Asunto(s)
Acrodermatitis , Corticoesteroides/administración & dosificación , Artralgia , Articulaciones de los Dedos , Falanges de los Dedos de la Mano , Metotrexato/administración & dosificación , Acrodermatitis/sangre , Acrodermatitis/diagnóstico , Acrodermatitis/tratamiento farmacológico , Acrodermatitis/fisiopatología , Antirreumáticos/administración & dosificación , Artralgia/diagnóstico , Artralgia/etiología , Artritis Psoriásica/diagnóstico , Diagnóstico Diferencial , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Falanges de los Dedos de la Mano/irrigación sanguínea , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/patología , Dermatosis de la Mano/sangre , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Dermatosis de la Mano/fisiopatología , Humanos , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/etiología , Imagen de Perfusión/métodos , Radiografía/métodos , Resultado del Tratamiento , Ultrasonografía Doppler/métodos , Adulto JovenRESUMEN
The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.
Asunto(s)
Amputación Quirúrgica/métodos , Arteriopatías Oclusivas/cirugía , Síndrome CREST/complicaciones , Falanges de los Dedos de la Mano/cirugía , Animales , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Femenino , Falanges de los Dedos de la Mano/irrigación sanguínea , Humanos , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Arteria RadialRESUMEN
BACKGROUND: Replantation of amputated fingertips is a technical challenge, as many salvage procedures fail because no suitable vein in the fingertip is available for anastomosis. In this study, we examined our experience in fingertip replantation in cases without venous anastomosis with our established fingertip replantation treatment protocol. METHODS: Between August 2002 and August 2010, a retrospective study examined all patients who had undergone fingertip replantation at Chang-Gung Memorial Hospital. All the patients (n = 24) suffered from complete digital amputations at or distal to the interphalangeal joint of the thumb, or distal to distal interphalangeal joint of the fingers. A total of 30 fingertips that were salvaged by microsurgical anastomosis of the digital arteries but not of digital veins were included in this study. On satisfactory arterial anastomosis, a 2-mm incision was made over the fingertip with a number 11 Scalpel blade, and 0.1 to 0.2 mL heparin (5000 IU/mL) was injected subcutaneously around the incision immediately and once per day thereafter to ensure continuous blood drainage from the replanted fingertip. None of the replanted nail plate was removed, and no medical leeches were used. The perfusion of the replanted digits and patient's hemoglobin level were closely monitored. The wound bleeding was maintained until physiologic venous outflow was restored. RESULTS: Of 30 fingertips, 27 (90%) replanted fingertips survived. The average length needed for maintaining external bleeding by chemical leech was 6.8 days (range, 5-10 days). Twelve patients (including a 2-year-old child) received blood transfusions. The average amount of blood transfusion in the 23 adults was 4.0 units (range, 0-16 units) for each patient or 3.29 units (range, 0-14 units) for each digit. A 2-year-old child received 100 mL blood transfusion or 50 mL for each digit. CONCLUSIONS: This study showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high success rates in fingertip replantation. The protocol is safe and reliable, as it avoids the use of medical leeches and the removal of nail plate from the replanted finger. However, full informed patient consent must include the potential need for transfusion and extended hospital stay.
Asunto(s)
Amputación Traumática/cirugía , Traumatismos de los Dedos/cirugía , Falanges de los Dedos de la Mano/irrigación sanguínea , Reimplantación/normas , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica , Transfusión Sanguínea , Niño , Preescolar , Femenino , Falanges de los Dedos de la Mano/cirugía , Humanos , Recuperación del Miembro/métodos , Recuperación del Miembro/normas , Masculino , Microcirugia/métodos , Microcirugia/normas , Persona de Mediana Edad , Reimplantación/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
We report on a four-year-old girl who suffered a complex mincer injury to the left hand, resulting in a partial amputation of her hand. To salvage the injured hand, revascularization was performed. The indication, advantages and outcome of the procedure are discussed.
Asunto(s)
Falanges de los Dedos de la Mano/irrigación sanguínea , Traumatismos de la Mano/cirugía , Traumatismo Múltiple , Reimplantación/métodos , Preescolar , Femenino , Falanges de los Dedos de la Mano/fisiopatología , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Rango del Movimiento ArticularRESUMEN
SUMMARY: We report on a patient with an infected nonunion of the left little-finger phalanges following a gunshot injury. The defect was treated by transplanting a partial fifth metacarpus, vascularised by the fourth dorsal metacarpal vessels. Bone union was obtained 6 months after surgery and no signs of infection were found at the site of the nonunion. Although the range of the interphalangeal joints of the finger was limited, the patient was satisfied because the preserved little finger had a metacarpophalangeal (MP) joint with unrestricted motion.
Asunto(s)
Trasplante Óseo/métodos , Falanges de los Dedos de la Mano/lesiones , Fracturas Óseas/cirugía , Metacarpo/trasplante , Heridas por Arma de Fuego/cirugía , Falanges de los Dedos de la Mano/irrigación sanguínea , Falanges de los Dedos de la Mano/cirugía , Fracturas Óseas/etiología , Humanos , Masculino , Metacarpo/irrigación sanguínea , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Traumatismos de los Dedos/cirugía , Falanges de los Dedos de la Mano/lesiones , Dedos/cirugía , Cuerpos Extraños/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Enfermedad Crónica , Circulación Colateral/fisiología , Femenino , Traumatismos de los Dedos/diagnóstico por imagen , Falanges de los Dedos de la Mano/irrigación sanguínea , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/cirugía , Dedos/irrigación sanguínea , Dedos/diagnóstico por imagen , Cuerpos Extraños/diagnóstico por imagen , Deformidades Adquiridas de la Mano/diagnóstico por imagen , Humanos , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Traumatismos de los Tejidos Blandos/diagnóstico por imagenRESUMEN
In this case report, the use of middle phalanx of index finger for reconstruction bone defect of the first metacarpal is described. The reasons for this kind of usage and 1-year follow-up of the patient are discussed. During the follow-up, a pseudoarthrosis was observed in the repaired first ray. And this may be considered as a useful complication, when there is stiffness in the carpometacarpal joint. It may be a result of a stiff joint or vice versa.