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Fingertip Amputation

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81. Harnessing Neuroplasticity to Enhance Functional Recovery During Chronic Recovery From Upper Extremity Nerve Repair

Volunteers: No Criteria Inclusion Criteria: Individuals whom have received a unilateral allogeneic transplantation proximal to the wrist and are at the chronic stage of recovery (approx. 12 - 18 months following surgery, when Tinel's sign reaches the distal fingertips). Individuals whom have undergone a complete amputation the hand between the wrist and elbow followed by successful re-attachment and are at the chronic stage of recovery (approx. 12 - 18 months following surgery, when Tinel's sign reaches (...) within the brain's sensory and motor systems. The current approach to rehabilitation of function in allogeneic hand transplant recipients is largely the same as standard-of-care following hand replantation (re-attachment) and peripheral nerve repairs. This involves an eclectic combination of traditional therapies. In seeking to improve on this approach, there is potentially much to be gained by considering evidence that limb amputation not only impacts the peripheral nervous system but also the brain

2018 Clinical Trials

82. Digit Tip Regeneration: Merging Regeneration Biology with Regenerative Medicine Full Text available with Trip Pro

Digit Tip Regeneration: Merging Regeneration Biology with Regenerative Medicine Regeneration Biology is the study of organisms with endogenous regenerative abilities, whereas Regenerative Medicine focuses on engineering solutions for human injuries that do not regenerate. While the two fields are fundamentally different in their approach, there is an obvious interface involving mammalian regeneration models. The fingertip is the only part of the human limb that is regeneration-competent (...) and the regenerating mouse digit tip has emerged as a model to study a clinically relevant regenerative response. In this article, we discuss how studies of digit tip regeneration have identified critical components of the regenerative response, and how an understanding of endogenous regeneration can lead to expanding the regenerative capabilities of nonregenerative amputation wounds. Such studies demonstrate that regeneration-incompetent wounds can respond to treatment with individual morphogenetic agents

2018 Stem cells translational medicine

83. Autologous Adipose Tissue in the Treatment of Systemic Sclerosis Digital Ulcers

of digital ulcers (DUs) on the fingertips.The healing of DUs is often a lengthy process requiring accurate and intensive topical and systemic treatment. Nevertheless, in a significant number of cases this therapeutic approach is ineffective and distal necrosis with subsequent tissue loss or phalangeal amputation may eventually occur. In a recent open pilot study performed by Del Papa et al., it has been demonstrated that autologous adipose tissue grafting (AT-G), which is known to contain both adipose (...) -derived stem cells and a stromal/vascular fraction, was effective in inducing prompt healing of long lasting DUs localized in the fingertips of a small number of patients with SSc. The DU healing was accompanied by the rapid disappearance of local ischemic pain and evidence of a partial restoration of the capillary bed in the digits when assessed by nailfold videocapillaroscopy (NVC). With the purpose of confirming these preliminary results, the investigators have designed a monocentric randomized

2018 Clinical Trials

84. Paraneoplastic acral vascular syndrome in a patient with metastatic melanoma under immune checkpoint blockade. Full Text available with Trip Pro

) was started. Three weeks after the first combination therapy he developed progressive erythema, paraesthesia and pain on the fingertips of both hands. Both cold and warmth was not well tolerated by the patient. Complete work-up excluded associated conditions or factors such as haematological disorders, rheumatologic disorders, hypertension, diabetes or smoking. Treatment was initiated with prostacyclin 20 μg twice daily and oral prednisolone 50 mg in tapering dosage. However, prostacyclin was stopped (...) . About 2 months after the second course of nivolumab and ipilimumab combination therapy several fingers showed severe gangrene which finally led to amputations of end phalanges of several fingers. Histopathology did not reveal evidence for vasculitis or other primary vascular pathologies. During the following 2 months the patient experienced dramatic progress of his metastatic disease and finally died at multi-organ failure.Presence of rapidly progressive digital ischemia in an elderly patient

2017 BMC Cancer

85. Multiple venous anastomoses decrease the need for intensive postoperative management in tamai zone I replantations Full Text available with Trip Pro

patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups.The (...) review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017).The number of venous anastomoses

