Cases reported "Finger Injuries"

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1/101. Leech-borne serratia marcescens infection following complex hand injury.

    leeches are commonly used in the postoperative course of plastic surgical operations where there is venous congestion in a pedicled or free flap. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. It is known that leeches can carry aeromonas hydrophila infection, and a second or third generation cephalosporin antibiotic has traditionally been given as prophylaxis against infection. We report a new observation that leeches can carry serratia marcescens and give rise to clinically significant infection. The implication for prophylaxis and treatment of leech-associated cellulitis is discussed.
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keywords = operative
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2/101. Volar dislocation of the proximal interphalangeal joint of the finger: an indication for urgent operative treatment.

    Two patients are described with persistent acute volar dislocation of the middle phalanx of a finger. Closed reduction was impossible due to intra-articular interposition of the lateral slip of the extensor mechanism, combined with a tear of a collateral ligament. It is important to recognize these injuries at an early stage and an operative treatment is required.
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keywords = operative
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3/101. Extensor tendon lacerations in a preterm neonate.

    A fetus of 30-weeks' gestation sustained 2 extensor tendon lacerations as an intraoperative complication of an emergency cesarean section. This report describes treatment of the tendon lacerations in the preterm neonate using 2 different repair techniques which both yielded an excellent clinical outcome.
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keywords = operative
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4/101. Operative treatment of mallet finger due to intra-articular fracture of the distal phalanx.

    Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial. Thirty-three digits with such fractures were treated by open reduction and internal fixation with Kirschner wires. Of these 33 fractures, 13 were associated with subluxation of the distal phalanx. After an average follow-up period of 29 months, the average loss of extension of the distal phalanx was 4 degrees, and the average flexion of the distal interphalangeal joint was 67 degrees. Radiographs of the distal joint in 27 digits appeared normal, while in the remaining 6 digits, slight degenerative changes were noted. In one there was a minor surgical complication. By using the operative technique described, a congruous reduction of the inta-articular fracture and satisfactory function were achieved.
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keywords = operative
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5/101. The role of magnetic resonance imaging in late presentation of isolated injuries of the flexor digitorum profundus tendon in the finger.

    Four patients had magnetic resonance imaging (MRI) after a clinical diagnosis of a flexor digitorum profundus tendon rupture of the hand. The delay before presentation ranged from 1 to 5 weeks. Three patients had closed ruptures and one had a minor laceration which had healed. MRI showed proximal retraction of the profundus tendon to the palm in two patients and limited retraction in the other two. MRI provides important preoperative information for surgical decision-making and planning in patients who present late with closed flexor tendon injuries of the hand.
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ranking = 1
keywords = operative
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6/101. Fingertip reconstructions using partial-toe transfers.

    Fifty-six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo-onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo-onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes-Weinstein test) and 6.3 mm (moving two-point discrimination) at 2.6 years after the transfer; those of the thin osteo-onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery.
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keywords = operative
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7/101. 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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keywords = operative
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8/101. Salvage of ischemic digits using a lateral arm fascial flap.

    Four patients underwent microvascular transfer of a lateral arm fascial flap to salvage severely ischemic digits by means of induction of neovascularization. The cause of the digital ischemia was direct trauma (crush injury) in one patient and chronic embolic phenomena (proximal arterial occlusion) in three patients. None of the patients had responded to traditional therapy, including treatment with one or more of the following: anticoagulation, lytic therapy, oral vasodilators, digital sympathectomy, and vein bypass grafting. Each patient underwent noninvasive (Doppler ultrasound, digital pressures, digital temperatures, vascular refill) and invasive (angiogram) vascular assessment preoperatively. After microvascular transfer of the lateral arm fascial flap, all patients reported symptomatic relief, and objective improvements were documented by both noninvasive and invasive assessment criteria. One patient developed a seroma at the donor site; another experienced a late complication of thrombosis of the flap after his wound dehisced. A 6-month follow-up evaluation demonstrated neovascular collateralization and stable improvement without regression in the remaining patients. The authors present their clinical experience and propose a treatment algorithm for patients with chronic digital ischemia.
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ranking = 1
keywords = operative
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9/101. Microvascular free on-top plasty in a mutilated hand.

    amputation of the index, middle, and ring fingers leaves a poor, unstable pinch and grasp between the thumb and little finger. In this type of mutilated hand, it is necessary to reconstruct one or two fingers for firm chuck pinch and good grasp. Functionally and cosmetically, toe transfer is superior to other methods of finger reconstruction because of its mobility, sensibility, pulp size, and nail availability. However, a transfer from the foot may not always be available. In such a case, any finger stump may be considered as a possible donor finger. The authors performed a microvascular free transfer of the remaining portion of the ring finger including the metacarpophalangeal joint to the top of the remaining portion of the index finger in a mutilated hand with intact thumb and little finger because the patient declined toe transfer. Postoperatively, more effective strength and stability, provided by three converging digits, was achieved in the hand. Accordingly, it was easier for the patient to grip small and large objects. The authors describe this procedure as a microvascular free on-top plasty.
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ranking = 1
keywords = operative
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10/101. Clinical application of the reversed pedicled venous flap containing perivenous areolar tissue and/or nerve in the hand.

    A reversed pedicled venous flap containing perivenous areolar tissue and/or nerve was used to cover traumatic skin defects of seven fingers in six patients. The series consisted of six men, ranging in age from 20 to 57 years (average: 39 years). The reconstructed sites were four dorsal skin defects and three volar skin defects of the finger. The flap was designed on the dorsum of the hand, in such a way as to place a vein at the centre of the flap and not to involve the dorsal metacarpal artery. The flap contained a dorsal vein, perivenous areolar tissue and fascia of the interosseous muscle. Cutaneous nerves were present in three of the seven flaps. The pedicle of the flap was dissected distally to the finger web space and the flap was transferred to the skin defect. The size of the flap ranged from 1.4x4.5 cm to 6.0x7.0 cm. The average length of the pedicle was 1.6 cm. skin grafting was needed at the donor site in one case (flap size: 6.0x7.0 cm), but primary closure was possible in the remaining cases. Postoperatively, the largest flap showed superficial necrosis, although it survived. The remaining flaps survived completely. This suggests that in a large flap the skin should be attached to the pedicle to prevent congestion. The flap can be elevated without reference to the dorsal metacarpal artery at the ulnar side of the dorsum of the hand. The flap is an effective option to reconstruct skin defects of the finger, especially the little finger.
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keywords = operative
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