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1.
Unfallchirurg ; 123(2): 126-133, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31915878

RESUMO

BACKGROUND: The ideal surgical and postoperative treatment for flexor tendon injuries, especially in zone 2, is still subject to continuous modifications and professional discussions. OBJECTIVE: Presentation of established rehabilitation concepts, specific problems and new treatment approaches with practical recommendations for application. MATERIAL AND METHODS: Comparison of commonly used treatment concepts by assessing surgical flexor tendon repair, splint choice and clinical application in patients. Discussion of new surgical approaches and standards and their influence on postoperative therapy after flexor tendon injuries. RESULTS: The Washington regimen has retained its status as the standard in the current follow-up treatment of flexor tendon injuries. New suture materials and techniques enable early active rehabilitation of sutured flexor tendons with good clinical results, such as increased range of motion for interphalangeal joint extension and improved distal interphalangeal joint flexion with overall acceptable frequencies of suture rupture. CONCLUSION: A stable tendon repair with smooth gliding is the foundation for treatment after flexor tendon injuries. After intraoperative active digital extension-flexion testing of the sutured tendon an early active rehabilitation approach should follow. New splint designs in combination with primary stable tendon suture techniques have the potential to improve the postoperative outcome, presupposing a reliable cooperation of the patient.


Assuntos
Traumatismos dos Dedos , Traumatismos dos Tendões , Traumatismos dos Dedos/reabilitação , Traumatismos dos Dedos/cirurgia , Humanos , Amplitude de Movimento Articular , Contenções , Técnicas de Sutura , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/cirurgia
2.
Unfallchirurg ; 123(2): 97-103, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31915879

RESUMO

Injuries to the flexor tendons in children are less common than in adults. The clinical examination and diagnostics require extensive experience. Leaving flexor tendons untreated will result in growth disorders of the affected finger. Therefore, the indications for operative exploration of any type of open injury in a child's hand should be liberally applied. As for adults the primary treatment of flexor tendon injuries as an emergency is rarely indicated. In the recent literature various tendon suture techniques and rehabilitation protocols have been differently assessed. According to the Ulm algorithm flexor tendon injuries in children are treated by a 2-strand core stitch technique followed by a continuous circular suture. Children under 6 years of age are postoperatively immobilized for 3 weeks with a fist bandage. Children older than 6 years are treated like adults with a dynamic aftercare as described by Kleinert for 5 weeks. The results are comparable with those of other aftercare protocols.


Assuntos
Traumatismos dos Dedos , Traumatismos da Mão , Traumatismos dos Tendões , Criança , Traumatismos dos Dedos/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Tendões
3.
Arch Orthop Trauma Surg ; 140(1): 139-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31691006

RESUMO

INTRODUCTION: Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. MATERIALS AND METHODS: Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. RESULTS: Mean follow-up period was 4.0 years (range 1.2-7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. CONCLUSION: In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.


Assuntos
Articulações dos Dedos/cirurgia , Articulações/transplante , Traumatismos dos Dedos/cirurgia , Humanos , Satisfação do Paciente , Força de Pinça , Amplitude de Movimento Articular , Articulação do Dedo do Pé/cirurgia
4.
Arch Orthop Trauma Surg ; 140(1): 43-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31486856

RESUMO

INTRODUCTION: Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. MATERIALS AND METHODS: Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. RESULTS: Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. CONCLUSION: The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.


Assuntos
Traumatismos dos Dedos , Articulações dos Dedos , Fratura-Luxação , Fixação de Fratura , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Humanos , Estudos Retrospectivos
5.
Unfallchirurg ; 123(2): 114-125, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31822942

RESUMO

The secondary reconstruction of flexor tendons is in most cases very demanding and tedious. The indications, selection of the correct surgical procedure, operative technique and further treatment have to be individually adjusted and are mostly very difficult. Due to the previous operations unpleasant surprises may occur intraoperatively, which must be recognized and treated by the surgeon. Nevertheless, a significant improvement of the function of the whole hand can be achieved for most patients, e.g. by a two-stage flexor tendon transplantation or other techniques described in this article.


Assuntos
Traumatismos dos Dedos , Traumatismos da Mão , Procedimentos Ortopédicos , Traumatismos dos Tendões , Traumatismos dos Dedos/cirurgia , Mãos , Traumatismos da Mão/cirurgia , Humanos , Traumatismos dos Tendões/cirurgia
6.
BMC Surg ; 19(1): 188, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829162

RESUMO

BACKGROUND: When restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects. METHODS: In this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study. RESULTS: All flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1. CONCLUSIONS: This technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains. TRIAL REGISTRATION: The registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.