2017 Archives of plastic surgery

86. Silicone Finger Cap ("Silikonfingerling")

Universität Dresden Information provided by (Responsible Party): Orthopädie- und Rehatechnik Dresden GmbH Study Details Study Description Go to Brief Summary: Amputation injuries of the fingertip are common in all ages. For decades it is known that conservatively treated fingertips can regenerate skin and soft tissues to form a functionally and cosmetically excellent new fingertip. Unfortunately, little is known about the mechanisms controlling this ability that, in humans, is confined to the fingertips (...) . Even less is known about the bacteria that regularly colonize these wounds without noticeable negative impact on regeneration and healing. Medical evidence on fingertip regeneration in humans is largely limited to retrospective studies and case reports. This study will be the first randomized controlled trial on the conservative treatment of fingertip amputations in children and adults. When managed without surgery, self-adhesive polyurethane film dressings are commonly used to establish a wet

2017 Clinical Trials

87. Finger Tip Injury

Tip Injury , Fingertip Injury , Finger Tip Injury Dressing From Related Chapters II. Types: Injuries s and Amputations s Nail Injuries Ligament and Tendon injuries ( ) ( , ) ( ) Infections III. Management: Non-adherent Dressing Technique Apply to a strip of petrolatum gauze ( , gauze) Wrap the non-adherent gauze around the Finger Tip Injury Cover with a 2x2 plain gauze pad Apply tube gauze over the finger and secured at the base of the finger or hand After-care Dressing may remain in place for up

2018 FP Notebook

88. Neuromimetic Event-Based Detection for Closed-Loop Tactile Feedback Control of Upper Limb Prostheses Full Text available with Trip Pro

Neuromimetic Event-Based Detection for Closed-Loop Tactile Feedback Control of Upper Limb Prostheses Upper limb amputees lack the valuable tactile sensing that helps provide context about the surrounding environment. Here we utilize tactile information to provide active touch feedback to a prosthetic hand. First, we developed fingertip tactile sensors for producing biomimetic spiking responses for monitoring contact, release, and slip of an object grasped by a prosthetic hand. We convert (...) to a prosthesis. Results from able-bodied and amputee subjects show the average number of objects that broke or slipped during grasping decreased by over 50% and the average time to complete a grasping task decreased by at least 10% for most trials when comparing neuromimetic tactile feedback with no feedback on a prosthesis. Our neuromimetic method of closed-loop tactile sensing is a novel approach to improving the function of upper limb prostheses.

2016 IEEE transactions on haptics

89. Functional Outcome Measures With Vibrotactile Feedback to Prostheses

by (Responsible Party): Isabella Shvartz, Hadassah Medical Organization Study Details Study Description Go to Brief Summary: Investigators wish to evaluate the effects of adding VTF to upper limb prostheses on functional outcome measures of upper limb prosthetic users. Condition or disease Intervention/treatment Phase Unilateral Transradial Amputation Device: Vibrotactile feedback system Not Applicable Detailed Description: Investigators will perform three experiments: Investigators will add vibrotactile (...) , to use it at their natural surroundings for a week, and study the reported activity and satisfaction levels. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 10 participants Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: The Effects of Adding Vibrotactile Feedback to Prostheses on Functional Outcome Measures of Transradial Amputation Prosthetic Users Study Start

2016 Clinical Trials

90. Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap. (Abstract)

Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap. To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer.Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance

2015 Journal of Hand Surgery - American

91. Phantom pain in a patient with brachial plexus avulsion injury. Full Text available with Trip Pro

Phantom pain in a patient with brachial plexus avulsion injury. Phantom limb pain is a painful sensation perceived in the absent limb following surgical or traumatic amputation. Phantom limb sensations, which are nonpainful, occur in nearly all amputees. Deafferentation can also produce similar symptoms. Here we report the presence of phantom pain in a deafferented limb.Case report.Hospital-based outpatient clinic.A 65-year-old man was referred to the pain clinic for management of upper (...) extremity pain secondary to brachial plexus avulsion (BPA) following a motor vehicle accident. Initially he noticed a feeling of growing and shrinking of his arm. Following this, the pain started gradually from his elbow extending to his fingertips covering all dermatomes. He described the pain as continuous, severe, and sharp. He also described the arm as being separate from his existing insensate arm and felt as though the fist was closed with the thumb pointing out. On physical examination, he had

