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1.
J Hand Microsurg ; 16(4): 100130, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39234368

ABSTRACT

Purpose: - Fingertip amputations are responsible for significant pain, suffering, discomfort as well as lost productivity and financial and physical hardship. Distal finger tip amputations pose a unique reconstructive challenge as the aim is to provide a supple cover with sensation. Wide variety of options are available for the reconstruction following fingertip amputations. This study evaluates the use of hatchet flap in the management of distal fingertip amputations. Methods: The hatchet flap was done in 35 fingers of 31 patients with fingertip amputations at the level of distal phalanx who presented to our unit, fulfilling the inclusion criteria during a period of 18 months. All transverse and dorsal oblique amputations (of any size) at the level of distal phalanx of any age group were included in the study. Volar fingertip amputations at the level of distal phalanx and fingertip amputations associated with other injury over the volar aspect of finger were excluded from the study. Results: The flap provided a very good padded soft tissue cover with good aesthetic shape to the finger tip. The scars were unnoticeable with an average 2 point discrimination of 6.7 â€‹mm at 12 weeks post operatively. Paresthesia was noted maximally at 1 week post operative duration. Joint stiffness was not noted in any patient. Most patients were able to return back to their normal daily routine at around 3 weeks. Complete flap necrosis was noted in 1 patient while partial tip necrosis was noted in 2 patients. Conclusion: The hatchet flap serves as a good local reconstructive flap option which preserves the tactile sensation and is a valuable addition to the wide armamentarium of reconstructive procedures available for treating the distal fingertip amputations.

2.
J Hand Microsurg ; 16(4): 100126, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39234378

ABSTRACT

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.

3.
Clin Dermatol ; 2024 Sep 09.
Article in English | MEDLINE | ID: mdl-39260461

ABSTRACT

Fingerprints are created by elevations and depressions on the fingertip pads. Each person has their own unique fingerprints which can be used in the identification of that individual when alive, during the immediate postmortem period, or even after the digits have become mummified. Mummification can occur naturally; it can be partial (such as localized to only the hands and feet, extensive, or complete. Obtaining fingerprints after the skin has become mummified can be attempted while the digits remaining intact with the hand; however, the digits may need to be removed from the hand and the finger pads may also need to be separated from the underlying bone to secure an adequate fingerprint. Frequently, the mummified tissue needs to be rehydrated; numerous solutions have been used that increase the turgor of the digits, provide softening and pliability of the tissue, and enhance the details of the finger pad ridges. An aqueous solution of sodium carbonate (either combined with acetic acid or combined with 95 percent ethanol and distilled water) was found to be most effective for rehydration. Thereafter, various techniques can be attempted to obtain the fingerprint. These include the traditional method of inking and rolling of the finger or photographing the finger. Powders (such as aluminum powder, black fingerprint powder, white cornstarch-based powder, or fluorescent powder) can be used to enhance the ridge features; adhesive tape can be pressed against the powdered digit and the print pattern preserved by applying the adhesive tape to a clear transparency sheet. In addition, molds (using modeling clay or silicone rubber) and casts (using plaster of Paris, dental casting materials, or putty) can be made of the digits; either the molds or the casts or both can be photographed with or without prior application of fingerprint powder. Transillumination, using a fiber optic light source to illuminate the epidermis and underlying remaining dermis of a scraped and defleshed finger pad can be used to demonstrate the finger ridge pattern when the photographing the tip of the digit. In summary, forensic dermatology can have an integral role in obtaining fingerprints from mummified digits, which can be successfully used for the identification of the decedent.

4.
Chin J Traumatol ; 2024 Sep 14.
Article in English | MEDLINE | ID: mdl-39322539

ABSTRACT

PURPOSE: The reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique. METHODS: A retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD. RESULTS: The mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory. CONCLUSION: Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.

5.
J R Coll Physicians Edinb ; : 14782715241288903, 2024 Sep 30.
Article in English | MEDLINE | ID: mdl-39345233

ABSTRACT

Glomus tumour is a rare benign neoplasm arising from specialized neuromyoarterial plexus situated in the subungual region. Here, we present a 36-year-old male who had severe pain in the distal part of left third finger mimicking distal interphalangeal joint arthritis (DIP). On evaluation, he was found to have severe tenderness just distal to the DIP joint line. Also, he had positive cold sensitivity test. MRI showed high-signal intensity lesion in the dorsal aspect of left third digit. Glomus tumour was suspected based on these findings. Surgical excision was done followed by histopathological examination, confirmed the diagnosis. We present this case to raise awareness about this rare condition and the possibility of misinterpreting distal pain as DIP arthritis.