Assuntos
Traumatismos dos Dedos/cirurgia , Retalho Perfurante , Lesões dos Tecidos Moles/cirurgia , Adulto , Artérias/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pele , Transplante de Pele , Resultado do Tratamento
7.
J Orthop Surg Res ; 14(1): 365, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727130

RESUMO

BACKGROUND: Flap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly. Sensory reconstruction of the fingers is important for patients to recover feelings. In this study, we report clinical outcomes of using free neurovascular transverse wrist crease flap for repairing finger defects from multiple centers. METHODS: This case series includes 72 consecutive patients with finger defects between June 2013 and June 2016 from multiple centers. A neurovascular transverse free radial artery superficial palmar branch flap, named transverse wrist crease flap, was designed to reconstruct soft tissue defects of the fingers with microvascular anastomosis. When there were soft tissue defects of the fingers with digital nerve defect, end-to-end neurorrhaphy between the median palmar cutaneous branch and the digital nerves was also performed. The donor incision was sutured directly. All the patients were followed-up for more than 24 months. RESULTS: The soft tissue defects of the fingers were all completely covered with this free neurovascular transverse wrist crease flap, and the flaps in 71 patients survived completely without ischemia. Vascular crisis appeared in one case, and the wound healed gradually after changing wound dressing for nearly 1 month. Slight infections of wounds appeared in eight cases. There were no complications in the donor site, like infection and poor wound healing. At the last follow-up, the mean static two-point discrimination was 9.6 ± 2.4 mm on the injured finger and 4.5 ± 0.8 on the contralateral corresponding finger. The motion range of the distal interphalangeal joint and proximal interphalangeal joint on the injured finger were 72.5 ± 23.3% and 78.7 ± 32.5% of the contralateral corresponding finger, respectively. Patient self-evaluations were good in 53 cases and fair in 19 cases. CONCLUSIONS: The results indicate that the free neurovascular transverse wrist crease flap is a good choice for repairing soft tissue defects of the fingers. LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Traumatismos dos Dedos/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Punho/cirurgia
8.
Plast Reconstr Surg ; 144(6): 1351-1357, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764651

RESUMO

BACKGROUND: Treating ring avulsion injuries continues to challenge the reconstructive hand surgeon. The complex operation draws from plastic surgery and orthopedic surgery principles to provide soft-tissue coverage, skeletal fixation, tendon repair, and neurovascular reconstruction. Furthermore, the application of microsurgical techniques has enabled the revascularization and replantation of completely avulsed fingers. METHODS: A retrospective review of 22 consecutive ring avulsion injuries (seven amputations, five replantations, and 10 revascularizations) from 1987 to 2015 performed by a single senior surgeon (D.T.W.C.) was conducted. RESULTS: Of these 22 ring avulsions, 10 revascularizations, five replantations, and seven amputations (five because of clinical factors, and two because of patient request) were performed. None of the 15 replantations and revascularizations resulted in loss of the ring finger or necrosis of the revascularized tip. CONCLUSIONS: With proper patient selection, appropriate level of injury identification, and meticulous surgical execution, the restoration of form and function to the hand is feasible in ring avulsion injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Microcirurgia/métodos , Reperfusão/métodos , Reimplante/métodos , Adulto , Amputação/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
10.
Tech Hand Up Extrem Surg ; 23(4): 176-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738739

RESUMO

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.


Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Adulto , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino
11.
Handchir Mikrochir Plast Chir ; 51(6): 434-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698486

RESUMO

BACKGROUND: After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. PATIENTS AND METHODS: From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. RESULTS: 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. CONCLUSION: For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.


Assuntos
Amputação Traumática , Infecções/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos , Polegar/cirurgia , Dedos do Pé/transplante , Amputação Traumática/cirurgia , Feminino , Traumatismos dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia Plástica/métodos , Dedos do Pé/cirurgia
12.
Plast Reconstr Surg ; 144(5): 878e-911e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688770

RESUMO

LEARNING OBJECTIVES: After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Perform single-digit replantation after viewing the videos. 3. Recognize appropriate cases for joint salvage techniques in periarticular amputation at each joint of the digit and wrist. 4. Outline the methods of flexor and extensor tendon reconstruction in an avulsed amputation of the digit or thumb. 5. Understand the order of digital replantation and transpositional replantation for a restoration of pinch or grip in multiple-digit amputation. SUMMARY: This article provides practical tips and caveats for the latest replantation surgical techniques for digit, hand, and upper extremity amputation. Four videos, clinical photographs, and drawings highlight important points of operative technique and outcomes of replantation.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Reimplante/métodos , Adulto , Feminino , Traumatismos do Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Força da Mão/fisiologia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Reoperação , Reimplante/efeitos adversos , Medição de Risco
13.
J Hand Surg Asian Pac Vol ; 24(4): 405-411, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690202

