Analysis of thumb pulp reconstruction based on different local flaps: A systematic review.

Background: The reconstruction of the thumb's pulp is challenging when considering that there is no consensus on which local flap will provide better prognosis and less financial impact. The aim of this study was to analyze the outcomes of the most used flaps for the trauma to the volar substance of the thumb, validating the main indications. Methods: This systematic review adhered to PRISMA guidelines and electronic searches were conducted in multiple databases (MEDLINE/PubMed, Virtual Health Library, Embase and Scopus) with studies published in the last ten years - until April 2022. Results: The search resulted in the screening of 573 records, and twenty studies were included. Among the flaps analyzed and compared by outcomes and prognostic factors, there are First Dorsal Metacarpal Artery (FDMCA), modified (MFDMCA), Moberg flap, Heterodigital Neurovascular Island, Neurovascular Island Pedicle and Modified Littler. Conclusion: Through this literature review, we can analyze different flaps widely used in the daily life of hand surgeons. The flaps that were also positive in a global context, but with few criticisms, are the MFDMCA, Moberg Flap, Neurovascular Island pedicle flap and FDMCA. However, it is important for the surgeon to consider different prognostic factors when choosing the flap, since these aspects directly impact the return to daily activities after the procedure.

Near-Infrared Spectroscopy with Supervised Machine Learning as a Screening Tool for Neutropenia.

The use of non-invasive tools in conjunction with artificial intelligence (AI) to detect diseases has the potential to revolutionize healthcare. Near-infrared spectroscopy (NIR) is a technology that can be used to analyze biological samples in a non-invasive manner. This study evaluated the use of NIR spectroscopy in the fingertip to detect neutropenia in solid-tumor oncologic patients. A total of 75 patients were enrolled in the study. Fingertip NIR spectra and complete blood counts were collected from each patient. The NIR spectra were pre-processed using Savitzky-Golay smoothing and outlier detection. The pre-processed data were split into training/validation and test sets using the Kennard-Stone method. A toolbox of supervised machine learning classification algorithms was applied to the training/validation set using a stratified 5-fold cross-validation regimen. The algorithms included linear discriminant analysis (LDA), logistic regression (LR), random forest (RF), multilayer perceptron (MLP), and support vector machines (SVMs). The SVM model performed best in the validation step, with 85% sensitivity, 89% negative predictive value (NPV), and 64% accuracy. The SVM model showed 67% sensitivity, 82% NPV, and 57% accuracy on the test set. These results suggest that NIR spectroscopy in the fingertip, combined with machine learning methods, can be used to detect neutropenia in solid-tumor oncology patients in a non-invasive and timely manner. This approach could help reduce exposure to invasive tests and prevent neutropenic patients from inadvertently undergoing chemotherapy.

Characteristics of fingertip injuries and proposal of a treatment algorithm from a hand surgery referral center in Mexico City.

BACKGROUND: Fingertips are the most commonly injured anatomical structures in the upper extremity. The aim of this work is to present our experience in the management of fingertip injuries. METHODS: All patients with fingertip injuries managed by Plastic and Reconstructive Surgery Division of Hospital General “Dr Manuel Gea Gonzalez” in Mexico from July 2010 to June 2015 were included; their demographic characteristics were described, as well as patterns of injury and management. RESULTS: A total of 1,265 patients were included in the study, 75% were males. The mean age of presentation was 20.5 ± 16.46 years; the age group most commonly affected was younger than 15 years (46.7%). Right and left-sided injuries were almost equally prevalent (51 vs. 49%). The most commonly injured fingers were the third (27.2%), and second (25.8%). Eighty-seven percent of the patients presented with single-digit injuries. Fingertip amputations were the most common type of injury with 620 cases (49%), followed by simple fingertip lacerations (574 cases, 45%), and nail bed injuries in 71 cases (5.6%). Surgical management was necessary in 95.8% of the cases. CONCLUSIONS: Fingertip injuries remain the most common reason for consultation in hand emergencies. A structured approach for their treatment is necessary to obtain the best clinical outcomes.

Fingertip-Coupled Spindle Signaling Does Not Contribute to Reduce Postural Sway Under Light Touch.

