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Fingertip Amputation

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141. Innervated Digital Artery Perforator Flap. (Abstract)

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

142. No such thing as "just" a nail bed injury. (Abstract)

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

143. Diabetes Mellitus (DM)

plasters and tape, harsh chemicals, corn cures, water bottles, and electric pads should not be used on skin. Patients should change stockings daily and not wear constricting clothing (eg, garters, socks or stockings with tight elastic tops). Shoes should fit well, be wide-toed without open heels or toes, and be changed frequently. Special shoes should be prescribed to reduce trauma if the foot is deformed (eg, previous toe amputation, , ). Walking barefoot should be avoided. Patients with should avoid (...) weight bearing until ulcers heal. If they cannot, they should wear appropriate orthotic protection. Because most patients with these ulcers have little or no macrovascular occlusive disease, debridement and antibiotics frequently result in good healing and may prevent major surgery. After the ulcer has healed, appropriate inserts or special shoes should be prescribed. In refractory cases, especially if is present, surgical removal of the metatarsal head (the source of pressure) or amputation

2013 Merck Manual (19th Edition)

144. Options for Limb Prostheses

fingers. Lateral hand prosthesis A lateral hand prosthesis enables the user to manipulate a small object (eg, turning a key in a lock) because it has a thumb that opposes the side of the index finger. Hook prosthesis A hook prosthesis enables the user to carry objects with a handle. It allows for thumb and finger flexion. A myoelectric hook improves the line of sight for functional grasp. Spherical hand prosthesis A spherical prosthesis allows thumb and fingertip flexion. A user with this type (...) that allows dorsiflexion and plantarflexion of the foot. This design allows the whole foot to quickly contact the ground after the heel touches the ground and for the knee to straighten quickly. Because of these features, the prosthesis provides good stability for the knee, which is particularly important for people with above-the-knee amputation. Single-axis design prostheses are not appropriate for active people. Foot prosthesis with multiple-axis (multiaxial) design A foot prosthesis with multiaxial

2013 Merck Manual (19th Edition)

145. Evaluation and Care of the Normal Neonate

of the cranial bones at the sutures and some swelling and ecchymosis of the scalp ( ). In a , the head has less molding, with swelling and ecchymosis occurring in the presenting part (ie, buttocks, genitals, or feet). The fontanelles vary in diameter from a fingertip breadth to several centimeters. A large anterior fontanelle may be a sign of . A is a common finding; blood accumulates between the periosteum and the bone, producing a swelling that does not cross suture lines. It may occur over one or both (...) stimulation, is sometimes present but disappears over a few weeks. Ambiguous genitals (intersex) may indicate several uncommon disorders (eg, ; 5-alpha-reductase deficiency; , , or Swyer syndrome). Referral to an endocrinologist is indicated for evaluation as is a discussion with the family about benefits and risks of immediate vs delayed sex assignment. Musculoskeletal system The extremities are examined for deformities, amputations ( ), contractures, and maldevelopment. due to birth trauma may manifest

2013 Merck Manual (19th Edition)

146. Overview of Fractures, Dislocations, and Sprains

syndrome threatens limb viability (possibly requiring amputation) and survival. Infection: Any fracture can become infected, but risk is highest with those that are open or surgically treated. Acute infection can lead to , which can be difficult to cure. Long-term complications of fractures include the following: Instability: Various fractures can lead to joint instability. Instability can be disabling and increases the risk of . Stiffness and impaired range of motion: Fractures that extend into joints (...) suspected fractures require imaging. Some fractures are minor and are treated similarly to soft-tissue injuries. For example, most injuries of toes 2 through 5 and many fingertip injuries are treated symptomatically whether a fracture is present or not; thus, x-rays are not needed. In many patients with ankle sprains, the probability of finding a fracture that would require a change in treatment is acceptably low, so x-rays are not needed. For ankle sprains, generally accepted criteria for obtaining x

