Spitzoid melanoma of the finger: a case report.

BACKGROUND: Melanoma is the most malignant skin tumor, with a high metastatic potential. Spitzoid melanoma is a subtype of melanoma requiring rapid management and extensive tumor resection. We have set the goal to recognize anatomical peculiarities and difficulties diagnoses posed by this type of tumor, as well as to recognize the management modalities, especially the surgical one, of malignant spitzoid melanoma. CASE PRESENTATION: A 25-year-old Tunisian male patient had consulted for nodular lesion of the right index, evolving for 4 years. A malignant tumor was strongly suspected, then confirmed as a melanoma by a biopsy excision. Initially, the excision was incomplete in depth, suggesting a complementary surgery, but the patient refused it; 3 years later, the patient again consulted after the appearance of an axillary lymphadenopathy and worsening of the skin lesion. A supplement of tumor removal with lymph node biopsy were performed. It was decided to perform an amputation of the second ray and the first commissure with cheiroplasty, reconstructing a four-finger hand. An homolateral axillary cleaning was performed at the same time. The postoperative result is considered esthetically and functionally satisfying. The evolution was marked by the appearance of pulmonary metastases, requiring adjuvant chemotherapy. A regression of the nodule under the mammary skin and total disappearance of axillary nodes have been marked; but the patient's condition rapidly deteriorated, and he died after a 2-month decline. CONCLUSION: Spitzoid melanoma is exceptional, posing difficulties in diagnostics, and it should not be underestimated, considering that it may involve the vital prognosis. Knowledge of this rare form of melanoma is important to avoid misdiagnosis, which delays diagnosis and subsequent therapy.

[Surgical treatment of polydactyly]. / Chirurgische behandeling van polydactylie.

This clinical lesson addresses the treatment options for polydactyly, emphasizing the lack of consensus in the Netherlands regarding the timing and method of intervention. The study aims to provide evidence-based recommendations for the management of post-axial polydactyly type B. Two cases are presented, each illustrating different approaches to surgical intervention for post-axial polydactyly type B in a 1-year-old boy (Patient A) and a newborn girl (Patient B). Patient A undergoes surgical removal of an extra digit under general anesthesia after waiting for a year, while Patient B undergoes prompt surgical removal under local anesthesia. Both procedures are successful with no complications, demonstrating positive outcomes for early surgical intervention under local anesthesia. The study advocates for revising outdated national guidelines, recommending surgical removal under local anesthesia within the first three months after birth for post-axial polydactyly type B. Delaying intervention increases stress, risks, and costs without apparent benefits. This clinical lesson calls for optimizing care for children with post-axial polydactyly type B through guideline updates.

Rehabilitation after replantation of a non-work-related finger amputation without vascular anastosmosis - case report.

Work in agriculture carries the risk of trauma as a result of mechanization (farm equipment and machinery), location of cultivated areas, and multi-functionality. In agriculture, the hands were the most affected parts of the body which sustained injury. Successful suturing of a finger initially disqualified from replantation is rare. The case is presented of a 55-year-old patient who had a non-work-related finger amputation. In a surgical centre not belonging to the reference ones in plastic surgery in Poland, a doctor with six months of surgical experience performed the replantation without vascular reconstruction (the amputated distal part of the finger served as a biological dressing). Despite the lack of vascular reconstruction and unfavourable prognosis, the amputated fragment of the finger maintained a partial blood supply. Subsequent flap surgery in the plastic surgery department, and rehabilitation of the patient due to finger contracture, led to functional recovery of the finger.

Artificial dermal repair for larger finger pulp defects: Satisfactory coverage with limitations in sensation and inevitable scar formation.