The details of how light touch (LT) of a stable surface reduces postural sway are still not well known. We hypothesized that removal of feedback provided by muscle afferents of the touching fingertip would increase postural sway in standing subjects. Eleven participants stood upright on a force plate with eyes closed and on an unstable surface. The experimental conditions involved two different finger positions: with partial muscle afferents (PMA), which includes sensory information from the fingertip flexor muscles, and no muscle afferents (NMA), without information from either fingertip flexor or extensor muscles. In the control condition, the participants kept the same posture, but with no finger touch (NT). Postural sway in both anteroposterior (AP) and mediolateral (ML) axes were recorded. Results showed that LT decreased all sway quantifiers as compared with the NT condition. The withdrawal of information from the touch finger muscle afferents (NMA condition) did not increase postural sway. Actually, there was a small, albeit statistically significant, decrease in the variability of center of pressure displacement in the AP direction. These results indicate that in some cases, muscle afferent input may either not contribute or even worsen the overall quality of sensory feedback from a given body segment, leading to no improvement or even a slightly decreased performance of the motor control system (evaluated by means of levels of postural sway in the present investigation). The results suggest that non-spindle fingertip afferents provide the bulk of the sensory feedback associated with the fingertip that is touching a ground-referenced object during quiet standing under LT.

Preliminary study on functional and aesthetic reconstruction by using a small artery-only free medial flap of the second toe for fingertip injuries

OBJECTIVES: This study was designed to introduce the feasibility of fingertip reconstruction by using a free medial flap of the second toe without vein anastomosis. METHODS: In total, 8 patients with fingertip injuries were treated successfully with this method. Patients who underwent reconstruction from September 2016 to October 2017 in our hospital with an artery-only free medial flap transfer of the second toe for fingertip injuries were included, and patients who underwent additional procedures that may impact the postoperative results and were followed up for less than 6 months were excluded. Clinical trial registration: ChiCTR19000021883. RESULTS: According to the Allen classification, five patients had Type 3 injuries, and three patients had Type 4 injuries. One arterial nerve and one digital nerve were repaired at the same time. No additional dissection was performed in either the donor or recipient site of the dorsal or volar vein. Postoperative venous congestion was monitored based on the color, temperature and the degree of tissue oxygen saturation. The flap size ranged from 1.20*1.0 cm2 to 1.80*1.0 cm2. The reconstruction time was 71.86 (SD 14.75) minutes. The two-point discrimination and the monofilament results were satisfying; cold intolerance did not appear in five patients, and the other three patients had cold intolerance with grades of 4, 12 and 26, which were considered satisfactory. Moreover, leech therapy, continuous bleeding and needle sutures were not utilized in any cases. CONCLUSIONS: Reconstruction with a small artery-only free medial flap transfer of the second toe led to satisfactory sensory and motor function in the selected patients with fingertip injuries.

Resultados de la aplicación de colgajos homodigitales neurovascularizados en los defectos cutáneos del pulpejo digital / Results of the Application of Neurovascular Homodigital Flaps on Cutaneous Defects of Digital Fingertips

Introducción: las lesiones traumáticas de las manos encabezan la lista de accidentes laborales industriales. El tratamiento de estas lesiones tiene como objetivo restablecer la función de la punta del dedo, mejorando la calidad de vida del paciente.Objetivo: evaluar resultados de la aplicación de colgajos homodigitales neurovascularizados en las lesiones con pérdida compleja de sustancia del pulpejo digital de los dedos largos de la mano .Método: se realizó una investigación de tipo observacional, descriptiva de serie de casos en 33 pacientes con lesión del pulpejo digital de los dedos largos de la mano en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período comprendido desde el 1ro. de octubre de 2013 hasta el 30 de enero de 2015; se aplicaron colgajos homodigitales neurovascularizados monopediculados de circulación directa (17 pacientes) o indirecta (16 pacientes).Resultados: el sexo más afectado fue el masculino, con una mayor frecuencia en los pacientes entre 36-41 y > 41 años edad. Se constataron 4 complicaciones (12 por ciento de la muestra en estudio). Con la aplicación de las técnicas quirúrgicas se logró 72,7 por ciento de resultados entre excelentes y buenos, así como una adecuada sensibilidad protectora y una cobertura cutánea satisfactoria. La satisfacción de los pacientes fue significativa (93,9 por ciento).Conclusiones: se demostró la eficacia de la aplicación de los colgajos homodigitales neurovascularizados en las pérdidas complejas de sustancia del pulpejo en los dedos largos de la mano(AU)