7.
Heliyon ; 10(15): e35606, 2024 Aug 15.
Article in English | MEDLINE | ID: mdl-39170155

ABSTRACT

Fingertip injuries, particularly those resulting from motorbike chain accidents, pose significant challenges due to their impact on daily life activities. This retrospective study conducted at B&B Hospital in Kathmandu from January 2018 to December 2022 aimed to explore the epidemiology and management of motorbike chain-related fingertip injuries. Among the 256 cases of fingertip injuries studied, 136 were attributed to motorbike chain accidents. Males comprised the majority of cases, and the index and middle fingers were the most frequently injured. Various surgical procedures were employed for treatment, with V-Y Plasty being the most common. These findings underscore the complexity of managing these injuries and highlight the importance of preventive measures and patient-centered care.

8.
J Clin Med ; 13(13)2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38999212

ABSTRACT

Background Fingertip injuries with volar pulp tissue defects present a significant challenge in management. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressings for these injuries. Methods A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol included wound debridement, application of artificial dermis (Pelnac®), and a semi-occlusive dressing (IV3000®). The outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. Results The mean treatment duration was 45.29 days (SD = 17.53). Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score = 2.58, SD = 0.67). The sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean = 0.45, SD = 0.67), and cosmetic satisfaction was high (mean = 4.09, SD = 0.94). The overall patient satisfaction was high (mean = 4.41, SD = 0.67), regardless of injury severity. Conclusions The conservative treatment protocol using artificial dermis and semi-occlusive dressings is a promising strategy for managing fingertip injuries with volar pulp defects. This approach minimizes surgical morbidity and achieves excellent functional and aesthetic outcomes.

9.
Eur J Orthop Surg Traumatol ; 34(6): 3119-3127, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38971888

ABSTRACT

PURPOSE: Adequate debridement and defect closure is an important treatment in fingertip injuries in addition to administration of antibiotic. However, administration of anitibiotics remains controversial whether it necessary for fingertip injuries that have been treated with adequate debridement and defect closure. The goal of study is to assess the differences of infection rate between subgroups with administration of antibiotics and without antibiotic in FTI treated by debridement and simple defect closure. METHODS: The study design was a double-blind randomized clinical trial. Data collection was carried out at Cipto Mangunkusumo General Hospital, Jakarta and Tangerang Regency Hospital, Banten, in July 2022-February 2023. The target population of this study were adult patients with Fingertip injuries that treated by debridement and simple defect closures with antibiotics administration and without antibiotic. Infection was assessed at day-7, 14, and 21 follow-up. RESULTS: There were 31 FTI subjects with 41 fingers affected. The number of male subjects was 27 people and female subjects 4 people. The most affected finger was the little finger (12 fingers, 30.8%), with most type of Allen classification was type IV (18 fingers, 43.90%), most procedure performed was primary suture (24 fingers, 58.54%). 15 subjects randomized to antibiotic group and 16 subjects to no-antibiotic group. There was 1 subject of antibiotic group and 1 subject of no-antibiotic group has infection. There are no significant differences between two groups. CONCLUSION: There were no significant differences of infection rate between antibiotics administration and without antibiotic in FTI cases that treated by debridement and simple defect closures.


Subject(s)
Anti-Bacterial Agents , Debridement , Finger Injuries , Humans , Double-Blind Method , Male , Finger Injuries/surgery , Female , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Adult , Debridement/methods , Middle Aged , Young Adult
10.
ACS Appl Mater Interfaces ; 16(32): 42986-42994, 2024 Aug 14.
Article in English | MEDLINE | ID: mdl-39083246

ABSTRACT

A flexible arc-shaped micro-Fiber Bragg Grating (mFBG) array three-dimensional tactile sensor for fingertip signal detection and human pulse monitoring is presented. It is based on a three mFBGs array which is embedded in an arc-shaped poly (dimethylsiloxane) (PDMS) elastomer, which can effectively discriminate the normal force, left force, and right force by monitoring the reflected intensity variation of the three mFBGs. Different from the traditional FBG sensors, this sensor measures force by detecting changes in light intensity, effectively avoiding the wavelength cross-sensitivity impact of temperature variations on the sensor performance. This design strategy simplifies the sensor structure, reduces the system complexity and signal interrogation cost, and enhances reliability and practicality. Through systematic experiments, we successfully validated the sensor's superior performance, achieving a minimum detection force of 0.01 N and providing robust data support for practical applications. In addition, the sensor has been used to monitor human pulse accurately. The successful fabrication and experimental validation of this sensor lay a foundation for its widespread application in fields such as robot perception and human vital signal detection.