2013 Merck Manual (19th Edition)

147. Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai Zone I replantation. (Abstract)

of which was used for venous drainage. In this article, the authors report their experience with a similar technique and propose a new algorithm for distal finger replantation.From January of 2008 to February of 2009, five replantations were performed using a single central artery. The replanted levels were pulp, avulsed fingertip of the thumb, and distal phalanges. There was no volar vein, dorsal vein, or second artery available in the amputated part for standard venous drainage. Venous drainage

2010 Plastic and reconstructive surgery

148. Complications in the upper extremity following intra-arterial drug abuse. (Abstract)

by oedema, cyanosis and marbling of the skin. Treatments included brachial block anaesthesia, low molecular weight heparin, embolectomy and fasciotomies. Despite these measures, amputations, mainly of the fingertips, were necessary in 15 patients. Complications in the upper extremity after self-injection by drug addicts are increasing; information and preventive procedures to minimize these complications are important and demanding tasks for health care bodies.

2010 Journal of Hand Surgery - European

149. The Occlusive Dressing

amputations are very common injuries among the patients arriving at the Emergency Department. Fingertips amputations classified in 2nd and 3rd zones, in accordance with Rosenthal's classification (after the solum unguis), constitute a large proportion of them. The treatment aims at restoring a pulp with its sensitivity and a good subcutaneous fat tissue. The usual care of these amputations is a surgical treatment: it consists of pulp reconstruction by a flap (for example palmar V-Y advancement flaps (...) of Atazoy). These technique involve hospital admission, brachial plexus anaesthesia, a surgical approach with cicatrix and donor site morbidities, postoperative cares, post-surgical pain management. And of course attention must be paid to the risks of postoperative complications related either to anaesthesia and/or to surgery, like necrosis, infection, and others. We have developed a nonoperative treatment for fingertips amputations: the occlusive dressing. It's a technique that has been known for about

2009 Clinical Trials

150. The Gigogne flap: an original technique for an optimal pulp reconstruction. (Abstract)

may be chosen among the well-known flaps usually applied in pulp reconstruction. The second plasty, the Gigogne flap, is an advancement VY plasty done on the main cutaneous paddle of the first proximal flap. We performed 15 Gigogne flaps in 13 patients, who suffered zone II and III digital pulp amputations. The Gigogne flap increased the advancement capacity of the proximal flap as well as restoring the physiological pulp fatty pad, thus reconstructing a functional and aesthetic fingertip.

2009 Journal of Hand Surgery - European

151. Reducing Foot Complications for People with Diabetes

Complications for People with DiabetesSummary of Recommendations 11 Nursing Best Practice Guideline RECOMMENDATION *LEVEL OF EVIDENCE Practice 1.0 Physical examination of the feet to assess risk factors for foot ulceration/ Ib Recommendations amputation should be performed by a health care professional. 1.1 This examination should be performed at least annually in all people with IV diabetes over the age of 15 and at more frequent intervals for those at higher risk. 2.0 Nurses should conduct a foot risk (...) assessment for clients with known IV diabetes. This risk assessment includes the following: History of previous foot ulcers; Sensation; Structural and biomechanical abnormalities; Circulation; and Self-care behaviour and knowledge. 3.0 Based on assessment of risk factors, clients should be classified as “lower” IV or “higher” risk for foot ulceration/amputation. 4.0 All people with diabetes should receive basic foot care education. Ib 4.1 Foot care education should be provided to all clients

2004 Registered Nurses' Association of Ontario

153. Aerobic and Strengthening Exercise for Acute Leukemia

on a firm flat surface and tape is placed across it at a right angle to the 15 inch mark. The participant sits with the yardstick between the legs with legs extended at right angles to the taped line on the floor. The heels of the feet touch the edge of the taped line and are 10-12 inches apart. The participant reaches forward with both hands as far as possible, keeping the hands parallel. The best value for three trials, in centimeters, at the most distant point of the fingertips is recorded. Other (...) than 10 at diagnosis, white blood cell count less than 50,000 cells/microliter and receiving continuation/maintenance therapy based on the original disease classification In first remission Maintenance phase of therapy (Eligibility extends from Day 0 of maintenance therapy up to six months prior to the completion of therapy) Current age 5-10 years Modified Lansky performance scale must score 60 or higher at time of enrollment Written informed consent Exclusion Criteria: Lower extremity amputation

