Digital Replantation in Industrial Punch Injuries

PURPOSE: Industrial punch accidents involving fingers cause segmental injuries to tendons and neurovascular bundles. Although multiple-level segmental amputations are not replanted to regain function, most patients with an amputated finger want to undergo replantation for cosmetic as much as functional reason. The authors describe four cases of digital amputation by an industrial punch that involved the reinstatement of the amputated finger involving a joint and neurovascular bundle. Amputated segments were replanted to restore amputated surfaces and distal segments. METHODS: A single institution retrospective review was performed. Inclusion criteria of punch injuries requiring replantation were applied to patients of all demographic background. Injury extent (size, tissue involvement), operative intervention, pre- and postoperative hand function were recorded. RESULT: Four cases of amputations were treated at our institute from 2004 to 2008 from industrial punch machine injury. Average patient age was 32.5 years (25~39 years) and there were three males and one female. Sizes of amputated segments ranged from 1.0x1.0x1.2 cm3 to 3x1.5x1.6 cm3. Tenorrhaphy was conducted after fixing fractured bone of the amputated segments with K-wire. Proximal and distal arteries and veins were repaired using the through & through method. The average follow-up period was thirteen months (2~26 months), and all replanted cases survived. Osteomyelitis occurred in one case, skin grafting after debridement was performed in two cases. Because joints were damaged in all four cases, active ranges of motion were much limited. However, a secondary tendon graft enhanced digit function in two cases. The two-point discrimination test showed normal values for both static and dynamic tests for three cases and 9 mm and 15 mm by dynamic and static testing, respectively, in one case. CONCLUSION: Though amputations from industrial punch machines are technically challenging to replant, our experience has shown it to be a valid therapy. In cases involving punch machine injury, if an amputated segment is available, the authors recommend that replantation be considered for preservation of finger length, joint mobility, and overall functional recovery of the hand.

Loop Suture Technique for Flexor Digitorum Profundus Tendon Repair in the Insertion Site

PURPOSE: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. METHODS: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the follow-up. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. RESULTS: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. CONCLUSION: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.

A Case of Pulmonary Cryptococcosis in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Pulmonary cryptococcosis is a non-infectious opportunistic or silent infection caused by Cryptococcus neoformans. It enters the body through the respiratory tract and spreads to lung, skin, liver, and lymphoid organs. Recently its incidence has been gradually increasing because of developing diagnostic tools, increased use of steroids and immunosuppressive drugs, increased survival rate of patients with chronic diseases, and increased incidence of immunodeficiency syndrome. We report a case of pulmonary cryptococcosis in a patient with rheumatoid arthritis who was being treated with low dose glucocorticoid, methotrexate and cyclosporine for 14 months.

A case of eosinophilic panniculitis diagnosed in the lower extremity skin lesions with tenderness / 천식및알레르기

Eosinophilic panniculitis is characterized by prominent infiltration of eosinophils in the subcutaneous fat. Clinically it may be considered as a reactive process because most patients have an associated systemic condition. We report a case of tender subcutaneous nodules and plaques with erythema on the lower legs in a 30-year-old man with blood eosinophilia. The histologic features were characterized by massive eosinophilic infiltration in the septae and lobule in the parenchymal area of subcutaneous tissues. Despite exhaustive investigation, no obvious trigger of the panniculitis could be identified. The cutaneous lesions regressed and the eosinophil count became normal during the seven days course of treatment with intravenous corticosteroid. Another flare-up occurred about one month after treatment. The patient is presently being treated with prolonged use of alternate-day steroid without recurrence.

A case of Churg-Strauss syndrome associated with zafirlukast / 천식및알레르기

Churg-Strauss syndrome (CSS) is an eosinophil associated disease, characterized by vaculitis and granulomatosis on small vessel, asthma and eosinophil tissue infiltration. Several cases of CSS have been reported in patients treated with cysteinyl leukotriene receptor antagonist and weaned-off systemic or inhaled corticosteroids. A 39-year-old man with a history of childhood allergic rhinitis was diagnosed with bronchial asthma and his symptoms were well controlled with fluticasone propinate, salmeterol and zafirlukast. However four months later, he was admitted again with prominent skin lesions, tingling sensation on both extremities and fever. We diagnosed CSS with a history of sinusitis and bronchial asthma, marked peripheral eosinophilia, vasculitis and neuropathy. His symptoms and laboratory findings promptly improved after ten days of intravenous corticosteroid and cessation of zafirlukast without recurrence for six months during the follow-up period. We conclude that zafirlukast may cause CSS and attention should be taken when using zafirlukast.