Subject(s)
Fingers , Touch , Humans , Fingers/physiology , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Wearable Electronic Devices , Pulse , Equipment Design , Dimethylpolysiloxanes/chemistry , Fiber Optic Technology/instrumentation
11.
Orthop Traumatol Surg Res ; : 103954, 2024 Jul 20.
Article in English | MEDLINE | ID: mdl-39038515

ABSTRACT

INTRODUCTION: The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications. HYPOTHESIS: The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children. MATERIALS AND METHODS: Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed. RESULTS: Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3). CONCLUSION: The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk. LEVEL OF EVIDENCE: IV; retrospective study.

12.
J Hand Surg Eur Vol ; : 17531934241258860, 2024 Jun 11.
Article in English | MEDLINE | ID: mdl-38861532

ABSTRACT

We retrospectively reviewed the outcomes of 54 patients treated with occlusive dressings (OD) (27 patients) or local flap (LF) coverage (28 patients) for fingertip amputations with bone exposure. All patients healed completely within a mean of 5 weeks in the OD group and 3.5 weeks in the LF group. At a mean follow-up of 26 months (range 12-38), 2-point discrimination was significantly better in the OD group (4 mm) than the LF group (6 mm). Proximal interphalangeal joint (PIP) stiffness was more common in the LF group, affecting one-third of patients. A cost analysis showed that ODs were 6.5 times less expensive than LFs performed in the operating theatre. OD appears to be a reliable and more cost-effective alternative to LF for treating zone 2 and 3 fingertip amputations with exposed bone, with similar healing time, better tactile discrimination and a lower rate of PIP joint stiffness.Level of evidence: IV.

13.
Am J Transl Res ; 16(5): 1798-1805, 2024.
Article in English | MEDLINE | ID: mdl-38883379

ABSTRACT

OBJECTIVE: This study investigates the clinical efficacy of integrating digital design with three-dimension (3D) printing technology in the transplantation of flaps for fingertip defects. METHODS: A retrospective analysis was conducted from October 2019 to June 2021 on 90 cases of patients with fingertip defects. These included 45 cases in which digital design, coupled with 3D printing, assisted the operation (3D printing group), and another 45 cases where patients underwent traditional pedicle flap transplantation and skin grafting (traditional operation group). A six-month postoperative follow-up assessed various measurements between the two groups, comparing the skin flap survival rate, aesthetic outcome, cold intolerance, sensory recovery, and overall skin flap performance. RESULTS: ① Statistical analysis utilizing the independent samples t-test revealed a significant reduction in both operation time and flap anastomosis rate for the 3D printing group compared to the traditional operation group (P < 0.05). ② Conversely, the survival rate, aesthetic outcome, and cold intolerance showed no significant disparities between the groups (P > 0.05). ③ Further, the Mann-Whitney U test indicated no significant difference in sensory recovery and overall efficacy assessment between the two cohorts (P > 0.05). CONCLUSION: Integrating digital design with 3D printing technology facilitated the surgical management of fingertip defects, achieving customized and precise approaches in flap transplantation. This precision in personalized skin flap design contributed to reduced operative time and enhanced surgical efficiency in such procedures.