RESUMO

Background: The objective was to study the hypotheses that an advanced zone II flexor tendon rehabilitation protocol would avoid rupture, achieve a high range of excursion, and minimize interphalangeal contracture during both the early phases and at the conclusion of healing. We also proposed the null hypothesis of no difference between any two of the zone II subdivisions. Methods: Fifty-one consecutive adult patients with zone II flexor tendon repairs of a single finger were retrospectively evaluated on an active contraction rehabilitation protocol with no splint, no tenodesis protection, and immediate full composite extension. There were 38 males and 13 females with a mean age of 39 years (range 18-69) involving 15 index, 7 long, 6 ring, and 23 small fingers. Repairs were located in flexor subzone IIA for 8 fingers; subzone IIB, 14; subzone IIC, 19; and subzone IID, 10. Differences in outcome between any two subzones were compared by T-test with p < 0.05. Results: Mean active arcs of motion in degrees at 3 weeks post repair were PIP 1-93; DIP 0-44; and total active motion (TAM) 221. At 6 weeks PIP 2-98; DIP 1-51; and TAM 236. At 10-12 weeks PIP 1-101; DIP 1-56; and TAM 246. Final TAM by flexor subzone IIA was 243; IIB, 251; IIC, 246; and IID, 246. There were no significant differences between any two subzones. Mean final DASH score was 5. There were no ruptures. Conclusions: The results support the hypotheses. Outcomes of the therapy protocol demonstrated the lack of interphalangeal joint flexion contractures, high range of total active motion achieved early and sustained, and no ruptures. No differences were identified between and two of the flexor subzones.


Assuntos
Traumatismos dos Dedos/cirurgia , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Adolescente , Adulto , Idoso , Feminino , Traumatismos dos Dedos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura , Contenções , Traumatismos dos Tendões/fisiopatologia , Adulto Jovem
14.
J Hand Surg Asian Pac Vol ; 24(4): 488-490, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690204

RESUMO

One of the serious complications of Seymour fractures is infection. A 24-year-old male presented with the open infected distal phalanx fracture of the middle finger. Wound debridement, irrigation, use of antibiotics and external fixation with the aid of mini-Ilizarov provided a resolution to the infectious process and enabled us to achieve a stable osseous union in correct position.


Assuntos
Desbridamento/métodos , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Expostas/cirurgia , Infecção dos Ferimentos/cirurgia , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/diagnóstico , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/diagnóstico , Fraturas Expostas/diagnóstico , Humanos , Masculino , Radiografia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/etiologia , Adulto Jovem
15.
Clinics (Sao Paulo) ; 74: e1226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644661

RESUMO

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.


Assuntos
Artérias/cirurgia , Traumatismos dos Dedos/cirurgia , Dedos/irrigação sanguínea , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Dedos do Pé/irrigação sanguínea , Adulto , Feminino , Dedos/cirurgia , Seguimentos , Humanos , Masculino
16.
Toxicon ; 171: 29-34, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31585139

RESUMO

Envenomations by the Southwestern Speckled Rattlesnake (Crotalus pyrrhus) are fairly rare. Previous descriptions in the literature do not include locality, an important factor in the clinical symptoms or syndromes of snakebites resulting from geographic variation in venom composition. Here, we describe two cases of envenoming by C. pyrrhus from two Arizona localities (Tinajas Altas Mountains, Yuma County, and Phoenix Mountains, Maricopa County). Both patients experienced swelling, but neither demonstrated coagulopathy, thrombocytopenia, or hypofibrinogenemia. The Phoenix Mountains patient developed hemorrhagic bullae and tissue damage in his bitten extremity, necessitating the amputation of the distal portion of his middle finger. Treatment for both consisted of medication for pain, isotonic crystalloid, and antivenom therapy with recovery in each case. Based on visual inspection of 1D-gels and RP-HPLC chromatograms, venom samples were largely similar but appeared to differ quantitatively for several toxin families between and within populations.


Assuntos
Antivenenos/uso terapêutico , Venenos de Crotalídeos/química , Crotalus , Mordeduras de Serpentes/tratamento farmacológico , Adulto , Amputação , Animais , Arizona , Venenos de Crotalídeos/toxicidade , Soluções Cristaloides/uso terapêutico , Traumatismos dos Dedos/cirurgia , Humanos , Soluções Isotônicas/uso terapêutico , Masculino , Mordeduras de Serpentes/patologia , Mordeduras de Serpentes/cirurgia , Resultado do Tratamento
17.
Bone Joint J ; 101-B(10): 1263-1271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564142

RESUMO

AIMS: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS: Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION: A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.


