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Fingertip Amputation

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61. Artery-only fingertip replantations using a controlled nailbed bleeding protocol. (Abstract)

Artery-only fingertip replantations using a controlled nailbed bleeding protocol. We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair.We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint (...) of the fingers or interphalangeal joint of the thumb. Patients with incomplete and complete amputations who had undergone vein and/or nerve repair along with artery repair were excluded. All patients received the same protocol including removal of the nail at the surgery and intravenous heparin 70 U/kg administered at the time of arterial anastomosis. After surgery, the nailbed was mechanically made to bleed with a sterile needle and mechanically scrubbed with a heparin-saline gauze. All patients received

2013 Journal of Hand Surgery - American

62. Fingertip replantation at the eponychial level with venous anastomosis: an anatomic study and clinical application. (Abstract)

Fingertip replantation at the eponychial level with venous anastomosis: an anatomic study and clinical application. We present an anatomic study of the vein distribution at the eponychial level, in order to standardize outpatient fingertip replantation. The cross sectional anatomy of 100 fingers was studied by dissection following dye injection. The distribution of the veins >0.3 mm was recorded on a pie-chart. Thirty fingers in 27 patients with fingertip amputations at the eponychial level (...) were replanted by anastomosis of the palmar subcutaneous veins, to reconstruct the venous reflux of the amputated digits. The operations were aided by the anatomical study and confirmed that the palmar area is the preferred site for venous anastomosis Following a distal finger amputation at the level of the eponychial fold we propose starting the search for veins between the 3 to 5 o'clock or 7 to 9 o'clock positions, as these are the areas where there are most likely to be suitable veins.

2013 Journal of Hand Surgery - European

63. Modification of VY flap to preserve fingertip contour Full Text available with Trip Pro

Modification of VY flap to preserve fingertip contour VY flap is a reliable treatment for fingertip amputation injuries. Insetting the flap to replicate fingertip contour can be challenging with the conventional method of using sutures. We propose a modification of inset technique with K-wire to simplify contouring during flap inset.Seven patients underwent VY flap reconstruction with the modified inset technique for fingertip defects ranging from 10 × 15 to 20 × 15 mm. The flaps were advanced (...) between 6 and 10 mm and inset with K-wires. The donor site is allowed to heal by secondary intention. At 6 months, static two-point discrimination, sensitivity, and flap appearance were assessed.All flaps healed uneventfully, and each patient returned to work between 8 and 10 weeks. Fingertip and nail contour were satisfactory in every case.This modification simplified contouring during flap inset and provided a viable alternative to flap inset and contour adjustment.

2012 Hand (New York, N.Y.)

64. Lessons for adult fingertip regeneration: glimpses from basic research. (Abstract)

population. The impressive regeneration of amputated salamander limbs has been shown to work through an evolutionarily divergent mechanism and may not be open to direct translational approaches in mammals. In addition, researchers are beginning to understand the complexity of the interrelated mechanisms of axis determinants in chick embryo limb development. In this article, we review lessons to be learned from these divergent experiments, to understand fingertip regeneration in humans.Copyright © 2012 (...) Lessons for adult fingertip regeneration: glimpses from basic research. Understanding the mechanisms involved in limb and finger regeneration holds promise for improving current treatment therapies. Recent animal studies have improved our understanding of the limb regeneration process markedly. Improved sophistication in experimentation has allowed results that partly reveal the cells of origin in fingertip regeneration in mouse models, which implicates a tissue-resident progenitor cell

2012 Journal of Hand Surgery - American

65. A modification of the Souquet advancement flap in fingertip reconstruction. (Abstract)

A modification of the Souquet advancement flap in fingertip reconstruction. The Hueston local transposition flap and Souquet advancement flap are two commonly employed options in fingertip reconstruction after amputation. Both are rectangular flaps rotated so that the free edge advances to cover the defect in the fingertip. They differ in that the Hueston flap does not include the neurovascular bundle in the free edge, while the Souquet flap does include the bundle. In consequence, the Hueston

2012 Journal of Hand Surgery - European

66. Transplantation of fingertips. Full Text available with Trip Pro

Transplantation of fingertips. 4933302 1971 08 20 2018 11 13 0003-4932 173 5 1971 May Annals of surgery Ann. Surg. Transplantation of fingertips. 812-26 Peacock E E EE Jr Madden J W JW Trier W C WC eng Journal Article United States Ann Surg 0372354 0003-4932 AIM IM Amputation surgery Finger Injuries surgery Fingers blood supply innervation physiology transplantation Humans Ischemia Methods Postoperative Complications Retrospective Studies Skin Transplantation Surgery, Plastic Transplantation