15.
J Plast Reconstr Aesthet Surg ; 95: 411-418, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38734540

ABSTRACT

BACKGROUND: Reverse homodigital artery island flap (RHDI) has been reported to have some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been used to decrease these complications. This study aimed to provide a review of the CRDI procedure and compare the clinical outcomes of CRDI with those of RHDI. METHODS: RHDI has been performed for fingertip amputations with deficit of 1.5-2.5 cm before 2018, and CRDI has been performed since 2018. We assessed the functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. RESULTS: We identified 22 patients who underwent RHDI and 10 patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing were 47.0 days (IQR: 34.3-55.8 days) and 34.5 days (IQR: 29.3-44.3 days) in RHDI and CRDI, respectively. The hook nail deformity occurred significantly more frequently in RHDI compared to that in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found to be significantly more in RHDI than in CRDI (36.4% vs. 0.0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260-280º). The median postoperative Hand20 scores were similar between the two groups. CONCLUSION: CRDI was associated with superior clinical outcomes in terms of lower rates of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.


Subject(s)
Amputation, Traumatic , Finger Injuries , Surgical Flaps , Humans , Finger Injuries/surgery , Male , Female , Surgical Flaps/blood supply , Retrospective Studies , Adult , Middle Aged , Amputation, Traumatic/surgery , Esthetics , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/adverse effects , Treatment Outcome , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Fingers/blood supply , Fingers/surgery , Wound Healing/physiology
16.
JPRAS Open ; 40: 245-252, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38694441

ABSTRACT

Background: The fingertip amputation is an amputation type of the finger beyond the proximal nail fold. There is no vein available for anastomoses on the dorsal side of the finger, and the palmar vein of the finger is small and tightly attached to the skin. Therefore, it is relatively difficult to implement surgical anastomoses, which poses challenges to the clinical treatment of fingertip amputations. Case report: A 29-year-old male was admitted to the hospital due to "the amputation of the fingertips of the right index, middle, and ring fingers caused by a heavy object compression 3 h ago". The admission examination revealed that the right index, middle, and ring fingers were completely severed at the 1/2 plane of the nail bed, with irregular sections, severe contusion, and pollution. The X-ray examination showed comminuted fractures of the distal phalanges of the right index, middle, and ring fingers. Based on these findings, the patient was diagnosed with multiple severed fingertips of the right hand (Tamai Zone 1). The patient underwent debridement, vascular exploration, and replantation of the right index, middle, and ring fingertips under emergency general anesthesia. After surgery, anti-inflammatory, spasmolytic, and anticoagulant treatment and regular dressing changes were conducted. The patient did not receive a blood transfusion, and all three fingers survived. The appearance of these fingers was favorable 3 months after surgery, and the flexion and extension of these fingers were normal. Eventually, the patient achieved excellent Chen's hand function scores. Conclusions: To the best of our knowledge, this may be the first successful case regarding the replantation of three fingertips after amputations in Tamai Zone 1 with favorable outcomes. It can be maintained that super microsurgery can be used for the replantation of multiple fingertip amputations.

17.
Biomech Model Mechanobiol ; 23(4): 1369-1376, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38700788

ABSTRACT

Predicting how the fingertip will mechanically respond to different stimuli can help explain human haptic perception and enable improvements to actuation approaches such as ultrasonic mid-air haptics. This study addresses this goal using high-fidelity 3D finite element analyses. We compute the deformation profiles and amplitudes caused by harmonic forces applied in the normal direction at four locations: the center of the finger pad, the side of the finger, the tip of the finger, and the oblique midpoint of these three sites. The excitation frequency is swept from 2.5 to 260 Hz. The simulated frequency response functions (FRFs) obtained for displacement demonstrate that the relative magnitudes of the deformations elicited by stimulating at each of these four locations greatly depend on whether only the excitation point or the entire finger is considered. The point force that induces the smallest local deformation can even cause the largest overall deformation at certain frequency intervals. Above 225 Hz, oblique excitation produces larger mean displacement amplitudes than the other three forces due to excitation of multiple modes involving diagonal deformation. These simulation results give novel insights into the combined influence of excitation location and frequency on the fingertip dynamic response, potentially facilitating the design of future vibration feedback devices.


