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1.
J Int Med Res ; 50(1): 3000605211067748, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35023378

RESUMO

Cutaneous alterations are common in neonates and usually occur in the first few days of life. Most of these are transient and benign, appearing as physiological responses to birth. Skin pigmentation disorders are considered transitory dermatoses of newborn infants. Nail pigmentation manifests as asymptomatic brown to bluish-black skin pigmentation over the fingers and toes in newborns. Hyperpigmentation of the distal phalanx of both hands and feet is commonly found in dark-skinned newborns, but it is rare in fair-skinned newborns and East Asian populations. We herein describe a Chinese infant with transient neonatal hyperpigmentation of the proximal nail fold.


Assuntos
Hiperpigmentação , China , Dedos , Humanos , Lactente , Recém-Nascido
2.
J Coll Physicians Surg Pak ; 32(1): 92-95, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34983155

RESUMO

OBJECTIVE: To determine if local flap coverage is functionally compatible of digital defects. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Plastic and Reconstructive Surgery, Fauji Foundation Hospital, Rawalpindi, from January 2017 to June 2019. METHODOLOGY: Patients with small and medium skin defects on digits were included. Data was collected for both independent and dependent variables, emphasising on functional outcome based on five parameters (adequate coverage of the defect, functional length of the digit, painless scar, finger-tip sensation, and inter-phalangeal joint motion). Follow-up was done for six months. RESULTS: Total number of patients included in the study was 96, with 45 male and 51 female patients. Mean age of study participants was 26.6 ± 16.9 years. Small to medium size defects were included in the study for coverage by local flaps like cross figure, lateral proximal phalanx, flag, thenar, homo-digital flaps etc. Results were studied in terms of functional outcomes. All the five parameters were achieved in 84 (87.5%) patients. Complications were observed in 10 (10.4%) patients. The most frequent complication was wound infection, which was observed in 2 (2.1%) patients. CONCLUSION: Local flaps for finger defects are a very effective way of providing durable soft tissue coverage. Key Words: Digital defects, Digital reconstruction, Local flaps for digits, Hand injuries.


Assuntos
Traumatismos dos Dedos , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Criança , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Humanos , Masculino , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
4.
Plast Reconstr Surg ; 149(1): 38e-47e, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34936614

RESUMO

BACKGROUND: Fingertip replantation is technically challenging. Venous congestion is one of the most common causes of replantation failure. Therefore, various venous drainage procedures and salvage techniques have been used in venous congestion. Negative-pressure wound therapy has proven beneficial in limb injuries, yet limited studies of fingertip replantation exist. This study aims to analyze risk factors in fingertip replantation and to evaluate the feasibility and clinical benefits of negative-pressure wound therapy compared with other salvage techniques. METHODS: From January of 2015 to December of 2019, 27 patients (27 digits) who experienced fingertip amputation over Tamai zone I or II underwent replantation. Salvage negative-pressure wound therapy was applied for venous congestion postoperatively. Replantation data were collected for further analysis. RESULTS: The overall survival rate of digit replantation with salvage negative-pressure wound therapy was 92.6 percent (25 of 27). The blood transfusion rate was 11.1 percent (three of 27). The average hospitalization time was 8.04 ± 1.43 days and the median duration of negative-pressure wound therapy was 6 days (range, 4 to 8 days; interquartile range, 2 days). There is no significant difference between the survival and failure groups for all risk factors evaluated. CONCLUSION: Negative-pressure wound therapy is a simple and effective salvage option to relieve venous congestion in fingertip replantation with a satisfactory survival rate, low blood transfusion rate, and short inpatient stay. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Amputação Traumática/terapia , Traumatismos dos Dedos/terapia , Dedos/cirurgia , Tratamento de Ferimentos com Pressão Negativa/métodos , Reimplante/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Adulto Jovem
5.
Plast Reconstr Surg ; 149(1): 57e-59e, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34936618

RESUMO

SUMMARY: Syndactyly is one of the most common congenital differences treated by hand surgeons. Although dozens of techniques for syndactyly release have been described, a reliable method is based on a dorsal rectangular flap for commissure construction and a combination of interdigitating zigzag flaps and skin grafts for digital coverage. In this article, the authors present a detailed description of syndactyly release emphasizing principles integral to successful outcomes.