2015 Pain Medicine

92. Use of the Mechanical Leech for Successful Zone I Replantation Full Text available with Trip Pro

Use of the Mechanical Leech for Successful Zone I Replantation Replantation of zone I finger injuries remains a challenge, particularly if the fingertip was previously scarred or atrophied, which makes it difficult to secure a suitable vein at the amputation site. In cases of artery-only anastomosis, we propose using a mechanical leech technique to maintain sufficient venous outflow until the internal circulation regenerates. We applied this procedure to eight patients who had zone 1 (...) amputations without veins that were suitable for anastomosis. Emergent surgery was performed and an artery-only anastomosis was created. As there were no veins available, we cut a branch of the central artery and anastomosed it with a 24-gauge angioneedle, which served as a conduit for venous drainage. The overall survival rate for zone I replantation using mechanical leech was 87.5% and the average time to maintain the mechanical leech was 5 days. The mechanical leech technique may serve

2014 The Scientific World Journal

93. CSL Behring Sclero XIII

Study Description Go to Brief Summary: Many patients with Scleroderma (Systemic sclerosis) experience damage to blood vessels, mainly to the small arteries. A common manifestation of this is Raynaud's phenomenon (fingers or toes turning white then blue in the cold) and digital ulcers (open sores on the fingertips). The purpose of this study is to see how effective the study drug Human Factor XIII Concentrate is in treating patients who have these and other common manifestation of Scleroderma (...) for digital ulcers Digital ulcer worsening: surgical intervention required [ Time Frame: 24 weeks ] Number of additional surgical treatments for digital ulcer in outpatient clinic Digital ulcer worsening: Digital ulcer infection [ Time Frame: 24 weeks ] Number of digital ulcers with infections Digital ulcer worsening: Gangrene [ Time Frame: 24 weeks ] Number of episodes of gangrene Digital ulcer worsening: Amputation [ Time Frame: 24 weeks ] Number of amputations Digital ulcer worsening: Need of local

2014 Clinical Trials

94. Pediatric thenar flaps: a modified design, case series and review of the literature. (Abstract)

proximal interphalangeal joint (PIPJ) ROM was 103° (95°-110°) [normal maximum: 110°] in flexion, and an average 60° distal interphalangeal (DIPJ) ROM (55°-65°) [normal maximum: 65°] in flexion. Objective sensibility in the flap was ascertained as an average static two-point discrimination of 7mm (6mm-10mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications.The thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring (...) Pediatric thenar flaps: a modified design, case series and review of the literature. Fingertip injuries are extremely common in children, and severe trauma with pulp loss requires soft-tissue reconstruction to restore length, bulk, and sensibility. The thenar flap is a well-described technique but there are few reports of its use in pediatric patients.Pediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution.Sixteen pediatric

2014 Journal of Pediatric Surgery

95. Oblique Triangular Neurovascular Osteocutaneous Flap for Hook Nail Deformity Correction. (Abstract)

Oblique Triangular Neurovascular Osteocutaneous Flap for Hook Nail Deformity Correction. Hook nail deformity results in aesthetic and functional problems after fingertip amputations. Previously described techniques do not correct the osseous defect, which may be the principle cause of the problem. We present a surgical technique based on a compound homodigital advancement flap combining bone of the distal phalanx, finger pulp, and skin. We describe this technique, report a case, and discuss

2014 Journal of Hand Surgery - American

96. A Comparison of Complications in 400 Patients After Native Nail Versus Silicone Nail Splints for Fingernail Splinting After Injuries. Full Text available with Trip Pro