Introduction: traumatic injuries of the hand are in the top list of industrial working accidents. The treatment of these injuries has as goal to restore the function of fingertips, improving the patients' quality of life.Objective: evaluate results of the application of neurovascular homodigital flaps on cutaneous defects of digital fingertips of the hand large fingers.Method: an observational and descriptive investigation was conducted in a case chain of 33 patients at Hermanos Ameijeiras Hospital from October 2013 to January 2015. Neurovascular homodigital flaps were applied with direct circulation (17 patients) or indirect circulation (16 patients).Results: male sex was more affected, frequency higher was between 36 and 41 years old and over 41 years old. Four complications were confirmed representing 12 percent. 72.7 percent obtained good and excellent results with the application of these surgical techniques receiving an appropriate protector of sensibility and satisfactory cutaneous covering. Application of these procedures was 93.9 percent satisfied.Conclusions: the application of neurovascular homodigital flaps was established on cutaneous defects of digital fingertip of the hand large fingers(AU)

Resultados de la aplicación de colgajos homodigitales neurovascularizados en los defectos cutáneos del pulpejo digital / Résultats de l'utilisation du lambeau neurovasculaire homodigital dans les défauts de la pulpe digitale / Results of the Application of Neurovascular Homodigital Flaps on Cutaneous Defects of Digital Fingertips

Introducción: las lesiones traumáticas de las manos encabezan la lista de accidentes laborales industriales. El tratamiento de estas lesiones tiene como objetivo restablecer la función de la punta del dedo, mejorando la calidad de vida del paciente. Objetivo: evaluar resultados de la aplicación de colgajos homodigitales neurovascularizados en las lesiones con pérdida compleja de sustancia del pulpejo digital de los dedos largos de la mano . Método: se realizó una investigación de tipo observacional, descriptiva de serie de casos en 33 pacientes con lesión del pulpejo digital de los dedos largos de la mano en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período comprendido desde el 1ro. de octubre de 2013 hasta el 30 de enero de 2015; se aplicaron colgajos homodigitales neurovascularizados monopediculados de circulación directa (17 pacientes) o indirecta (16 pacientes). Resultados: el sexo más afectado fue el masculino, con una mayor frecuencia en los pacientes entre 36-41 y > 41 años edad. Se constataron 4 complicaciones (12 por ciento de la muestra en estudio). Con la aplicación de las técnicas quirúrgicas se logró 72,7 por ciento de resultados entre excelentes y buenos, así como una adecuada sensibilidad protectora y una cobertura cutánea satisfactoria. La satisfacción de los pacientes fue significativa (93,9 por ciento). Conclusiones: se demostró la eficacia de la aplicación de los colgajos homodigitales neurovascularizados en las pérdidas complejas de sustancia del pulpejo en los dedos largos de la mano(AU)

Introduction: traumatic injuries of the hand are in the top list of industrial working accidents. The treatment of these injuries has as goal to restore the function of fingertips, improving the patients' quality of life. Objective: evaluate results of the application of neurovascular homodigital flaps on cutaneous defects of digital fingertips of the hand large fingers. Method: an observational and descriptive investigation was conducted in a case chain of 33 patients at Hermanos Ameijeiras Hospital from October 2013 to January 2015. Neurovascular homodigital flaps were applied with direct circulation (17 patients) or indirect circulation (16 patients). Results: male sex was more affected, frequency higher was between 36 and 41 years old and over 41 years old. Four complications were confirmed representing 12 percent 72.7 percent obtained good and excellent results with the application of these surgical techniques receiving an appropriate protector of sensibility and satisfactory cutaneous covering. Application of these procedures was 93.9 percent satisfied. Conclusions: the application of neurovascular homodigital flaps was established on cutaneous defects of digital fingertip of the hand large fingers(AU)