Assuntos
Dedos/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Sindactilia/cirurgia , Pré-Escolar , Estética , Dedos/anormalidades , Humanos , Lactente , Masculino , Técnicas de Sutura , Resultado do Tratamento
6.
Appl Ergon ; 99: 103636, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34773741

RESUMO

In this study the geometric parameter of the contact length is introduced, which intends to combine force exertion and perceived handle comfort in an anthropometric length in order to determine an optimal handle circumference. To prove suitability of the approach, 31 subjects were determined and correlations to handle circumferences with the highest finger forces and highest rated comfort were investigated. For all fingers, medium correlations were found among the contact lengths and the circumferences determined with maximum force (p < 0.001, rindex = 0.348, rmiddle = 0.419, rring = 0.374 and rlittle = 0.337) with high accordance of median values. Weak to moderate correlations were found between circumferences with maximum comfort and the contact lengths (p < 0.001, rindex = 0.150, rmiddle = 0.265, rring = 0.174). Using finger-specific proportionality factors, the contact lengths can be determined directly from the hand lengths, which enables great benefits for user-centered design.


Assuntos
Força da Mão , Design Centrado no Usuário , Desenho de Equipamento , Dedos , Mãos , Humanos
7.
BMJ ; 375: e067849, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34911738

RESUMO

OBJECTIVES: To explore whether random chance, weak research methodology, or inappropriate reporting can lead to claims of statistically significant (yet, biologically meaningless) biomarker associations, using as a model the relation between a common surrogate of prenatal testosterone exposure, second-to-fourth digit ratio (2D:4D), and a random indicator of good luck. DESIGN: Cross sectional study. SETTING: University sports performance laboratory in the United States. Data were collected from May 2015 to February 2017. PARTICIPANTS: 176 adults (74 women, 102 men), including university students, faculty, and staff with no history of injuries, disease, or medical conditions that would affect digit length. MAIN OUTCOME MEASURES: 2D:4D, body composition parameters potentially influenced by androgens (bone mineral content, bone mineral density, body fat percentage), and good luck (using poker hands from randomly selected playing cards as a surrogate). RESULTS: 2D:4D significantly correlated with select body composition parameters (Spearman's r s range -0.26 to 0.23; P<0.05), but the correlations varied by sex, participant hand measured, and the method of measuring 2D:4D (by photocopy or radiography). However, the strongest correlation observed was between right hand 2D:4D in men measured by radiograph and poker hand rank (r s=0.28, P=0.004). CONCLUSIONS: Greater prenatal exposure to testosterone, as estimated by a lower 2D:4D, significantly increases good luck in adulthood, and also modulates body composition (albeit to a lesser degree). While these findings are consistent with a wealth of research reporting that 2D:4D is related to many seemingly disparate outcomes, they are not meant to provide confirmatory evidence that 2D:4D is a universal biomarker of nearly everything. Instead, the associations between 2D:4D and good luck are simply due to chance, and provide a "handy" example of the reproducibility crisis within medical and scientific research. Biologically sound hypotheses, pre-registration of trials, strong methodological and statistical analyses, transparent reporting of negative results, and unbiased interpretation of data are all necessary for biomarker studies and other areas of clinical research.


Assuntos
Composição Corporal , Dedos/anatomia & histologia , Jogo de Azar , Adulto , Estudos Transversais , Feminino , Humanos , Masculino
8.
Artigo em Inglês | MEDLINE | ID: mdl-34905493

RESUMO

Tremors are a common movement disorder that affects a person's life adversely. With various drawbacks of current treatment methods, there is a need for a mechanical solution. The authors present a soft orthosis based on layer jamming for the suppression of hand tremors. A vacuum supplied to the layer jamming elements which contain a stack of layers attached to the glove leads to increased stiffness in the glove, suppressing the tremor. The behavior of the tremor in a cohort of patients in Sri Lanka was studied and showed that the tremor's mean frequency was 5.05 ± 2.03 Hz. An existing analytical model was modified and verified experimentally to select the layer jamming element. An element with sandpaper (320 grade) and tracing paper was chosen based on the high stiffness provided at a lower weight (total weight of the glove = 30g). Experimental results show minimal variation in stiffness for vacuum pressures between 10-50 kPa (abs.). The performance evaluation on a test rig was used to verify the efficacy of the glove and showed optimal placement on the palmar side with a mean tremor amplitude reduction of 78.32%. Clinical trials conducted on 11 recruited tremor patients showed a mean frequency power reduction of 41.74 ± 12.11%, 41.99 ± 14.82%, and 24.71 ± 12.18% in the index and middle fingers and in grasping, respectively with a maximum power reduction of 59.15%. The soft, low weight orthosis shows a high tremor suppression in both the test rig and clinical experiments.