Assuntos
Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Alemanha , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Amplitude de Movimento Articular/fisiologia , Medição de Risco
18.
Hand Surg Rehabil ; 38(6): 375-380, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31521798

RESUMO

We sought to evaluate the long-term quality of life and functional outcome of patients who underwent digital replantation after amputation. A retrospective single-center study was conducted of patients treated between January 2010 to May 2016. Twenty-eight patients who underwent successful replantation after single or multiple digital amputation were reviewed in person after at least 2years' follow-up (mean 4.6years). Total active range of motion, grip and pinch strength were assessed. Functional outcomes were evaluated using the SF-36 and DASH questionnaires. The patients' occupational status and daily activities were reported. Mean total active range of motion was 42% of the contralateral healthy side. Better active mobility and higher grip strength were found when the amputation was distal to the insertion of the common flexor tendon. Mean grip and pinch strength were 80% and 65%, respectively. Fusion did not significantly influence active mobility. The mean DASH score was 22.3. In our study, 77% of the patients returned to the same job and 75% experienced cold intolerance. The majority of patients who underwent digital replantation maintain a quality of life that allows them to return to work. Fusion, especially in the thumb, can be performed with few functional consequences. Even many years after the replantation procedure, sensory recovery remains poor.


Assuntos
Amputação Traumática , Traumatismos dos Dedos/cirurgia , Reimplante , Adolescente , Adulto , Idoso , Temperatura Baixa/efeitos adversos , Avaliação da Deficiência , Feminino , Seguimentos , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Retorno ao Trabalho , Limiar Sensorial , Adulto Jovem
19.
Ann Chir Plast Esthet ; 64(5-6): 694-708, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31526527

RESUMO

Traumatic digit amputation generates functional, aesthetic and psychological disabilities. Such post-traumatic consequences call for a rigorous therapeutic approach, aiming at an early secondary surgical procedure - which is ideally to be performed before the patients psychologically recover from their initial trauma. The therapeutic principle consists in improving the global function of the hand, basically aiming at re-creating a quality pollici-digital pinch, ideally thin, stable, sensitive, strong, mobile enough, but also, when possible, at improving the aesthetic aspect of the hand. The therapeutic arsenal includes not only surgical processes using local ressources in order to improve the allocation of the remaining digital capital such as phalangisation, elongating techniques, proximal amputation, digital translocation and redistribution but also remote processes - such as osteoplastic and toe-to-hand transfer techniques. The authors expose their approach and indications of secondary digit reconstruction procedures in mutilated hand. They conclude that a thorough knowledge and mastery of the vast available therapeutic arsenal, a fine and profound analysis of the benefits and downsides of each available surgical technique, a comprehensive acknowledgement of the patient's personal information such as age, gender, profession, dominant hand, status of the mutilated hand, physical and psychological health as well as patient's desire are all necessary in order to define the best therapeutic strategy for each particular case.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Humanos , Dedos do Pé/transplante
20.
Plast Reconstr Surg ; 144(3): 679-683, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461026

RESUMO

BACKGROUND: Although cryopreservation has been widely used in clinical practice, it remains limited to small or thin bloodless tissues with a simple structure and function. In August of 2002, the authors performed the first successful transplantation of a cryopreserved vascularized rat hind limb. Subsequently, the authors extended this cryopreservation technique to the preservation of human fingers. METHODS: In December of 2002 and December of 2003, the authors performed two in situ implantations of cryopreserved amputated fingers for two patients by means of the "two-step" and programmed cryopreservation methods. In case 1, computed tomographic angiography was performed on the affected hand 6 months after surgery. In case 2, pieces of skin were obtained from the thawed amputated finger for pathologic examination before replantation. RESULTS: One finger was cryopreserved for 81 days and the other for 5 days. Both fingers were replanted successfully. Computed tomographic angiography revealed a patent radial proper digital artery in case 1. The pathologic results of case 2 showed satisfactory skin cell morphology. After 15- and 14-year follow-up assessments of the two patients, the replanted fingers achieved satisfactory appearance and function. CONCLUSIONS: The authors confirmed the effectiveness of deep cryopreservation for the long-term preservation of human fingers. The current application scope of these cryopreservation techniques includes small limbs with minimal amounts of muscle tissue. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Amputação Traumática/cirurgia , Criopreservação/métodos , Traumatismos dos Dedos/cirurgia , Reimplante/métodos , Adulto , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
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