Challenges and Solutions in Prosthetic Fitting of Digits after Flap Reconstruction.

Surgical reconstruction can restore length and function, but cannot adequately resolve the problem of disfigurement. Prosthetic fitting can play a complementary role in enhancing the aesthetic outcomes post reconstruction. However, complex reconstruction involving flaps coupled with the surgical imperative for limb length preservation can lead to outcomes where the reconstructed stumps are challenging to fit with prosthesis. This article describes how prosthetic fitting was tackled in a case of a triple-digit amputation after reconstruction that presented with finger stumps that were bulky, long and stiff in extension contracture, compounded by the presence of substantive scar tissues. We discuss major prosthesis modifications that were unconventional but necessary to enable fitting, the techniques involved, as well as the aesthetic and functional considerations behind the modifications. The results showed that enhanced aesthetic appearance, together with a marginal improvement in hand function, was achieved post-prosthetically, meeting the patient's and the clinical team's fitting objective. Level of Evidence: Level V (Therapeutic).

Functional use of esthetic hand prosthesis: A patient's perspective.

Published reports on the functional benefits of esthetic prosthesis are based on either anecdotal evidence or simplified, nonstandard forms of hand function evaluation performed by the researcher. It is not clear whether and how patients actually make functional use of their prosthesis on a daily basis. We report a case of a patient with a partial hand amputation who was initially ambivalent about fitting an esthetic prosthesis, but went on to make functional use of her prosthesis for activities of daily living, work, and social life at 3 years after injury. We present the patient's own assessment and video recordings, made without influence from rehabilitation personnel that demonstrates this functional use. From this case, we discuss the important factors of a favorable residual limb type, together with targeted modifications made to the prosthesis to optimize function.

Color-matching techniques for creating esthetic hand and finger prostheses.

BACKGROUND: Color matching is a critically important part of, and by far, also the most challenging aspect of producing esthetic silicone prosthesis. There is a knowledge gap in the literature and a lack of opportunities for training in the expertise, particularly regarding color-matching techniques. OBJECTIVE: This article details a color-matching technique that is able to achieve life-like coloration in esthetic prosthesis. TECHNIQUE: Each prosthesis is molded in an outer and inner layers of silicone tinted to different shades and opacities incorporating an intermediate touch-up layer to reproduce the detailed coloration of the hand (because of the presence of veins, finger joint/dermal pigmentations, a vascularized nail bed, and pinkish palm). This method of color-matching prosthesis combining intrinsic and extrinsic techniques simulates the layered anatomy and optical properties of the human skin to effectively replicate its esthetic and life-like coloration. Technical tips for achieving an accurate color match to the patient's skin, including pigment formulation adjustments for a tanned vs. a fair skin, and for painting the touch-up details are discussed. Methods for modifying the color tones of completed prosthesis and for minimizing metameric color differences when the prosthesis is viewed under different light sources are also presented. DISCUSSION: The technique is instrumental in achieving good outcomes for life-likeness and esthetic coloration in the prostheses fitted at our center. Studies previously published that investigated patients' evaluation of important esthetic characteristics of their prosthesis after a period of adjustment to fitting have shown a generally high level of patient satisfaction.

Clinical intervention of a tighter-than-tolerated fit of aesthetic hand and finger prosthesis via controlled silicone swelling: A novel, speedier and versatile alternative method.