Assuntos
Dedos , Tremor , Mãos , Força da Mão , Humanos , Aparelhos Ortopédicos
9.
Nat Commun ; 12(1): 7177, 2021 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-34907178

RESUMO

Robotic hands perform several amazing functions similar to the human hands, thereby offering high flexibility in terms of the tasks performed. However, developing integrated hands without additional actuation parts while maintaining important functions such as human-level dexterity and grasping force is challenging. The actuation parts make it difficult to integrate these hands into existing robotic arms, thus limiting their applicability. Based on a linkage-driven mechanism, an integrated linkage-driven dexterous anthropomorphic robotic hand called ILDA hand, which integrates all the components required for actuation and sensing and possesses high dexterity, is developed. It has the following features: 15-degree-of-freedom (20 joints), a fingertip force of 34N, compact size (maximum length: 218 mm) without additional parts, low weight of 1.1 kg, and tactile sensing capabilities. Actual manipulation tasks involving tools used in everyday life are performed with the hand mounted on a commercial robot arm.


Assuntos
Mãos/fisiologia , Robótica/métodos , Antropometria , Fenômenos Biomecânicos , Desenho de Equipamento , Dedos/anatomia & histologia , Dedos/fisiologia , Mãos/anatomia & histologia , Articulação da Mão/anatomia & histologia , Articulação da Mão/fisiologia , Força da Mão/fisiologia , Humanos , Amplitude de Movimento Articular/fisiologia , Robótica/instrumentação , Tato/fisiologia
10.
PLoS One ; 16(12): e0261450, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34929012

RESUMO

Assessment of repetitive movements (e.g., finger tapping) is a hallmark of motor examinations in several neurologic populations. These assessments are traditionally performed by a human rater via visual inspection; however, advances in computer vision offer potential for remote, quantitative assessment using simple video recordings. Here, we evaluated a pose estimation approach for measurement of human movement frequency from smartphone videos. Ten healthy young participants provided videos of themselves performing five repetitive movement tasks (finger tapping, hand open/close, hand pronation/supination, toe tapping, leg agility) at four target frequencies (1-4 Hz). We assessed the ability of a workflow that incorporated OpenPose (a freely available whole-body pose estimation algorithm) to estimate movement frequencies by comparing against manual frame-by-frame (i.e., ground-truth) measurements for all tasks and target frequencies using repeated measures ANOVA, Pearson's correlations, and intraclass correlations. Our workflow produced largely accurate estimates of movement frequencies; only the hand open/close task showed a significant difference in the frequencies estimated by pose estimation and manual measurement (while statistically significant, these differences were small in magnitude). All other tasks and frequencies showed no significant differences between pose estimation and manual measurement. Pose estimation-based detections of individual events (e.g., finger taps, hand closures) showed strong correlations (all r>0.99) with manual detections for all tasks and frequencies. In summary, our pose estimation-based workflow accurately tracked repetitive movements in healthy adults across a range of tasks and movement frequencies. Future work will test this approach as a fast, quantitative, video-based approach to assessment of repetitive movements in clinical populations.


Assuntos
Movimento , Gravação em Vídeo/métodos , Adulto , Feminino , Dedos , Mãos , Humanos , Perna (Membro) , Masculino , Projetos Piloto , Postura , Smartphone
11.
Sensors (Basel) ; 21(24)2021 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-34960285

RESUMO

Upright posture control and gait are essential for achieving autonomous daily living activities. Postural control of upright posture relies, among others, on the integration of various sensory information. In this context, light touch (LT) and light grip (LG) of a stationary object provide an additional haptic sensory input that helps to reduce postural sway. When LG was studied through the grasp of a cane, the sensory role of this assistive tool was often limited to a mediation interface. Its role was restricted to transmit the interaction forces between its tip and the ground to the hand. While most studies involve participants standing in an unstable way, such as the tandem stance, in this paper we study LG from a different perspective. We attached a handle of a cane firmly to a stationary support. Thus, we can focus on the role of the hand receptors in the LG mechanism. LG condition was ensured through the tactile information gathered by FSR sensors placed on the handle surface. Moreover, participants involved in our study stood in a usual way. The study involved twelve participants in an experiment composed of two conditions: standing relaxed while lightly gripping an equipped handle attached to the ground, and standing in the same way without gripping the handle. Spatial and frequency analyses confirmed the results reported in the literature with other approaches.