1971 Annals of Surgery

67. Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations Full Text available with Trip Pro

Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twenty (...) -one fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied

2011 Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India

68. Revascularization of complete and incomplete distal finger amputations in children below 2 years of age: a report of three cases. (Abstract)

Revascularization of complete and incomplete distal finger amputations in children below 2 years of age: a report of three cases. Three cases of fingertip amputation at the level between the distal phalanx and the nail base in children below 2 years of age were treated by replantation or revascularization. The injury was complete in two, and incomplete in one. All three fingerstips survived with artery anastomosis without the need for a blood transfusion. In two venous anastomosis failed (...) and venous drainage was achieved by 3-hourly pinprick. Survival of an amputated finger can be expected in cases where venous reconstruction is not possible, provided that there is adequate venous drainage.

2011 Journal of Hand Surgery - European

69. Making the V-Y advancement flap safer in fingertip amputations Full Text available with Trip Pro

Making the V-Y advancement flap safer in fingertip amputations Amputation of the fingertip is a common injury of the upper extremity. Over the years, a variety of reconstructive techniques have been described. For dorsal oblique and transverse amputations, the Atasoy V-Y advancement flap is a popular choice because it preserves finger length, sensation and function. However, closure under tension remains a problem, putting the flap at risk of partial or full necrosis. To avoid this untoward

2010 The Canadian Journal of Plastic Surgery

70. Composite Grafting for Traumatic Fingertip Amputation in Adults: Technique Reinforcement and Experience in 31 Digits. Full Text available with Trip Pro

Composite Grafting for Traumatic Fingertip Amputation in Adults: Technique Reinforcement and Experience in 31 Digits. Composite grafting is used to treat nonreplantable fingertip amputations. This procedure has a high success rate and good results in treating fingertip amputations in children, but a lower success rate in adults.From July 2007 to December 2008, 27 patients with 31 injured fingertips were admitted because of traumatic fingertip amputation at the emergency department of Tri (...) -Service General Hospital, National Defense Medical Center, Taipei, Taiwan. All 31 injured fingers had a nonreplantable distal amputated fingertip and underwent composite grafting. We refined the surgical technique by excising the bony segment, defatting, deepithelialization, tie-over suturing, and finger splinting to increase the graft survival. The patients' age, mechanism of damage, lesion size, surgical result, and postoperative complications were recorded.The mean age of the patients was 40.5

2010 Journal of Trauma

71. Raynaud's phenomenon

of fingertip/finger raised painful red lesions on finger tips auto-amputation female FHx connective tissue disease vibration injury Buerger's disease prolonged cold exposure/frostbite colder climate smoking ischaemia migraine glaucoma Diagnostic investigations clinical diagnosis ANA FBC ESR creatinine urinalysis Treatment algorithm ACUTE ONGOING Contributors Authors Professor of Medicine Division of Rheumatology Department of Medicine University of Western Ontario Schulich School of Medicine and Dentistry

2018 BMJ Best Practice

73. Adult Type 1 diabetes mellitus

of a national clinical guideline will provide the diabetes multidisciplinary team, patients and the HSE with a framework that will ensure that adults with type 1 diabetes have equitable access to high quality care, thus improving patient’s outcomes and reducing diabetes complications. 2.2 Clinical and financial impact of type 1 diabetes The complications of type 1 diabetes can result in disability: including vision loss, kidney failure and foot ulceration leading to amputation, as well as premature heart

2018 National Clinical Guidelines (Ireland)

74. Physiologic Predictors of Severe Injury: Systematic Review

decisions can be made based on observable characteristics of the injury (e.g., a crush injury or amputation), but other injuries require additional assessment. Triage guidelines and protocols include the assessment of circulatory and respiratory compromise as essential components of the triage process to identify high-risk trauma patients and inform transport destination decisions. In the current guidelines, 5 field triage of injured patients consists of four steps designed to identify different levels

2018 Effective Health Care Program (AHRQ)

75. National Clinical Guideline on Adult type 1 diabetes mellitus

ulceration leading to amputation, as well as premature heart disease and stroke. The morbidity associated with these complications can have a devastating impact on quality of life and generate a significant cost to the state. A systematic review and meta-analysis which included studies with people living with type 1 diabetes in Ireland showed the prevalence of diabetes complications ranged widely depending on study population and methodology used (6.5–25.2 % retinopathy; 3.2–32.0 % neuropathy; 2.5-5.2