Introduction: les lésions traumatiques de la main sont à l'avant-garde des accidents du travail. Le traitement de ces lésions est visé à restaurer la fonction de la pointe du doigt, améliorant ainsi la qualité de vie du patient. Objectif: l'objectif de cette étude est d'évaluer les résultats de l'utilisation du lambeau neurovasculaire homodigital dans le recouvrement des lésions avec une grande perte de substance pulpaire des doigts longs de la main. Méthode: une étude observationnelle et descriptive d'une série de 33 patients, souffrant des lésions pulpaires des doigts longs de la main, a été réalisée à l'hôpital Hermanos Ameijeiras pendant la période comprise entre le 1er octobre 2013 et le 30 janvier 2015; des lambeaux neurovasculaires homodigitaux et monopédiculaires à flux artériel antérograde ont été appliqués chez 17 patients et à flux artériel rétrograde chez 16 patients. Résultats: dans ce groupe, les hommes et les tranches d'âge de 36-41 et >41 ans ont été les plus souvent touchés. Quatre complications ont été constatées (dans 12 pourcent des cas). L'utilisation des techniques chirurgicales a obtenu d'excellents à bons résultats (72,7 pourcent), ainsi qu'une appropriée sensibilisation protectrice et une couverture cutanée satisfaisante. La satisfaction des patients a été significative (93,9 pourcent ). Conclusions: on a constaté l'efficacité du lambeau neurovasculaire homodigital pour le recouvrement des pertes de substance pulpaire des doigts longs de la main(AU)

Angiotensin II Type 1 receptor (AGTR1) gene polymorphisms are associated with vascular manifestations in patients with systemic sclerosis (SSc).

INTRODUCTION: Systemic sclerosis (SSc) shows variable clinical expression in different ethnic groups; vascular abnormalities are a prominent feature of this disease and its clinical expression may be influenced by genetic factors. PATIENTS AND METHODS: Herein, we describe 15 polymorphisms of the renin-angiotensin-aldosterone pathway in 170 Mexican admixed SSc patients (defined as patients with Mexican ancestry for at least 3 generations) and 199 healthy controls. We determined the presence of angiotensin II Type 1 receptor (AGTR1), angiotensin converting enzyme (ACE) and Endothelin 1 single nucleotide polymorphisms (SNPs) using 5' exonuclease TaqMan genotyping assays on a 7900HT real-time fast polymerase chain reaction (PCR) system. RESULTS: These polymorphisms had a similar distribution between SSc patients and controls, but we found that the AGTR1 G-680T (rs275652) (p = 0.02; OR 3.5; 95%CI 1.2-10.4) and AGTR1 A-119G (rs275653) (p = 0.008; OR 4.2; 95% CI 1.5-12.1) polymorphisms were associated with severe vascular involvement in our SSc patients. CONCLUSIONS: This is the first report of the association of these polymorphisms with vasculopathy in Mexican admixed SSc patients. Our findings suggested that the angiotensin II Type 1 receptor genotype may influence the clinical expression of vasculopathy in these patients. Functional analyses should follow.

Distal phalanx amputation with delayed presentation and successful reconstruction with reposition and flap after 2 weeks.

Traumatic finger amputations are common, causing significant functional and cosmetic deficits. Microsurgical replantation techniques are the mainstay of treatment for most such injuries although they require adequate conservation of the amputated segment for a successful result. In distal finger amputations, replantation is the procedure of choice, as long as the amputated fragment is viable. If replantation is not an option, reposition + flap using a neurovascular flap can be an efficient option, as this offers improved skin coverage. To the best of our knowledge, this case illustrates the longest cold ischaemic time with a successful outcome.

The pulp switch flap: an option for the treatment of loss of the dominant half of the digital pulp.