2008 Clinical Trials

154. The morbidity of the button-over-nail technique for zone 1 flexor tendon repairs. Should we still be using this technique? (Abstract)

directly related to the button-over-nail technique. Complications included nail deformities, fixed flexion deformities of the distal interphalangeal joint, infections and prolonged hypersensitivity. Two patients required amputation of the fingertip. We recommend that the button-over-nail technique should be avoided or used only with caution and with close attention to the details of the technique.

2008 Journal of Hand Surgery - European

155. Treatment of chronic digital ischemia with direct microsurgical revascularization. (Abstract)

Treatment of chronic digital ischemia with direct microsurgical revascularization. The authors present their technique for treating digital ischemia using a radial-to-digital artery bypass graft performed in a bloodless field under tourniquet with the use of a microscope. The outcomes in 6 patients were resolution of fingertip ulcers, avoidance of more proximal amputations, and elimination of ischemic pain.

2007 Journal of Hand Surgery - American

156. The Role of Splinting in Fingertip Injuries

insertions crush, avulsion, amputation, or penetrating injury to the fingertip isolated injury, within two weeks Exclusion Criteria: operative fixation required unable to participate in rehab Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its identifier (NCT number): NCT00580164 (...) The Role of Splinting in Fingertip Injuries The Role of Splinting in Fingertip Injuries - Full Text View - Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. The Role of Splinting in Fingertip Injuries The safety and scientific

2007 Clinical Trials

157. Reconstruction of circulation in the fingertip without vein repair in zone I replantation. (Abstract)

Reconstruction of circulation in the fingertip without vein repair in zone I replantation. In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery. We present a new technique for reconstructing circulation without (...) vein anastomosis in zone I replantation and analyze the outcomes of this technique in terms of eliminating external bleeding and of a high survival rate of the replanted digits.Between 1997 and 2007, we performed 120 replantations in 112 patients (83 male and 29 female; mean age, 33 years; range, 3-54 years). All were zone I amputations, based on the Tamai classification. We surgically repaired both proper digital arteries, excluded the vein, and then ligated 1 of the arteries. Using this technique

2008 Journal of Hand Surgery - American

158. Fingertip replantation. (Abstract)

Fingertip replantation. Fingertip replantation is now an established technique. Although successful replantation is an ideal method for treatment of fingertip amputation, various other methods still are widely used and may be functionally acceptable. The indications for replantation to treat fingertip amputation is still controversial. This article presents a global view of the current status of replantation for the treatment of fingertip amputation. The surgical technique, strategies

2007 Journal of Hand Surgery - American

159. Relationship between sensory recovery and advancement distance of oblique triangular flap for fingertip reconstruction. (Abstract)

Relationship between sensory recovery and advancement distance of oblique triangular flap for fingertip reconstruction. Oblique triangular flaps often need extensive advancement for fingertip coverage. The purpose of this report is to retrospectively investigate the relationship between sensory recovery and advancement distance of oblique triangular flaps.Fourteen consecutive fingertip amputations in 11 patients were treated with oblique triangular flaps between 2005 and 2006. These cases had (...) been regularly followed up (range, 14-21 months) until sensory recovery of the fingertip covered with the flap reached a plateau, and then final sensory condition was evaluated with the Semmes-Weinstein monofilament test and a moving 2-point discrimination test, in addition to evaluation of existence of dysesthesia.Dysesthesia existed in 7 fingers, and there was an associated a significant difference between a flap advancement distance of more than 12 mm and a flap advancement distance of less than

2008 Journal of Hand Surgery - American

160. Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature (Full text)

Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation (...) , such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including "pocket procedures" to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful "arterialization" of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted

2006 Hand (New York, N.Y.) PubMed abstract

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