ABSTRACT
ABSTRACT Objective To evaluate postoperative epidemiological and functional factors in patients operated to treat duplicate thumb. Methods This retrospective case series evaluated 20 patients (23 thumbs) treated from January 2012 to December 2016 at our service. Epidemiological and clinical factors were studied, including Tada score. Results Of the 34 children who were treated surgically, only 20 appeared for the functional evaluation and were included in the study. Of the operated cases, 60% were Wassel type 4. All evaluated cases had good functional results (Tada score ≥5, mean score: 6.65). The most frequently used surgical technique was resection of the radial thumb with reconstruction of the radial collateral ligament (47.8% of cases). Conclusion Surgical correction of duplicated thumb yields good results, as long as attention is paid to abnormalities in bones, ligaments, and tendons. Level of Evidence IV; Case series.
RESUMO Objetivo Avaliar os fatores epidemiológicos e funcionais pós operatórios dos pacientes operados por duplicação de polegar. Métodos Essa é uma série retrospectiva de casos em que foram avaliados 20 pacientes (23 polegares), operados entre janeiro de 2012 e dezembro de 2016, no Hospital Menino Jesus/ SP. Foram estudados fatores epidemiológicos e clínicos, dentre os quais o score funcional de Tada. Resultados Das 34 crianças operadas, apenas 20 compareceram para avaliação funcional. Dos casos operados, 60% eram Wassel tipo 4. Todos os casos avaliados obtiveram resultado funcional bom (Tada maior ou igual a 5), com score médio de 6,65. A técnica cirúrgica mais utilizada foi a ressecção do polegar radial com reconstrução do ligamento colateral radial, presente em 47,8% das vezes. Conclusão A correção cirúrgica da duplicação de polegar cursa com bons resultados, desde que se atente para as anormalidades osteoligamentares e tendíneas. Nível de Evidência IV; Série de casos.
ABSTRACT
The authors report a case of superficial acral fibromyxioma (SAF) in a 74-year-old male who presented with a painless mass in a periungual dorsoradial region of the right thumb. It is a rare benign neoplasm, which was recently described, that arouse on the skin and subcutaneous tissue of the hands and feet, especially in the proximity to the ungual region of male adults. Surgical treatment was performed with the excision in blocks of the margins of the lesion and fragmentation of the nail and nail matrix, according to the literature recommendation. Although there may be local recurrence in 22% of the cases, the patient presents no symptoms, deformities or functional limitations. In addition, there was no sign of tumor recurrence 18 months after the surgery. We are not aware of a similar case report in the Brazilian literature.
Subject(s)
Humans , Female , Aged , Antigens, Surface , Fibroma/diagnosis , Hand/surgery , Thumb/surgeryABSTRACT
Objective To evaluate the clinic effects of perioperative psychological intervention combined appropriate sedation by target-controlled infusion of midazolam during operation via symptom check List 90 (SCL-90) and observers assessment of alertness/sedation scale (OAA/S) in patients undergoing thumb or finger reconstruction.Methods Eighty patients undergoing thumb or finger reconstruction were randomly divided into group A,B,C,and D (n =20 cases per group).All patients were received brachial plexus block and spinal-epidural combined anesthesia.Patients in group A were given perioperative psychological intervention combined appropriate sedation by target-controlled infusion of midazolam during operation; patients in group B were received routine treatment; patients in group C were given perioperative psychological intervention; and patients in group D were sedated with midazolam during operation.The vital signs and the scores of OAA/S were observed during operation.The scores of visual analogue scale (VAS) and SCL-90 were recorded after operation.Results The OAA/S grade in groups A and D were stability than that in groups B and C (P ＜ 0.05) ; the scores of VAS and the results of psychological status assessment by SCL-90 in group A were superior to groups B,C,and D (P ＜ 0.05).Conclusions Perioperative psychological intervention combined appropriate sedation in operation on thumb or finger reconstruction is a excellence anaesthesia processing method.It might have beneficial effects on postoperative recovery profile,and strengthen the tolerance to pain and improve the patient's psychological status during operative period.