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Fingertip Amputation

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121. Hand, Finger Nail and Tip Injuries

like or are contraindications to crossfinger and thenar flaps because of the risk for resultant joint stiffness. The mechanism of injury can influence availability of certain local flaps. A literature review by Sindhu et al indicated that in the United States, up to 90% of fingertip amputations are not treated with replantation, while in Asian countries, as a result of moral values and the importance of body integrity, most patients with fingertip amputations undergo replantation. [ ] Occupation (...) to regenerate soft tissues. The complications potentially encountered with the open technique include loss of volume and pulp. [ ] Primary Closure and Revision Amputation Many fingertip injuries can be closed primarily or by recruiting adjacent soft tissues. Viability of the remaining soft tissues must be ascertained before application of a tourniquet. Occasionally, the fillet flap principle can be applied in reconstructing these wounds. Occasionally, bone shortening or revision amputation is required

2014 eMedicine Surgery

122. Hand Infections

, epitrochlear and/or axillary lymphadenopathy may be present. Beta-hemolytic streptococci and S aureus are the usual pathogens. Felon A is an infection of the soft tissues at the volar pad of the terminal phalanx. [ ] The soft tissue of the fingertips is divided into multiple compartments by vertical fibrous septa extending from the dermis to the distal phalanx. Infections in this area thus mimic a compartment-like syndrome. A hot, red digital pulp implies the presence of pus and should be drained even (...) of irrigation and debridement procedures, patient comorbidities, and postoperative infection following nonjoint surgery. A higher risk for arthrodesis and amputation was noted in subjects who had more than 3 irrigation and debridement procedures. [ ] Osteomyelitis Like septic arthritis, of the bones of the hand can result from local extension of other hand infections, or it may be caused by hematogenous spread from a distant site. Most occurrences result from local extension. Staphylococci and streptococci

2014 eMedicine Surgery

123. Replantation (Treatment)

PM. Preoperative management of the amputated limb. Emerg Med J . 2005 Jul. 22(7):478-80. . Maricevich M, Carisen B, Mardini S, Moran S. Upper extremity and digital replantation. Hand (NY) . December 2011. 6(4):356-63. . Chai Y, Kang Q, Yang Q, Zeng B. Replantation of amputated finger composite tissues with microvascular anastomosis. Microsurgery . 2008. 28(5):314-20. . Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg (...) == processing > Replantation in Emergency Medicine Treatment & Management Updated: Sep 12, 2017 Author: Mark I Langdorf, MD, FAAEM, FACEP, MHPE, RDMS; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Replantation in Emergency Medicine Treatment Prehospital Care At the scene, collect and preserve all amputated parts, even those crushed and not thought to be useful. Parts not suitable for replantation can provide tendons or bone. Cool the amputated part to 4°C to preserve

2014 eMedicine Emergency Medicine

124. Nerve Entrapment Syndromes (Treatment)

AND TREATMENT OF POSTERIOR INTEROSSEOUS NERVE ENTRAPMENT: SYSTEMATIC REVIEW. Acta Ortop Bras . 2017 Jan-Feb. 25 (1):52-54. . Clavert P, Thomazeau H. Peri-articular suprascapular neuropathy. Orthop Traumatol Surg Res . 2014 Dec. 100 (8 Suppl):S409-11. . Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am . 1977 Jan. 2(1):44-53. . Wilson KE, Tat J, Keir PJ. Effects of Wrist Posture and Fingertip Force on Median Nerve Blood Flow Velocity. Biomed Res Int . 2017. 2017:7156489 (...) . . American Academy of Orthopaedic Surgeons. MANAGEMENT OF CARPAL TUNNEL SYNDROME EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE. American Academy of Orthopaedic Surgeons. 2016 feb 29; Accessed: September 21, 2017. Moriarty JM, Bandyk DF, Broderick DF, Cornelius RS, Dill KE, Francois CJ, et al. ACR Appropriateness Criteria Imaging in the Diagnosis of Thoracic Outlet Syndrome. J Am Coll Radiol . 2015 May. 12 (5):438-43. . . Dellon AL. Neurosurgical prevention of ulceration and amputation by decompression

2014 eMedicine Surgery

125. Replantation (Treatment)

> Replantation Treatment & Management Updated: Nov 08, 2018 Author: L Andrew Koman, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Replantation Treatment Medical Therapy Appropriate antibiotics and wound care are indicated to prevent infection. Next: Preoperative Details Amputated parts should be stored dampened with isotonic sodium chloride solution or Ringer's lactate in a cooled environment (on ice within a cooler or in a refrigerator). Contact with a saline ice (...) and the use of heparin-soaked pledgets to allow controlled bleeding. Late complications include loss of motion from joint stiffness and tendon adhesions. Fusions, tenolysis, or both may be required. In addition, nonunions are common because distal fragments may be avascular. Previous Next: Outcome and Prognosis The outcome and prognosis are variable. [ , ] Thumbs have the best prognosis, [ ] as do digits amputated distal to the insertion of the flexor digitorum superficialis. [ , , , ] Survival of digits