Subject(s)
Computer Simulation , Fingers , Finite Element Analysis , Fingers/physiology , Humans , Vibration , Biomechanical Phenomena , Models, Biological
18.
Soft Robot ; 11(4): 573-584, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38662448

ABSTRACT

Replication of the human sense of touch would be highly advantageous for robots or prostheses as it would allow an agile and dexterous interaction with the environment. The article presents an approach for the integration of a micro-electromechanical system sensing skin with 144 tactile sensors on a soft, human-sized artificial fingertip. The sensing technology consists of thin, 1D sensing strips which are wrapped around the soft and curved fingertip. The sensing strips include 0.5 mm diameter capacitive sensors which measure touch, vibrations, and strain at a resolution of 1 sensor/mm2. The method allows to leverage the advantages of sensing skins over other tactile sensing technologies while showing a solution to integrate such skins on a soft three-dimensional body. The adaptable sensing characteristics are dominated by the thickness of a spray coated silicone layer, encapsulating the sensors in a sturdy material. We characterized the static and dynamic sensing capabilities of the encapsulated taxels up to skin thicknesses of 600 µm. Taxels with 600 µm skin layers have a sensitivity of 6 fF/mN, corresponding to an ∼5 times higher sensitivity than a human finger if combined with the developed electronics. They can detect vibrations in the full tested range of 0-600 Hz. The softness of a human finger was measured to build an artificial sensing finger of similar conformity. Miniaturized readout electronics allow the readout of the full finger with 220 Hz, which enables the observation of touch and slipping events on the artificial finger, as well as the estimation of the contact force. Slipping events can be observed as vibrations registered by single sensors, whereas the contact force can be extracted by averaging sensor array readouts. We verified the sturdiness of the sensing technology by testing single coated sensors on a chip, as well as the completely integrated sensing fingertip by applying 15 N for 10,000 times. Qualitative datasets show the response of the fingertip to the touch of various objects. The focus of this article is the development of the sensing hardware and the basic characterization of the sensing performance.

19.
JPRAS Open ; 40: 175-184, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38558878

ABSTRACT

Introduction: Traumatic fingertip amputation is the most common type of upper extremity injuries. The V-Y advancement flap is a reliable method for reconstructing fingertip defects, but it is associated with complications such as hook-nail deformity and suture site ischemia. Here, we describe our modifications to V-Y advancement flap technique, termed as "V advancement eversion flap" and review the outcomes of this procedure in 21 patients with fingertip amputation. Methods: This was a retrospective review of 21 consecutive patients with fingertip injury who were treated surgically using the V advancement eversion flap technique at a single trauma center between 2006 and 2019. We analyzed the age, injury location and mechanism, Allen classification, injury geometry, and objective and subjective clinical outcomes. Results: Twenty-three fingertip amputations with defect sizes greater than 1.0 cm2 from the tip to lunula were included in this study. The mean age of the patients was 43.6 years (range, 24-65 years). The average follow-up period was 20 months (range, 12-37 months). The average wound healing time (apparent epithelization) was 29.4 days (range, 14-41 days). At the final follow-up, all flaps had healed uneventfully without noticeable hook-nail deformity. In the static two-point discrimination test, the mean value was 4.61 mm in the injured finger. Patient ratings of the outcomes were "excellent" in 18 and "good" in 5 cases. Conclusion: The V advancement eversion flap technique, when properly designed and executed in fingertip amputation cases, can minimize morbidity and result in successful wound healing without flap necrosis and hook-nail deformity.

20.
Heliyon ; 10(7): e28652, 2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38633637

ABSTRACT

Coronary heart disease (CHD) is a leading cause of mortality globally and poses a significant threat to public health. Coronary angiography (CAG) is a gold standard for the clinical diagnosis of CHD, but its invasiveness restricts its widespread application. In this study, we utilized a pulse diagnostic device equipped with pressure and photoelectric sensors to synchronously and non-invasively capture wrist pressure pulse waves and fingertip photoplethysmography (FPPG) of patients undergoing CAG. The extracted features were utilized in constructing random forest-based models to assessing the severity of coronary artery lesions. Notably, Model 3, incorporating both wrist pulse and FPPG features, surpassed Model 1 (solely utilizing wrist pulse features) and Model 2 (solely utilizing FPPG features). Model3 achieved an Accuracy, Precision, Recall, and F1-score of 78.79%, 78.69%, 78.79%, and 78.70%, respectively. Compared to Model1 and Model2, Model 3 exhibited improvements by 4.55%, 5.25%, 4.55%, and 5.12%, and 6.06%, 6.58%, 6.06%, and 6.54% respectively. This fusion of wrist pulse and FPPG features in Model 3 highlights the advantages of multi-source information fusion for model optimization. Additionally, this research provides invaluable insights into the novel development of diagnostic devices imbued with TCM principles and their potential in managing cardiovascular diseases.

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