Cases reported "Finger Injuries"

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1/92. Dorsolateral toe flap as a neurovascular graft carrier in finger reconstruction.

    Simultaneous finger nerve and artery grafting, and soft-tissue coverage with a dorsolateral toe flap, including a plantar digital neurovascular bundle, were performed in a single patient. Although only fair sensory recovery was achieved, due to complicated wound healing, the toe flap as a neurovascular graft carrier can be a treatment of choice for reconstructing complex finger palmar defects.
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ranking = 1
keywords = nerve
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2/92. Digital nerve repair by autogenous vein graft in high-velocity gunshot wounds.

    Gunshot wounds to the hands are high-energy injuries that cause widespread tissue damage, including to the nerves. Great difficulty is encountered in later reconstruction with nerve grafting of gaps in these destructive and scarred wounds. We present our experience with three patients with digital nerve repair by autogenous vein graft performed at an early stage in this type of injury. Based on our experience and that of others, this simple and rapid technique suggests a high rate of satisfactory results. It also avoids extensive and destructive late dissection and the morbidity associated with other late reconstructive procedures.
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ranking = 7
keywords = nerve
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3/92. bone resorption of the proximal phalanx after tendon pulley reconstruction.

    A 35-year-old male worker sustained a degloving injury of the left hand. An abdominal flap was used for skin coverage. Tenolysis and reconstruction of the A2 pulley was done using a procedure based on the 3-loop technique, which was modified by putting the tendon loop under the extensor apparatus and periosteum. X-ray revealed hourglass-shaped bone resorption around the proximal phalanx, just under the reconstructed pulley. Diaphyseal narrowing remained present in follow-up x-rays obtained 9 and 10 years later. The remodeling of the resorption was poor. Too much pressure may have caused this bone resorption from the shortened pulley and the circulatory deprivation may have been caused by the dissected periosteum and blocking by the surrounding tendon loop. The degloving injury, which also deprived the digits of a blood supply, may have been an additional underlying risk factor. We recommend that future comparative studies of pulley reconstruction take into account mechanical effectiveness as well as force distribution.
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ranking = 0.23063528208832
keywords = block
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4/92. 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 = 0.46127056417665
keywords = block
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5/92. Double-toe transplantation following temporary insertion of a block of silicone for reconstruction of a traumatic metacarpal defect.

    The treatment of the mutilated hand with more than one digit missing and a metacarpal defect is challenging. We used double-toe transfer after temporary insertion of a block of silicone to fill the bony defect.
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ranking = 1.1531764104416
keywords = block
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6/92. Extensor digiti minimi tendon "rerouting" transfer in permanent abduction of the little finger.

    Permanent abduction of the little finger is a bothersome deformity which usually occurs in the context of sequelae of ulnar nerve palsy (Wartenberg's sign), but also in rheumatoid arthritis. The authors report an original technique for correction of this deformity. The extensor digiti minimi tendon is sectioned at its distal insertion and transferred in the wrist through the extensor retinaculum. The "rerouted" tendon is finally resutured distally on the radial aspect of the interosseous muscle. Side-to-side suture of the transferred tendon to the extensor digitorum tendon of the little finger further reinforces the solidity of the procedure. The distal insertion of the extensor digiti minimi tendon is consequently radialized. Its new direction eliminates the abduction component, and the tendon then behaves as an active adductor of the little finger. Five cases (2 cases of ulnar nerve palsy, 3 cases of rheumatoid arthritis) are reported with a mean follow-up of 19 months. All patients have complete active adduction of the little finger in extension, with a persistent capacity for abduction. The other correction techniques published in the literature are discussed.
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ranking = 2
keywords = nerve
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7/92. A modified reversed digital island flap incorporating the proper digital nerve.

    A standard reversed digital artery flap is based on the digital artery and vena comitantes alone, leaving the proper digital nerve intact. In the authors' opinion, in situations in which the fingertip pulp is lost completely, it is unnecessary to leave the nerve in situ. Using their technique, the proper digital nerve is included in the pedicle. The pedicle is raised as a monobloc of fatty tissue containing the small veins important for drainage. The proper digital nerve in the flap is sutured to the stump of the opposite proper digital nerve. They found this flap to be very reliable, and quite easy and quick to raise. A patient is presented and discussed in detail.
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ranking = 9
keywords = nerve
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8/92. Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report.

    Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment.
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ranking = 0.23063528208832
keywords = block
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9/92. Sixty-four cases of thumb and finger reconstruction using transplantation of the big toe skin-nail flap combined with the second toe or the second and third toes.

    The purpose of this article is to introduce the results of thumb and finger reconstruction using transplantation of the big toe wraparound flap combined with the second toe or the second and third toes. Between August of 1981 and December of 1998, in a series of 64 cases involving 58 patients with digitless hands, either (1) the thumb and index fingers were reconstructed by transplantation of a big toe wraparound flap combined with the adjacent second toe harvested from the ipsilateral foot; or (2) the thumb, index, and long fingers were reconstructed by transplantation of an ipsilateral big toe wraparound flap combined with the adjacent second and third toes. The phalanx of the new thumb was usually an iliac block. The success rate of this series was 92.2 percent. At long-term follow-up, the average static 2-point discrimination was less than 10 mm. The distance between the tip of the new thumb and the new index finger ranged from 6 to 10 cm (average, 8 cm). Opposition action was nimble and forceful. The patients could lift a 6- to 12-kg weight with their reconstructed digits. All patients were satisfied with their new hands and were able to use them in their daily activities. The transplants for reconstructing the thumb and fingers are harvested from the same foot in a procedure known as one-foot donation. Function of the bilateral digitless hand can be recovered with this procedure.
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ranking = 0.23063528208832
keywords = block
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10/92. A reverse ulnar hypothenar flap for finger reconstruction.

    A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.
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ranking = 2
keywords = nerve
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