BACKGROUND: This prospective study aimed to evaluate the outcomes of the use of dermal templates for lengthy volar soft tissue defects (1.5-4 cm) in the fingers. METHODS: The volar soft tissue defects of 15 patients (19 fingers) were treated with Lando dermal template coverage between June 2022 and November 2022. We evaluated sensory recovery, scar formation, and overall appearance of the repair site at an average of 13 months (range, 12-17 months) of follow-up. RESULTS: The defect healed in all cases. We found an average static 2-point discrimination of 7 mm (range 4 to 14 mm). Scar formation was evident in all cases. The repair did not restore the bulkiness of the volar finger, especially in the finger with the bony exposure. Nail deformities and joint contracture were observed in some cases. CONCLUSION: Dermal template repair does not restore normal sensation and inevitably leads to scar formation when the defect is longer (>1.5 cm). Bulkiness of the volar finger is not restored in most patients, especially when there was bone or tendon exposure in the initial wound site.

Vascularized posterior interosseous nerve graft for digital neurovascular bundle reconstruction.

INTRODUCTION: Despite the progress in microsurgery in recent decades, neurovascular bundle defects during ring finger injuries still pose challenges for the surgeon. Usually, a reversed venous graft and a non-vascularized nerve graft are utilized to reconstruct this defect. One of the most common challenges encountered when using a venous graft is the caliber mismatch between the graft and the digital arterial ends. The use of an arterialized nerve graft (neurovascular graft) is poorly described and could represent an attractive reconstructive option. CASE PRESENTATION: We present the case of a 36-year-old manual worker, a non-smoker, with no significant medical or surgical comorbidities, who presented a ring avulsion type trauma, leading to the amputation of the third left finger at the distal interphalangeal joint and avulsion of the circumferential skin at the level of the middle and proximal phalanges (Urbaniak III). The patient presented a neurovascular bundle defect of 3 cm, reconstructed by the vascularized posterior interosseous nerve graft along the distal perforator of the dorsal branch of the anterior interosseous artery serving both as an interpositional arterial conduit and as a nerve graft. The results of postoperative nerve regeneration at three years are satisfactory, with the patient demonstrating a two-point discrimination measured at 6 mm. CONCLUSION: Simultaneous digital artery and nerve reconstruction using a neurovascular flap is very appealing to the hand surgeon as it offers several advantages over traditional methods, particularly the ideal diameter match between the digital arteries and the distal perforator of the dorsal branch of the anterior interosseous artery.

[Anatomical cartography of the radial nerve at the elbow level for intraradial nerve transfers for finger extension reconstruction in spastic upper limb - A cadaveric study]. / Cartographie anatomique du nerf radial dans la région du coude pour son application aux transferts nerveux intraradiaux dans la chirurgie de la spasticité.

INTRODUCTION: Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection. MATERIAL AND METHOD: Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture). RESULTS: BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases. CONCLUSION: BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible. LEVEL: IV, feasibility study.

An extremely rare case of absent extensor digitorum communis of the right index finger.

The hand is a unique structure in human body performing complex activities of daily life making it prone to injuries. While operating on zone VI extensor tendon injury, a surprising entity was observed. The extensor digitorum to the right index finger was absent. This is an extremely rare entity in the literature. Also, all previous studies on the extensor digitorum are cadaveric. Our findings are first of its kind intraoperative, incidental, and confirmed on MRI. Thus, it becomes a case report of special worth mentioning in literature.

Trichorhinophalangeal Syndrome Orthopaedic Manifestations and Management: A Systematic Review.

Trichorhinophalangeal syndrome (TRPS) is an autosomal dominant genetic malformation disorder which is best characterized by both its craniofacial and skeletal abnormalities. The purpose of this paper is to identify the various orthopedic manifestations and management in patients with TRPS. A systematic search of PubMed, Ovid MEDLINE, and Cochrane Library was conducted. They were each individually searched for primary articles yielding information on the orthopedic manifestations and management of patients with TRPS. The goals and results of each of the included studies were described. Data regarding the demographics, orthopedic condition, treatment strategy, and outcomes were extracted and analyzed. 221 unique articles were retrieved, with 13 articles being included in the study. 26 patients with TRPS were identified. Trials of conservative management were reported for 14 patients, and surgical intervention was pursued for 8 patients. The mean age for surgery was 14.1 years. The most common orthopedic manifestations of TRPS are clinodactyly, Perthes-like changes, and coxa magna. Early identification and maintenance of TRPS is important for being able to monitor musculoskeletal health of the patients in order to prevent detrimental outcomes. Additional high-quality research is required regarding the orthopedic manifestations and treatment of this patient population.

