal joint reconstruction in great toe-to-hand free tissue transfers.

    he recommended technique of skeletal fixation of great toe-to-hand free tissue transfers for thumb reconstruction is related to the length of the first ray present. When the entire first metacarpal is intact, fusion of the disarticulated great toe proximal phalanx to the metacarpal head has been described. Another possibility in this selected situation with cartilage present on the metacarpal head is to reconstruct a new metacarpophalangeal (MP) joint from a cuff of collateral ligaments and plantar plate on the proximal phalanx, anchored to the metacarpal head. In a series of 45 great toe-to-thumb transfers, eight were done with a composite MP joint reconstruction technique. A description of this technique and clinical results are presented. Based on the results in these patients, this technique should be considered as an alternative to joint fusion when the entire first metacarpal is intact.
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9/13. Free microvascular transfer of second toe ray and serratus anterior muscle for management of thumb loss at the carpometacarpal joint level.

    A 50-year-old machine operator suffered traumatic amputation of the thumb, ring, and small fingers. The thumb had been amputated at the carpometacarpal joint and was reconstructed 6 months later by microneurovascular transplantation of the second toe including the second metatarsal. Opposition was provided and the first web space was released at a second stage by reconstruction with the lowest two digitations of the serratus anterior muscle covered with a split-thickness skin graft.
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10/13. Selective finger transposition and primary metacarpal ray resection in multidigit amputations of the hand.

    In multidigit amputations parts with the most favorable prognosis (cleaner amputation, less crushed, short ischemia time) can be "selectively" replanted in positions most appropriate to providing useful function and cosmetic acceptability, regardless of their anatomic origin. Digits with poor prognosis are not reattached. These principles are applied in four selected cases involving multidigit amputations proximal to the proximal interphalangeal joints in which the least traumatized digits were selectively joined to the more ulnar metacarpal rays; intervening metacarpal shafts were primarily resected to clear the first web space of obstructing bony stumps. The narrowed palmar arch, although weaker, achieves wider palmar span grasp. fingers in contiguity, although fewer in number, allow improved precision handling, chuck pinch, and cosmetic acceptability.
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