2014 eMedicine Surgery

126. Nail Pathology (Treatment)

of mind" technique. The parents should be informed that the composite tip graft either survives or dies with this technique. Convert to a full-thickness skin graft to treat the composite fingertip amputation in adults and in children older than 10 years. The tissue is defatted to the level of the dermis, and the nail bed is preserved. The distal phalanx is shortened just below the remaining pulp soft tissue, and the full-thickness graft is applied and held with a stent dressing. The tip pulp (...) obtained vascularity. Again, the judicious use of sterile matrix grafts or germinal matrix grafts offers the best reconstructive results. Hook-nail deformity A hook-nail deformity is usually the result of a fingertip amputation, with partial or complete loss of the supporting tuft of the distal phalanx and a loss of the distal nail bed and fingertip soft tissue. The regenerating nail plate follows the contour of the repaired fingertip amputation, angling in a dorsal to volar direction. Amputated

2014 eMedicine Surgery

127. Arteriovenous Fistulas (Overview)

is a term reserved for a singular communication between an artery and a vein that usually has an acquired etiology. The first recorded case of an arteriovenous malformation (AVM) was in the late 16th century. In 1757, Hunter described an AVF as an abnormal communication between an artery and a vein. Krause in 1862 used injection studies of an amputated specimen to characterize the abnormal vasculature. In 1875, Nicoladoni described the reflex slowing of the pulse following occlusion of an artery (...) , Szajner M. Endovascular Treatment of Renal Arteriovenous Fistula with N-Butyl Cyanoacrylate (NBCA). Pol J Radiol . 2017. 82:304-306. . . Media Gallery Buttock port-wine stain. Lower extremity venous malformation. Upper extremity arteriovenous malformation (AVM). Hypertrophied subclavian artery resulting from low-resistance high-volume flow through an upper extremity arteriovenous malformation (AVM). Hand angiogram demonstrating arteriovenous connections. Note the steal of blood from the fingertips

2014 eMedicine Surgery

128. High-Pressure Injection Injuries (Overview)

that HPI injuries to the hand are relatively common, given the widespread use of pressure machinery. Previous Next: Prognosis HPI injuries often manifest as innocuous lesions on the fingertip of a patient's nondominant hand. Depending on the substance involved, these injuries may follow a benign clinical course (for air and clean water) or may be deceptively destructive and lead to soft-tissue necrosis and amputation (for grease and paint). Proper triage and management of HPI injuries of the hand (...) , leading to high amputation rates. [ , ] Grease has been shown to be associated with oleogranulomata formation (a reaction to foreign bodies), fistula formation, fibrosis, and poor functional outcomes. [ , , ] Joint contractures and ankylosis are also seen. [ ] Previous Next: Etiology Common substances involved in HPI injuries include the following [ , , ] : Grease (accounting for 57% of injuries, at pressures of up to 5000-10,000 psi) Paint (up to 5000 psi; see the images below) Diesel fuel

2014 eMedicine Surgery

129. Nerve Entrapment Syndromes (Overview)

: SYSTEMATIC REVIEW. Acta Ortop Bras . 2017 Jan-Feb. 25 (1):52-54. . Clavert P, Thomazeau H. Peri-articular suprascapular neuropathy. Orthop Traumatol Surg Res . 2014 Dec. 100 (8 Suppl):S409-11. . Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am . 1977 Jan. 2(1):44-53. . Wilson KE, Tat J, Keir PJ. Effects of Wrist Posture and Fingertip Force on Median Nerve Blood Flow Velocity. Biomed Res Int . 2017. 2017:7156489. . Ball C, Pearse M, Kennedy D, Hall A, Nanchahal J (...) EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE. American Academy of Orthopaedic Surgeons. 2016 feb 29; Accessed: September 21, 2017. Moriarty JM, Bandyk DF, Broderick DF, Cornelius RS, Dill KE, Francois CJ, et al. ACR Appropriateness Criteria Imaging in the Diagnosis of Thoracic Outlet Syndrome. J Am Coll Radiol . 2015 May. 12 (5):438-43. . . Dellon AL. Neurosurgical prevention of ulceration and amputation by decompression of lower extremity peripheral nerves in diabetic neuropathy: update 2006. Acta