Extensor Carpi Radialis Brevis Tendon Transfer for Thumb and Finger Flexion Reconstruction after Failed Extensor Carpi Radialis Brevis Motor Branch Transfer in a Tetraplegic Patient.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).

Measurement and observation of the first web space based on morphology and clinical applications.

PURPOSE: To describe and evaluate the anatomical skin shape of the first web space in cadavers and to guide flap design for this area. METHODS: Twelve cadavers (24 hands on both sides) were selected. Marker points were chosen based on the characteristics of the first web for morphological measurement and observation. The morphological characteristics of the first web under the radial or palmar abduction position of the thumb were measured and compared. The best morphologic features and parameters of the first web repairing flap were obtained. RESULTS: When the thumb was in the palmar abduction position, the maximum distance a(p) was 6.78 ± 0.72 cm and the skin area s(p) was 20.09 ± 2.63 cm2, both of which were significantly greater than the distance a(r) of 5.86 ± 0.74 cm and the skin area s(r) of 17.39 ± 2.15 cm2 when the thumb was in the radial abduction position (P < 0.05). There was no significant difference in the length b(r) and b(p) of the long axis of the flap between two different abduction positions (P > 0.05). It is found that the shape of the first web area was not a symmetrical spindle but an irregular quadrilateral inclined to the index finger side. CONCLUSION: The flap design and measurement for the first web space covering should take the maximum palmar abduction position of the thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and morphological characteristics of the region.

A Prospective Study of Contracture of the Finger and its Management in a Tertiary Care Center.

BACKGROUND: When the range of motion between two finger segments, both active and passive, is restricted, finger contracture occurs. The aim of this study is to investigate the best procedure to eliminate finger contracture and the functional and esthetic results of the different surgical procedures. MATERIALS AND METHODS: A total of 31 patients with soft-tissue abnormalities of the hand were included in this prospective study. They underwent either contracture removal with K-wire and skin grafts or various flap procedures in the department of plastic surgery. Complaints of stiffness and discomfort were classified into five categories: none, mild, moderate, marked, and severe. The difficulty a person had in picking up objects, grasping, writing, etc., was used to determine the degree of disability. Absenteeism from work and surgical site infections were also recorded. RESULTS: The mean age was 20.25 years, with a mean age of 23.05 for men and 15.83 for women. Overall, most cases occurred in the age range of 3-10 years. For K-wire surgery with skin grafting, the typical time off work was 24 days. The average recovery time ranged from 15.2 days for skin grafts to 16.9 days for tenolysis, 28.33 days for groyne flaps, and 41 days for abdominal flaps. Of all cases, 12 (38.00%) had a fair result, 10 (31.04%) had a moderate result, and 9 (30.96%) had an excellent result. CONCLUSION: The most feasible method for treating these situations, which offers the greatest potential for a functional and cosmetic result, is contracture reduction with skin grafting.

Résumé Contexte:Lorsque l'amplitude de mouvement entre deux segments de doigts, actifs et passifs, est restreinte, une contracture des doigts se produit. Le Le but de cette étude est d'étudier la meilleure procédure pour éliminer la contracture des doigts et les résultats fonctionnels et esthétiques des différents interventions chirurgicales.Matériels et méthodes:Au total, 31 patients présentant des anomalies des tissus mous de la main ont été inclus dans cette étude prospective. étude. Ils ont subi soit une ablation des contractures avec du fil K et des greffes de peau, soit diverses procédures de lambeau dans le service de chirurgie plastique. Les plaintes de raideur et d'inconfort ont été classées en cinq catégories: aucune, légère, modérée, marquée et grave. La difficulté d'une personne qu'ils avaient à ramasser des objets, à les saisir, à écrire, etc., a été utilisé pour déterminer le degré d'incapacité. Absentéisme au travail et sur le site chirurgical des infections ont également été enregistrées.Résultats:L'âge moyen était de 20,25 ans, avec un âge moyen de 23,05 ans pour les hommes et de 15,83 ans pour les femmes. Dans l'ensemble, la plupart des cas sont survenus dans la tranche d'âge de 3 à 10 ans. Pour la chirurgie au fil K avec greffe de peau, le temps d'arrêt typique était de 24 jours. La moyenne le temps de récupération variait de 15,2 jours pour les greffes de peau à 16,9 jours pour la ténolyse, 28,33 jours pour les lambeaux d'épi et 41 jours pour les lambeaux abdominaux. Parmi tous les cas, 12 (38,00 %) ont eu un résultat passable, 10 (31,04 %) ont eu un résultat modéré et 9 (30,96 %) ont eu un excellent résultat.Conclusion:le plus La méthode réalisable pour traiter ces situations, qui offre le plus grand potentiel de résultat fonctionnel et esthétique, est la réduction des contractures. avec greffe de peau.