A tighter-than-tolerated fit of aesthetic hand prosthesis is conventionally rectified by stretching the affected segment to plastic deformation. This method is not only time-consuming, but also ineffective in stretching irregular, non-cylindrical prosthesis segments apart from the "wrist and digits". This study investigates controlled silicone swelling as an alternative method of expanding aesthetic hand and finger prosthesis to address a tight fit. The technique of "controlled" swelling that minimizes oil uptake to as little as is necessary to achieve the desired magnitude of elastomer expansion was demonstrated using experimental test samples. Brush-coats of a cosmetics-grade oil, KF-96A-10CS, 2 a time, were applied on CosmesilTM samples to obtain elastomer expansion. The same technique of staggered oil delivery was used on tight-fitting segments of patients' prosthesis, with test-fitting of each incremental expansion till satisfactory outcomes were achieved. Percentage circumference increases in swelled test samples and in all rectified/ patients' prostheses were then compared to validate the effectiveness of the method. Circumference increases in the test samples after each 2 coats were significantly different (P <.001). Representative (unreinforced) Samples 1, 2, and 3 recorded circumferential increases of 4.0% to 11.4% within 30 minute after swelling by 2.6% to 9.7% from 2 to 6 oil coats. This largely correlated with patient data, where circumferential increases of 3.6% to 9.5% from 2 to 6 oil coats were collectively recorded in all fit-rectified finger prostheses. Swelling in the expanded proximal segment of all 24 finger prostheses was estimated to be within 9.7%. Of these, 22 (92%) required 2 to 4 oil coats, inferring a lower still swelling of 6.5%. The rapid and consistent elastomer expansion enabled prosthetic fit rectification to be achieved in a much shortened time. Clinical outcomes indicated that low swelling magnitudes involving small amounts of 2 to 6 brush-coats of oil have no adverse effects on the prostheses. None of the participating patients had reported any incidence of discernible change in all of the important properties of their prostheses. Outcomes based on the CosmesilTM-KF-96A-10CS elastomer-oil combination demonstrated that controlled silicone swelling involving minimal use of oil is an effective method of intervention for a tighter-than-tolerated prosthetic fit of silicone hand and fingers.

Fitting very short finger stumps with silicone prosthesis: a nonsurgical method.

BACKGROUND AND AIM: The fitting of short finger stumps with silicone prosthesis is a challenge because of the suboptimal finger-prosthesis contact due to length and distal tapering of digital stumps. The purpose of this report was to describe and evaluate the Micropore(™)-polyvinyl chloride tube technique for fitting short finger stumps. TECHNIQUE: For a total of 10 patients, short finger stumps were fitted using the technique. A short length of polyvinyl chloride tube, trimmed and contoured to fit, was secured on the distal stump tip with Micropore tape. The prosthesis was worn over the polyvinyl chloride tube extension. Three different fitting methods were evaluated: fitting with and without the Micropore-polyvinyl chloride tube technique, and with the use of skin adhesive on the stump. DISCUSSION: All patients achieved a very secure prosthetic fit with the Micropore-polyvinyl chloride tube technique. No incidences of prosthesis slippage were reported at the longest follow-up of 30 months. The Micropore-polyvinyl chloride tube technique is an effective method for fitting short finger stumps.

Assessment of colour differences in silicone hand and digit prostheses: perceptible and acceptable thresholds for fair and dark skin shades.

This study addresses the dilemma of initial clinical and social acceptance of a newly fabricated silicone prosthesis in relation to its colour match to the natural skin. This was achieved by derivation of specific colour difference thresholds defining perceptible and acceptable levels of colour sensitivity. Two separate sets of 10 fair and dark shade digit prosthesis samples were each fabricated with a stepped increase in colour difference (deltaE) against the baseline hand prosthesis. Ninety individuals with normal colour vision scores were selected as colour assessors. The colour difference of each prosthesis in the two series was evaluated visually against the baseline by the assessors, using defined scores. The thresholds for perceptible and acceptable colour difference determined in this study were deltaE= 0.8 and deltaE= 1.8 for the fair series and deltaE = 1.3 and deltaE = 2.6 for the dark series, respectively. The acceptable threshold values differed from the perceptible threshold values by deltaE= 1.0 for the fair-shade samples and deltaE= 1.3 for the dark-shade samples. This study demonstrated that subjective visual assessment is positively correlated with deltaE values computed from colorimetric measurements for both fair and dark-shade silicone samples (p<0.001). This results shows that human subjects with normal colour vision are capable of accurately assessing colour differences. These observations emphasize the importance of subjective feedback on colour by the patient, provided the latter has perfect colour-tested vision. The study also showed that human subjects were less sensitive to perceived colour differences in darker-shade than fairer-shade samples (p < 0.001). This finding seems relevant in a clinical setting involving a multi-ethnic patient population.