Assuntos
Força da Mão , Postura , Bengala , Dedos , Humanos , Equilíbrio Postural , Posição Ortostática
12.
Sensors (Basel) ; 21(24)2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34960434

RESUMO

A robot's ability to grasp moving objects depends on the availability of real-time sensor data in both the far-field and near-field of the gripper. This research investigates the potential contribution of tactile sensing to a task of grasping an object in motion. It was hypothesised that combining tactile sensor data with a reactive grasping strategy could improve its robustness to prediction errors, leading to a better, more adaptive performance. Using a two-finger gripper, we evaluated the performance of two algorithms to grasp a ball rolling on a horizontal plane at a range of speeds and gripper contact points. The first approach involved an adaptive grasping strategy initiated by tactile sensors in the fingers. The second strategy initiated the grasp based on a prediction of the position of the object relative to the gripper, and provided a proxy to a vision-based object tracking system. It was found that the integration of tactile sensor feedback resulted in a higher observed grasp robustness, especially when the gripper-ball contact point was displaced from the centre of the gripper. These findings demonstrate the performance gains that can be attained by incorporating near-field sensor data into the grasp strategy and motivate further research on how this strategy might be expanded for use in different manipulator designs and in more complex grasp scenarios.


Assuntos
Robótica , Percepção do Tato , Dedos , Força da Mão , Tato
13.
Vasc Health Risk Manag ; 17: 809-816, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34934323

RESUMO

Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2-3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach's syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.


Assuntos
Dedos/irrigação sanguínea , Hematoma/etiologia , Diagnóstico Diferencial , Traumatismos dos Dedos/complicações , Hematoma/diagnóstico por imagem , Hematoma/genética , Hematoma/patologia , Humanos , Dor , Recidiva , Síndrome
14.
Sensors (Basel) ; 21(24)2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34960489

RESUMO

The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F1,140 = 46.17, p < 0.01) and index finger (F1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.


Assuntos
Dedos , Força da Mão , Idoso , Envelhecimento , Mãos , Humanos , Polegar
15.
Ortop Traumatol Rehabil ; 23(5): 375-380, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34734561

RESUMO

Klippel-Trenaunay syndrome is a rare congenital malformation which may be associated with macrodactyly. The main problem is the need for custom-made shoes. We describe the case of a female newborn affected by Klippel-Trenaunay syndrome, with a larger and longer right foot; the difference increased progressively and, at 5 years of age, the right foot was 50% larger and 38% longer than the left one. Due to the progression of the deformity, reduction surgery was advised to reduce the foot's width. Resection of the second ray and 2nd cuneiform was performed. The result was excellent and there were no complications during a 10-year follow-up period with a decrease of width and length difference to 10% and 4%, respectively, in comparison to the contralateral foot. There were no gait anomalies. Abnormal foot width and length represented the main problems and guided the surgical strategy. Second ray resection was effective, without complications and with a good long-term functional outcome. Possibility of wearing fashionable conventional shoes without insoles was achieved to the patient's satisfaction.


Assuntos
Síndrome de Klippel-Trenaunay-Weber , Deformidades Congênitas dos Membros , Feminino , Dedos/anormalidades , Humanos , Recém-Nascido , Síndrome de Klippel-Trenaunay-Weber/complicações , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Deformidades Congênitas dos Membros/cirurgia
16.
Cir Cir ; 89(S1): 62-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762626

RESUMO

Achenbach syndrome is a condition of unknown etiology, characterized by changes in the coloration of the skin of the fingers and associated with acute pain. There are few epidemiological data, but it is estimated that it is a rare condition, which exceptionally appears under 40 years of age. We present the case of a young woman who has been diagnosed with Achenbach syndrome thanks to her history and after ruling out rheumatic, vascular, and metabolic pathology. We finalize by discussing data on the pathology and the differences found with the case we describe here.