Congenital Flexor Contracture of Ulnar Digits Masquerading as Volkmann Ischemic Contracture.

ABSTRACT: Congenital flexion contracture of ulnar digits is a rare entity with few cases reported in medical literature. This condition is often misdiagnosed as Volkmann ischemic contracture as both have similar presentation. The patient history, physical examination, radiological investigation, and intra-operative findings can differentiate these 2 conditions clearly. A 14-year-old female presented to a tertiary care hospital with flexion deformity of the left long, ring, and little fingers without neurological deficit since she was 3 years old. Patient had decreased handspan with difficulty in grasping daily life objects. Finger flexion deformity was also not aesthetically acceptable due to social stigma. Patient finger contracture was managed with flexor pronator slide (Max-Page) operation. The muscle slide operation was done using concealed medial incision. Aesthetic and functional correction was achieved with no recurrence at subsequent follow-ups.

Needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (Hand-2): study protocol for a randomised controlled trial.

BACKGROUND: Dupuytren's contractures (DC) are fibrous cords under the skin of the hand that cause one or more fingers to curl gradually and irreversibly towards the palm. These contractures are usually painless but can cause a loss of hand function. Two treatments for Dupuytren's contractures are widely used within the National Health Service (NHS) in the UK: removal of the contractures via surgery (limited fasciectomy) and division of the contractures via a needle inserted through the skin (needle fasciotomy). This study aims to establish the clinical and cost-effectiveness of needle fasciotomy (NF) versus limited fasciectomy (LF) for the treatment of DC in the NHS, in terms of patient-reported hand function and resource utilisation. METHODS/DESIGN: Hand-2 is a national multi-centre, two-arm, parallel-group randomised, non-inferiority trial. Patients will be eligible to join the trial if they are aged 18 years or older, have at least one previously untreated finger with a well-defined Dupuytren's contracture of 30° or greater that causes functional problems and is suitable for treatment with either LF or NF. Patients with a contracture of the distal interphalangeal joint only are ineligible. Eligible consenting patients will be randomised 1:1 to receive either NF or LF and will be followed up for 24 months post-treatment. A QuinteT Recruitment Intervention will be used to optimise recruitment. The primary outcome measure is the participant-reported assessment of hand function, assessed by the Hand Health Profile of the Patient Evaluation Measure (PEM) questionnaire at 12 months post-treatment. Secondary outcomes include other patient-reported measures, loss of finger movement, and cost-effectiveness, reported over the 24-month post-treatment. Embedded qualitative research will explore patient experiences and acceptability of treatment at 2 years post-surgery. DISCUSSION: This study will determine whether treatment with needle fasciotomy is non-inferior to limited fasciectomy in terms of patient-reported hand function at 12 months post-treatment. TRIAL REGISTRATION: International Standard Registered Clinical/soCial sTudy ISRCTN12525655. Registered on 18th September 2020.

Repair of distal finger soft-tissue defects with free fibular great toe neurovascular flaps.