2014 eMedicine Surgery

130. Nail Pathology (Overview)

of mind" technique. The parents should be informed that the composite tip graft either survives or dies with this technique. Convert to a full-thickness skin graft to treat the composite fingertip amputation in adults and in children older than 10 years. The tissue is defatted to the level of the dermis, and the nail bed is preserved. The distal phalanx is shortened just below the remaining pulp soft tissue, and the full-thickness graft is applied and held with a stent dressing. The tip pulp (...) obtained vascularity. Again, the judicious use of sterile matrix grafts or germinal matrix grafts offers the best reconstructive results. Hook-nail deformity A hook-nail deformity is usually the result of a fingertip amputation, with partial or complete loss of the supporting tuft of the distal phalanx and a loss of the distal nail bed and fingertip soft tissue. The regenerating nail plate follows the contour of the repaired fingertip amputation, angling in a dorsal to volar direction. Amputated

2014 eMedicine Surgery

131. Arteriovenous Fistulas (Treatment)

are not surgically resectable. Those patients severely afflicted with malformations who are not candidates for local extirpation may be candidates for amputation and rehabilitation with a limb prosthesis. In contrast to congenital AVMs, which are difficult to treat, almost all acquired arteriovenous fistulas (AVFs) are amenable to either surgical or interventional treatment. Occlusion of the feeding vessel with coils can be done. If the AVF is between a medium-sized or large artery and a vein, then occlusion (...) artery resulting from low-resistance high-volume flow through an upper extremity arteriovenous malformation (AVM). Hand angiogram demonstrating arteriovenous connections. Note the steal of blood from the fingertips. of 5 Tables Contributor Information and Disclosures Author Sateesh C Babu, MD Professor of Clinical Surgery, New York Medical College; Chief, Vascular and Endovascular Surgery, Westchester Medical Center Sateesh C Babu, MD is a member of the following medical societies

2014 eMedicine Surgery

132. Nail Pathology (Follow-up)

of mind" technique. The parents should be informed that the composite tip graft either survives or dies with this technique. Convert to a full-thickness skin graft to treat the composite fingertip amputation in adults and in children older than 10 years. The tissue is defatted to the level of the dermis, and the nail bed is preserved. The distal phalanx is shortened just below the remaining pulp soft tissue, and the full-thickness graft is applied and held with a stent dressing. The tip pulp (...) obtained vascularity. Again, the judicious use of sterile matrix grafts or germinal matrix grafts offers the best reconstructive results. Hook-nail deformity A hook-nail deformity is usually the result of a fingertip amputation, with partial or complete loss of the supporting tuft of the distal phalanx and a loss of the distal nail bed and fingertip soft tissue. The regenerating nail plate follows the contour of the repaired fingertip amputation, angling in a dorsal to volar direction. Amputated

2014 eMedicine Surgery

133. Iatrogenic Vascular Lesions: Surgical Perspective (Follow-up)

department with signs of irreversible ischemia and extensive necrosis. Neonate boy with a high supracondilear left lower limb amputation secondary to thrombosis of the femoral artery while having an arterial line in place. Patient came to our department with signs of irreversible ischemia and extensive necrosis. Distal right foot ischemia with fingertips gangrene in a newborn babygirl with a central venous catheter in ther right femoral vein, which after multiple canulation atempts with accidental (...) the quality of limb salvage, preventing late amputation due to poor limb function. On the other hand, distal shunts have poor patency and do not improve limb salvage. [ ] (See the image below.) Neonate boy with a high supracondilear left lower limb amputation secondary to thrombosis of the femoral artery while having an arterial line in place. Patient came to our department with signs of irreversible ischemia and extensive necrosis. For carotid artery lesions, ligation of the distal internal carotid

2014 eMedicine Pediatrics

134. Replantation (Overview)

of amputated digits has gradually moved from fantasy to reality. William Balfour performed the first successful fingertip reattachment in 1814; Thomas Hunter is credited with the first thumb replantation performed in the following year. Little progress was made until the pioneering work of William Steward Halstead and Alexis Carrel, who performed replantation experiments with dog limbs in the 1880s. Dr Carrel won the Nobel Prize in 1912 for his work on vascular anastomoses and for pioneering renal (...) Plast Reconstr Aesthet Surg . 2008 Dec. 61(12):e19-22. . Ihrai T, Balaguer T, Monteil MC, et al. [Surgical management of traumatic ear amputations: literature review]. Ann Chir Plast Esthet . 2009 Apr. 54(2):146-51. . Salah MM, Khalid KN. Replantation of multiple digits and hand amputations: four case reports. Cases J . 2008 Oct 23. 1(1):266. . Dec W. A meta-analysis of success rates for digit replantation. Tech Hand Up Extrem Surg . 2006 Sep. 10(3):124-9. . Li J, Guo Z, Zhu Q, et al. Fingertip