2018 HIQA Guidelines

76. Type 1 diabetes in adults: diagnosis and management

that normally make insulin. Loss of insulin secretion results in high blood glucose and other metabolic and haematological abnormalities, which have both short-term and long-term adverse effects on health. Over years, type 1 diabetes causes tissue damage which, if not detected and managed early, can result in disability: blindness, kidney failure and foot ulceration leading to amputation, as well as premature heart disease, stroke and death. The risk of all of these complications is greatly reduced (...) . Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 24 of 871.6.19 Support adults with type 1 diabetes to make the best use of data from self-monitoring of blood glucose through structured education (see recommendations 1.3.1 and 1.3.2). [new 2015] [new 2015] Sites for self-monitoring of blood glucose Sites for self-monitoring of blood glucose 1.6.20 Monitoring blood glucose using sites other than the fingertips cannot be recommended as a routine

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

77. CRACKCast E087 – Peripheral Arteriovascular Disease

urgently CT angiography or ultrasound usually prolong the limb’s ischemic time! Start IV heparin immediately! If thrombotic disease = the in-situ thrombosis needs aggressive thrombectomy with bypass grafting, amputation, or revascularization with intra-arterial tPA or heparinization In patients whom you can’t differentiate between the two – angiography usually helps! For people without these limb-threatening features, we still want to determine if it is an embolus or an in-situ thrombosis Emboli (...) – male 20-40 years old, who smokes tobacco Unknown pathogenesis Often spreads from artery inflammation to inflammation of the veins/nerves Clinical syndrome/criteria Foot claudication, hand claudication, fingertip/toe ulcers, Raynaud-type cold response plus 1) History of smoking 2) Onset before age 50 3) Infrapopliteal arterial occlusive lesions 4) Upper limb involvement / phlebitis migrans 5) Absence of atherosclerotic risk factors other than smoking Management Stop smoking cigarettes! If they don’t

2017 CandiEM

78. CRACKCast E050 – Orthopedics – Hand Injuries

-160 days If the nail bed isn’t properly repaired accurately granulation tissue will impede smooth nail growth Fingertip amputations Zone I: proximal ⅔ of the nail bed is preserved, no bony involvement Zone II: exposed bone Zone III: entire nailbed is lost Important: maintain thumb length in any way possible: Refer these to a hand surgeon, don’t rongeur or trim tissue. Index is the next most important digit – want to be able to preserve pulp-to-pulp pinch if possible Consider age, occupation (...) points of touch “Accuracy and objectivity is questioned; limited value in children, calloused fingers, distracted injuries, altered mental status” Skin wrinkle test is probably more accurate Fingertips: 5mm max (“5 fingers”) Base of palm: 10mm max Dorsum: 12mm max Motor testing – test nerves, important tendons, look for deformity Ulnar n. (passes through Guyon’s canal) Test function – finger abduction, MCP flexion Palsy – main en griffe (clawhand) Median n. Test function – thumb opposition to index

2016 CandiEM

79. Acral vascular necrosis associated with immune-check point inhibitors: case report with literature review. Full Text available with Trip Pro

developed sudden onset numbness and discoloration of fingertips bilaterally at week 25 after initiation of ICI treatment. Extensive workup to rule out hypercoagulable, autoimmune and vascular disease was unremarkable except for mild elevation of ANA and ESR. The symptoms quickly progressed into dry gangrene within four weeks and did not respond to medical or surgical treatment. Pembrolizumab was subsequently discontinued due to progression of metastatic disease. The patient refused further interventions (...) and transitioned to hospice care where she expired after two months.Acral ischemia can develop during treatment of malignancies. This complication, although uncommon, canresult in digital amputation. Physicians should be aware of the possible progression of acral vascular necrosis when Raynaud's like symptoms develop. Larger studies are needed to confirm the role of ICIs in the pathogenesis of acral vascular necrosis.

2019 BMC Cancer

80. Cross-finger subdermal pocketplasty as a salvage procedure for thumb tip replantation without vascular anastomosis: a case report Full Text available with Trip Pro

Cross-finger subdermal pocketplasty as a salvage procedure for thumb tip replantation without vascular anastomosis: a case report Objectives Fingertip amputation is often encountered in emergency departments, especially in hospitals located near industrial areas. Replantation of the fingertip can be considered when the normal architecture is preserved in cases of sharp amputation. The goal of replantation is to preserve cosmesis and function, especially for the thumb because of its involvement (...) in grasping and the key pinch. Even when microsurgical vascular anastomosis is applied, the absence of venous anastomosis along with the high rate of failure of arterial anastomosis in zone 1A fingertip amputation may lead to replantation failure. Methods We herein present a case report of thumb tip amputation salvaged via a modified cross-finger technique. The recipient site was on the ipsilateral radial side of the intermediate phalanx of the middle finger. Results The thumb tip was successfully

2018 The Journal of international medical research

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