The fingertip has an important role in bi-digital pinch quality, and pulp loss is common and difficult to solve. The pulp switch consists of a pulp island flap with a homodigital neurovascular pedicle, vascularized by the palmar digital artery of the non-dominant pulp transposed to the dominant pulp side. We report the results in 16 patients treated for loss of the dominant half of a digital pulp from January 2000 to December 2008. On review after a minimum of 6 (range 6-18) months, the Weber's test demonstrated an average of 8 mm in static 2 point discrimination test for all digits, except the ring finger. In the monofilament Semmes-Weinstein test, we obtained a score of 3.61 for the thumb and little fingers, and 4.31 for the other fingers. We did not find partial or total necrosis of the flap. The pulp switch flap gave satisfactory functional results for viability, sensitivity, and digital mobility providing a sensate bi-digital pinch with acceptable aesthetic results in a single surgical procedure.

Repellent activity of DEET against Amblyomma cajennense (Acari: Ixodidae) nymphs submitted to different laboratory bioassays / Atividade repelente do DEET contra ninfas de Amblyomma cajennense (Acari: Ixodidae) em bioensaio laboratorial

This study was developed to evaluate the repellent activity of N,N-diethyl-3-methylbenzamide (DEET) against Amblyomma cajennense nymphs. Two repellent bioassays were compared and the effective concentration and repellent time were calculated. The fingertip test was accomplished to evaluate in vivo four concentrations of the compound (0.200; 0.100; 0.050 and 0.025 mg.cm-2) and the filter-paper bioassay to evaluate in vitro the two highest concentrations. The compound provided repellence higher than 90 percent in all concentrations and at least 95 percent repellency in the highest concentration over 5 hours. The effective concentration against 50 percent of tested nymphs (EC50) was 0.006 mg.cm-2 and the EC99 was 0.036 mg.cm-2. Those concentrations were lower than the ones obtained against other tick species, denoting the effectiveness of DEET against A. cajennense. The repellency time against 50 percent of the ticks (RT50) was 4.8 hours and the RT90 was 2.7 hours. Both bioassays were adequate to evaluate A. cajennense repellency and provided similar results; however the in vivo test is more appropriate to estimate the effective concentration and repellency time.

Este estudo foi conduzido com o objetivo de avaliar a atividade repelente do N,N-diethyl-3-methylbenzamide (DEET) sobre ninfas de Amblyomma cajennense. Dois bioensaios para a avaliação de repelência foram comparados e cálculos da concentração eficaz e do tempo de repelência foram realizados. Foram empregados o bioensaio da ponta do dedo, para avaliação in vivo de quatro concentações do químico (0,200; 0,100; 0,050 e 0,025 mg.cm-2) e o bioensaio do papel filtro, para a avaliação in vitro das duas concentrações mais altas. O composto conferiu mais de 90 por cento de repelência em todas as concentrações utilizadas e 95 por cento de repelência por mais de cinco horas na maior concentração. A concentração do composto efetiva contra 50 por cento das ninfas testadas (CE50) foi de 0,006 mg.cm-2 e a CE99 foi de 0,036 mg.cm-2. Estas concentrações são mais baixas do que as observadas em outras espécies de carrapatos, denotando a efetividade do princípio contra A. cajennense. O tempo de repelência de 50 por cento dos carrapatos (TR50) foi de 4,8 horas e o TR90 de 2,7 horas. Os dois bioensaios avaliados permitiram a observação de percentuais de repelência igualmente altos e se mostraram adequados para tal avaliação, sendo que o teste in vivo é mais indicado para cálculo da concentração eficaz e da duração da repelência.

Repellent activity of DEET against Amblyomma cajennense (Acari: Ixodidae) nymphs submitted to different laboratory bioassays

This study was developed to evaluate the repellent activity of N,N-diethyl-3-methylbenzamide (DEET) against Amblyomma cajennense nymphs. Two repellent bioassays were compared and the effective concentration and repellent time were calculated. The fingertip test was accomplished to evaluate in vivo four concentrations of the compound (0.200; 0.100; 0.050 and 0.025 mg.cm-2) and the filter-paper bioassay to evaluate in vitro the two highest concentrations. The compound provided repellence higher than 90% in all concentrations and at least 95% repellency in the highest concentration over 5 hours. The effective concentration against 50% of tested nymphs (EC50) was 0.006 mg.cm-2 and the EC99 was 0.036 mg.cm-2. Those concentrations were lower than the ones obtained against other tick species, denoting the effectiveness of DEET against A. cajennense. The repellency time against 50% of the ticks (RT50) was 4.8 hours and the RT90 was 2.7 hours. Both bioassays were adequate to evaluate A. cajennense repellency and provided similar results; however the in vivo test is more appropriate to estimate the effective concentration and repellency time.