A Comparison of Complications in 400 Patients After Native Nail Versus Silicone Nail Splints for Fingernail Splinting After Injuries. The fingertip is the most commonly injured part of the hand and is an important aesthetic part of the hand.In this retrospective study we analyzed data from 700 patients operated on between 1997 and 2008 for complications after nail splinting with native nail or silicone nail. Inclusion criteria were patients living in Bern/Berner Land, complete documentation (...) hundred forty native nails and 161 silicone splints were used. There were 344 compression injuries, 44 amputations, and 13 avulsion injuries. Forty-three patients had an infection, with gram-positive bacteria (Staphylococcus aureus) causing most infections. A total of 157 nail dystrophies were observed, split nails most often. The native nail splint group showed significantly (p < 0.015) fewer nail deformities than the silicone nail splint group; otherwise, there were no statistical differences

2014 World Journal of Surgery

97. Nail Surgery (Diagnosis)

Onumah, MD; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Nail Surgery Overview Background The nail complex is the structural and functional unit of the nail. The nail consists of the plate; bed; matrix; proximal, lateral, and distal grooves; proximal and lateral folds; and hyponychium (see the image below). [ , , ] Aside from being aesthetically appealing, the healthy nail unit has the important function of protecting the distal phalanges, fingertips (...) the nail plate. [ , , ] Most commonly, the tumors are localized to the hand with involvement of the fingertips and the subungual region. Ultrasonography can be used to identify and locate the tumors. The onset of intense pulsating pain with the slightest pressure or with exposure to cold temperatures is pathognomonic for subungual glomus tumors. Microscopically, all the components in a glomus body are present in this tumor; the components are an afferent arteriole, an efferent venule, glomus cells


98. CREST Syndrome (Treatment)

Surgical excision of localized painful large deposits can relieve symptoms; recurrence is rare. Saddic et al report a case of painful fingertip calcinosis treated with surgical debridement. [ ] If calcinosis is diffuse, recurrence is more common. Overzealous debridement to remove all calcinosis is apt to compromise digital viability and should be avoided. [ ] Successful palliation and significant remission of calcinosis using a carbon dioxide laser has been shown in 2 case reports with a total of 7 (...) patients. [ , ] Surgical procedures may require extensive planning in patients with limited skin mobility. [ ] Raynaud phenomenon Cervical sympathectomy is less beneficial for scleroderma patients than for patients with Raynaud phenomenon secondary to peripheral vascular disease. Newer surgical approaches include digital sympathectomy, with or without revision of surgically correctable vascular disease. In the event of nonhealing digital ulcers, amputation, unfortunately, sometimes is unavoidable


99. Nail Surgery (Treatment)

flap formed from amputation of the distal half of the terminal phalanx is sutured dorsally over the defect created from the excision of the nail bed and the nail matrix for primary wound closure. [ ] Radical matricectomy has a success rate of almost 100%, with low postoperative morbidity, despite the poor cosmetic and functional outcome. [ ] Soft tissue resection for ingrown nails is performed in cases of lateral nail wall hypertrophy. This procedure spares the nail matrix and the nail plate, which


100. Scleroderma (Treatment)

delivery. Certain medications, such as D-penicillamine, mycophenolate mofetil, cytotoxic agents, and angiotensin-converting enzyme (ACE) inhibitors, should be discontinued prior to pregnancy Previous Next: Surgical Care Digital sympathectomy and botulinum toxin injections may be used in patients with severe Raynaud phenomenon who have an unrelenting acute attack and who are threatened by digital loss. Many ulcers require management by a wound care specialist. Debridement or amputation may be required (...) . . Boutry N, Hachulla E, Zanetti-Musielak C, Morel M, Demondion X, Cotten A. Imaging features of musculoskeletal involvement in systemic sclerosis. Eur Radiol . 2007 May. 17(5):1172-80. . Cutolo M, Sulli A, Smith V. How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol . 2013 Apr. 27(2):237-48. . Sulli A, Ruaro B, Alessandri E, Pizzorni C, Cimmino MA, Zampogna G. Correlations between nailfold microangiopathy severity, finger dermal thickness and fingertip blood perfusion in systemic


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