Assuntos
Dedos , Hematoma , Diagnóstico Diferencial , Feminino , Humanos , Doenças Raras , Síndrome
17.
BMC Neurol ; 21(1): 432, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740330

RESUMO

OBJECTIVE: To explore the sensitivity of median and ulnar nerve sensory latency differences in diagnosing carpal tunnel syndrome (CTS) at different severities. METHODS: CTS patients were divided into three groups based on disease severity (mild, moderate, and severe). Distal latency of sensory nerve action potential (SNAP) for the median and ulnar nerves was recorded. The sensitivity of SNAP distal latency to CTS and its correlation with CTS severity were analyzed. RESULTS: Significant differences were found in the median nerve sensory action potential distal latency (MSDL) and in the median and ulnar sensory latency difference to ring finger (MUD) but not in the ulnar nerve sensory action potential distal latency (USDL) between CTS and control. The sensitivity and specificity were 92.2 and 99.4% with an MSDL cutoff value of 2.40 ms, respectively, and were both 100% with a MUD cutoff value of 0.33 ms. There was no significant difference in USDL among the CTS and control groups. Significant differences were found in MSDL and MUD among the CTS severities and between mild and moderate CTS, but not between mild and severe CTS or between moderate and severe CTS. Correlations with CTS severity were observed for MSDL and MUD but not for USDL. CONCLUSION: The ulnar nerve of the CTS patients was not damaged. A smaller MSDL reflected median nerve damage, which can be used for the early diagnosis of CTS. MUD correlated with CTS severity with a higher sensitivity than MSDL, which can provide therapeutic insight without pain to patients.


Assuntos
Síndrome do Túnel Carpal , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/terapia , Dedos , Humanos , Nervo Mediano , Condução Nervosa , Nervo Ulnar
18.
BMJ Case Rep ; 14(11)2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728503

RESUMO

A primiparous woman in her late 30s at 28+1 weeks' gestation presented with a 3-day history of abdominal pain, loss of appetite, nausea and vomiting and was diagnosed with starvation ketoacidosis. A routine admission swab returned positive for COVID-19. She had been diagnosed with acrorenal syndrome from birth. Three days post admission, she deteriorated rapidly into respiratory failure requiring intubation and ventilation. She was treated with dexamethasone, prophylactic enoxaparin, a course of piperacillin/tazobactam followed by meropenem and fluconazole and 8 cycles of proning. An emergency caesarean section was performed on day 12 of hospital admission at 29+5 weeks' gestation to improve maternal oxygenation and ventilation. The baby had deformities consistent with acrorenal syndrome but no evidence of COVID-19. She spent 23 days in the intensive care unit. Our case describes an unusual presentation of COVID-19, the challenges in managing critically ill pregnant patients along with a rare background history of acrorenal syndrome.


Assuntos
COVID-19 , Cetose , Adulto , COVID-19/complicações , Cesárea , Feminino , Dedos/anormalidades , Deformidades Congênitas da Mão , Humanos , Rim/anormalidades , Gravidez
20.
J Indian Prosthodont Soc ; 21(4): 339-347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810361

RESUMO

This study aimed to perform an integrative review of the literature on the use of silicone finger prostheses in amputee patients. Searches were performed in the PubMed, EMBASE, Web of Science, Scielo, and Cochrane Library databases until July 2021. Descriptors used in this article were: Silicone, finger, rehabilitation, and prosthesis. Clinical research and clinical reports on silicone finger prostheses, available in full and in English were included. Initially, 152 articles were identified. After establishing the inclusion/exclusion criteria, 23 studies were identified and constituted the final sample. Regarding the publication date of the included studies, 17.2% of them were published between 2012 and 2016. Most of the rehabilitations occurred in India (69.9%; n = 16), and the mean age of patients who used prostheses was 38.1 years. The level of scientific evidence of the included studies was IV and VI. Therefore, patients rehabilitated with silicone finger prostheses highlighted significant improvements in functional range of motion, restoration of self-esteem, advantages in psychological therapy, more pleasant social interaction, and changes in their quality of life.


Assuntos
Amputados , Membros Artificiais , Adulto , Dedos , Humanos , Qualidade de Vida , Silicones
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