Este estudo foi conduzido com o objetivo de avaliar a atividade repelente do N,N-diethyl-3-methylbenzamide (DEET) sobre ninfas de Amblyomma cajennense. Dois bioensaios para a avaliação de repelência foram comparados e cálculos da concentração eficaz e do tempo de repelência foram realizados. Foram empregados o bioensaio da ponta do dedo, para avaliação in vivo de quatro concentações do químico (0,200; 0,100; 0,050 e 0,025 mg.cm-2) e o bioensaio do papel filtro, para a avaliação in vitro das duas concentrações mais altas. O composto conferiu mais de 90% de repelência em todas as concentrações utilizadas e 95% de repelência por mais de cinco horas na maior concentração. A concentração do composto efetiva contra 50% das ninfas testadas (CE50) foi de 0,006 mg.cm-2 e a CE99 foi de 0,036 mg.cm-2. Estas concentrações são mais baixas do que as observadas em outras espécies de carrapatos, denotando a efetividade do princípio contra A. cajennense. O tempo de repelência de 50% dos carrapatos (TR50) foi de 4,8 horas e o TR90 de 2,7 horas. Os dois bioensaios avaliados permitiram a observação de percentuais de repelência igualmente altos e se mostraram adequados para tal avaliação, sendo que o teste in vivo é mais indicado para cálculo da concentração eficaz e da duração da repelência.

Análisis de la unidad digital como medida de referencia para la prescripción tópica en México / Analysis of the digital unit as reference measurement for the topical prescription in Mexico

Introducción: La prescripción tópica a diferencia de otras vías de administración es un procedimiento impreciso en la mayoría de las ocasiones. La unidad digital (UD) es un parámetro propuesto para la dosificación de un medicamento tópico. Es la cantidad obtenida de un tubo con una abertura de 5 mm de diámetro colocado desde el pliegue distal del dedo índice hasta su punta. Objetivo: Evaluar la UD como medida de referencia para el tratamiento tópico en población mexicana. Métodos: Se cuantificó la longitud de la punta de dedo índice en 324 individuos. Posteriormente se cuantificó el peso de 1 UD y la superficie capaz de cubrir. Resultados: La longitud promedio de la punta del dedo índice fue 27 mm (IC95 26.7-27.2) en hombres, y 24 mm (IC95 24.3-24.8) en mujeres (p=0.001). El peso de 1 UD fue 0.45 g (IC95 0.41-0.48) en hombres (n=40), y 0.38 g (IC95 0.35-0.41) en mujeres (n=50), (p=0.0047). Una UD cubre 275 cm2 (IC95 255-294) en hombres (n=15), y 220 cm2 (IC95 200-240) en mujeres (n=15), (p=0.0005). Conclusión: Para el paciente y el dermatólogo, la UD puede ser una medida útil para dosificar y supervisar el uso de medicamentos tópicos en México.

INTRODUCTION: Topical prescription unlike other dosage forms is generally considered an inaccurate procedure. The fingertip unit (FTU) is a proposed measure for dosing a topical drug. FTU is the amount of ointment obtained from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger. OBJECTIVE: Asses FTU as a reference measure for topical prescription among the Mexican population. METHODS: The length of the II hand fingertip was recorded in 324 individuals and the weight of 1 FTU and its covering surface was registered. RESULTS: Average length of index fingertip was 24 mm (IC95 26.7-27.2) in males (n=40), and 24 mm (IC95 24.3-24.8) in females (n=50). One FTU weighed 0.45 g (IC95 0.41-0.48) in males (n=40), and 0.38 g (IC95 0.35-0.41) in females (n=50). One FTU covered 275 cm2 (IC95 255-294) in males (n=15), and 257 cm2 (IC95 200-240) in females (n=15). CONCLUSION: FTU may be a helpful measure for dosing and supervising the administration of topical medications for both patients and dermatologists in Mexico.