2014 eMedicine Emergency Medicine

135. Distal digital replantation. (PubMed)

replantation. They describe specific techniques and considerations for surgical repair in each of four distal zones as described by Sebastin and Chung.Zone 1A replantation involves an artery-only anastomosis of a longitudinal pulp artery. Venous anastomosis first becomes possible in zone 1B. Zone 1C involves periarticular amputations where arthrodesis of the distal interphalangeal joint is usually indicated. Repair of the artery, vein, and nerve is technically optimal in zone 1D, where venous anastomosis (...) should be performed. Overall, survival rates for distal digital replantation are similar to those reported for more proximal replantation. The literature reports good outcomes regarding nail salvage, fingertip sensibility, and range of motion, with restoration of length and aesthetic appearance.Distal replantation performed at institutions that specialize in microsurgery and specifically tailored to the level of injury is associated with good survival, function, and patient satisfaction and superior

2013 Plastic and reconstructive surgery

136. Program director opinions of core competencies in hand surgery training: analysis of differences between plastic and orthopedic surgery accredited programs. (PubMed)

the groups, followed by pedicled and free tissue transfer, and amputation and fingertip injuries.Despite being united under the subspecialty of hand surgery, program directors tend to emphasize clinical areas that are stressed in their respective primary disciplines. These differences promote the advantage of programs that provide exposure to both plastic surgery-trained and orthopedic surgery-trained hand surgeons.

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2013 Plastic and reconstructive surgery

137. Actinobacillus equuli ssp. haemolyticus in a semi-occlusively treated horse bite wound in a 2-year-old girl (PubMed)

Actinobacillus equuli ssp. haemolyticus in a semi-occlusively treated horse bite wound in a 2-year-old girl We report on the isolation of Actinobacillus equuli ssp. haemolyticus from wound smears of a 2-year-old girl who was admitted to the hospital due to partial amputation of the distal phalanx of her right middle finger caused by a horse bite. A. equuli typically causes diseases in horses and only very few reports describing human infections (mostly associated with wounds) are available (...) in the literature. Interestingly, although the bacteria could be found in consecutive samples taken at different points in time, there were no signs of advancing infection or inflammation. Moreover, the fingertip regenerated after 74 days under semi-occlusive dressings with very pleasant results. For strain identification two automated systems were employed producing discrepant results: VITEK 2 described the pathogens as Pasteurella pneumotropica while MALDI-TOF MS analysis revealed A. equuli. Sequence analysis

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2013 GMS German Medical Science

138. No such thing as "just" a nail bed injury. (PubMed)

staff. The case of a 6-year-old boy with a flexor sheath infection and devitalized fingertip 1 week after injury is presented. Emphasis is placed on the soft tissue and underlying bony injury that was overlooked at initial presentation, and how this led to serious infection requiring amputation. Thorough assessment of these common injuries and a high index of suspicion are essential.

2012 Pediatric Emergency Care

139. Innervated Digital Artery Perforator Flap. (PubMed)

experienced mild cold intolerance, and 1 patient exhibited mild postoperative hypersensitivity.The advantages of the IDAP flap include minimally invasive surgery; a reliable, versatile flap; and the ease of the technique for different-sized fingertip defect reconstructions with few complications. The IDAP flap may be useful in fingertip amputations when the amputated part is not suitable for replantation.Therapeutic IV.Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc (...) Innervated Digital Artery Perforator Flap. To describe a technique for covering defects of the fingertips: the innervated digital artery perforator (IDAP) flap.A total of 17 patients were treated with an IDAP flap. The size of the flaps varied between 2 ×1 cm and 3.5 × 2 cm. Postoperative evaluation of the patients consisted of the Semmes-Weinstein Monofilament test, static 2-point discrimination, patient satisfaction, extension loss, and an investigation into complications.All IDAP flaps

2012 Journal of Hand Surgery - American

140. Assessment of Three Instruments for the Non-invasive Measurement of Arterial Stiffness.

the sensor for the ASI Device is located on the fingertip. Validation is a prerequisite for obtaining Health Canada approval of devices for diagnostic purposes. The ASI Device has not been tested against other instruments capable of providing similar measurements. Therefore, a clinical trial to compare the ASI Device against similar devices is necessary. The study will compare measurements of arterial stiffness and other central haemodynamic parameters obtained with the ASI Device against similar (...) treatment; Cigarette/cigar smoking, current or within the last 6 months; Current (within the last 30 days) bacterial, viral or fungal infection; Taking any prescribed medication (with the exception of birth control or HRT) within the last 3 months or over-the-counter medication within the past 72 h; Pregnancy; Amputation or malformation of any limb or extremity (fingers, leg, or arm) which would impede the placement of sensors, probes, or blood pressure cuffs. Participants of the Obese/Type 2 Diabetes

2012 Clinical Trials

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