BACKGROUND: This work aimed to investigate the change in fingerprint depth and the recovery rule of fingerprint biological recognition function after repairing finger abdominal defects and rebuilding fingerprint with a free flap. METHOD: From April 2018 to March 2023, we collected a total of 43 cases of repairing finger pulp defects using the free flap of the fibular side of the great toe with the digital nerve. After surgery, irregular follow-up visits were conducted to observe fingerprint clarity, perform the ninhydrin test or detect visible sweating with the naked eye. We recorded fingerprint clarity, nail shape, two-point discrimination, cold perception, warm perception and fingerprint recognition using smartphones. The reconstruction process of the repaired finger was recorded to understand the changes in various observation indicators and their relationship with the depth of the fingerprint. The correlation between fingerprint depth and neural repair was determined, and the process of fingerprint biological recognition function repair was elucidated. RESULT: All flaps survived, and we observed various manifestations in different stages of nerve recovery. The reconstructed fingerprint had a clear fuzzy process, and the depth changes of the fingerprint were consistent with the changes in the biological recognition function curve. CONCLUSION: The free flap with the digital nerve is used to repair finger pulp defects. The reconstructed fingerprint has a biological recognition function, and the depth of the fingerprint is correlated with the process of nerve repair. The fingerprint morphology has a dynamic recovery process, and it can reach a stable state after 6-8 months.

Digital mucous cyst.

Mucous cyst is a benign but recurrent lesion. It is located on the dorsal surface of the digital extremity between the distal interphalangeal joint and the base of the nail. The nail is often affected by the cyst because of its topographical proximity. Nail plate deformity may even be the first obvious abnormality indicating the presence of a small mucous cyst or subungual cyst. Mucous cyst is associated with osteoarthritis of the joint, osteophytes probably being the main contributing factor. Surgical treatment by joint debridement and cyst removal is the most effective way of preventing recurrence.

Concurrent validity of objective assessment by finger tracking for open surgical suturing training.

BACKGROUND: The aim of this study is to evaluate whether the parameters 'time' and 'distance', measured by SurgTrac, correlate with the assessment of the same skills by blinded experts. METHODS: Basic open suturing tasks were executed by medical students. SurgTrac software measured objective parameters by tracking fingers. The executed tasks were recorded by a tablet and additionally assessed by a blinded expert with a Competency Assessment Tool-form (CAT-form). A Pearson's correlation was used to investigate the correlation between the parameters and the outcomes of the expert assessment. RESULTS: A strong correlation between the measured parameters of SurgTrac and the expert-assessment was found for knot tying by hand (r â€‹= â€‹-0.703) and vertical mattress suture (r â€‹= â€‹-0.644) and a moderate correlation for transcutaneous suture (r â€‹= â€‹-0.555) and intracutaneous suture (r â€‹= â€‹-0.451). CONCLUSION: The use of finger tracking by SurgTrac showed a good concurrent validity for the basic open suturing tasks knot tying by hand, transcutaneous suture and vertical mattress suture.

Anatomy, evolution, and clinical aspects of the superextended-intercompartmental-supraretinacular artery perforator flap (SISAP-flap): A proof of concept.

BACKGROUND: Extended soft tissue defects of the fingers-irrespective of their origin-are challenging to treat. In cases of missing amputates or crush injuries, the options are often limited to further amputation, ray resection, or free tissue transplantation. The SISAP-flap was developed to add an extra option to treat finger avulsion injuries or otherwise extended soft tissue finger defects. METHODS: Cadaveric SISAP-flaps were individually dissected, tested for arterial perfusion using red ink and radiopaque dye, and transposed into artificially created same-size defects. After introducing this flap in the clinic, which was partially successful in the first patient, we modified the flap to its definite design. RESULTS: Average cadaver flap size ranges between 11 cm and 22 cm in length, allowing dorsal wrapping of the flap over the fingertip and way back to the palmar metacarpophalangeal-joint. The flap is based on the distal web space perforator, which is commonly used by a dorsal metacarpal artery flap and supercharged using an intercompartmental, supraretinacular artery. Donor sites were closed primarily with little tension. Application of the flap in the clinic resulted in satisfactory functional and esthetic outcomes. CONCLUSION: The SISAP-flap is a new option for the reconstruction of extended finger defects and should be added to the reconstructive surgeon's armamentarium of pedicled flaps, providing relatively short operating times and promising clinical outcomes.