Clinical application of neurovascular staghorn flap for repairing of defects in fingertips / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.@*METHODS@#Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly.@*RESULTS@#All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases.@*CONCLUSION@#The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.

Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed.@*METHODS@#Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases.@*RESULTS@#All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes.@*CONCLUSION@#The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

Squamous Cell Carcinoma of the Finger Nail Bed: An Onychomycosis Like Lesion

@#Squamous cell carcinoma is a form of skin malignancy that involves squamous cells lining the epidermis. It is the second most common form of non-melanoma skin malignancy. We describe a case of squamous cell carcinoma involving the nail bed of an elderly gentleman that was initially diagnosed as a case of fungal infection of the nail bed.

Repair fingertip defect and soft tissue defect of donor site with nerve anastomosed relay flap / 中华显微外科杂志

Objective:To explore the method and effect of repairing fingertip defect and soft tissue defect in donor area by relay flap with suture nerve.Methods:From January 2017 to May 2019, 11 cases of fingertip defects were repaired with reverse island fascial pedicle flap of dorsal digital artery sutured with nerve, with a flap area of 0.6 cm×1.2 cm-1.6 cm×2.0 cm, and the flap donor area was repaired with dorsal metacarpal artery cutaneous branch flap. The patients were followed-up by outpatient, reexamination and WeChat interviews.Results:Twenty-two flaps of 11 cases survived completely and the wound healed in stage I. The postoperative follow-up ranged from 3 to 36 months, with an average of 13 months. The flap and pedicle were not bloated, the shape of finger was satisfactory, the texture was soft, and the skin color was close to the skin of finger. Sensory recovery≥S 3. The TPD of the flap was 6-11 mm, with an average of 8.4 mm. Hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Chinese Medical Association: excellent in 10 cases and good in 1 case. The patients were satisfied with the repair effect and resumed their daily life and work. Conclusion:This operation is simple, does not need to sacrifice the main blood vessels and nerves, can restore the good shape and sensction of the affected finger, with the activity close to normal. It is an effective method to repair the fingertip defect.

Semi-occlusive dressing as non-operative treatment vs. operative treatment for fingertip amputations: A retrospective cohort study

INTRODUCTION@#Treatment of fingertip amputations have demonstrated good outcomes with both surgical and nonsurgical management.@*OBJECTIVE@#The objective of this study was to compare non-operative treatment with semi-occlusive dressing with any surgical treatment for fingertip amputations in adult fingers, Allen types I-III in a retrospective cohort review.@*METHODS@#A retrospective chart review was done on adult patients with fingertip amputations Allen types I-III from January 1, 2018 to December 31, 2020. Patients included in the studies were distributed into two treatment groups: non-operative and operative groups. Outcomes to be measured were time to full healing, range of motion, nail deformities, Tinel’s sign, and discoloration of the reconstructed fingertip.@*RESULTS@#A total of 38 patients with 40 digits were included (19 patients with 20 digits for each treatment group). The results showed a larger defect for the operative group (3 cm2 vs 2.1 cm2), with shorter time to healing (1.4 months vs 2.2 months). There were more complications in the operative group like the Tinel’s sign, nail deformity and discoloration, as well as joint contractures. Range of motion was better for patients treated non-operatively.@*CONCLUSION@#Treatment with semi-occlusive dressing showed similar results in terms of wound healing but takes a longer time and less complications compared to operative treatment.

Middle fingertip to rascette line measurement novel approach to endotracheal tube depth for Filipinos: A pilot study

@#A predetermined endotracheal tube depth prior to intubation ensures correct tube placement relative to the carina. The objective of this study was to determine if the topographic measurement from the middle fingertip (MFT) to Rascette line (RL) or "wrist line" correlates with acceptable endotracheal tube (ET) depth during orotracheal intubation. This was a prospective, analytical cross-sectional pilot study of 54 adult Filipino patients who underwent general anesthesia with orotracheal intubation. The middle fingertip to Rascette line measurement was utilized as the basis for endotracheal tube depth with ET secured on the right corner of the mouth. After intubation, a chest x-ray was performed to measure the distance from the endotracheal tube tip to the carina. The study showed that the average middle fingertip to Rascette line measurement among Filipinos was 18.79cm (± 1.08) which resulted in 85.19% of patients with ET tip to carina within the acceptable distance of 2-Scm, with a mean value of 3.17cm. The mean MFT to RL measurement in females was 18.28cm and 19.81 cm in males. The mean distance of ET tip to carina in females was 2.91 cm and 3.66cm in males. There was a significant positive correlation between the middle fingertip to Rascette line measurement and height. This study also documented the total length from the right corner of the mouth to carina, by adding middle fingertip to Rascette line measurement and the distance from ET tip to carina, resulting in a mean value of 23.46cm (±2.06) in males and 21.19 cm (±1 .73) in females. In conclusion, middle fingertip to Rascette line measurement is an acceptable technique to determine individualized endotracheal tube depth during orotracheal intubation. This topographic measurement resulted in 96.29% of ET tip :?: 1 cm above the carina.

Effects of hand-transmitted vibration on fingertip terminal nerve: A meta-analysis / 环境与职业医学

Background Hand-transmitted vibration is one of the most common occupational hazards and is closely related to symptoms of fingertip terminal nerve damage. Objective To analyze the effects of hand-transmitted vibration on the terminal nerve of fingertips. Methods We systematically searched literature about the effects of hand-transmitted vibration on fingertip terminal nerve at home and abroad. The outcome index was the number (rate) of fingertip terminal nerve symptoms reported by the vibration group and the control group, such as finger numbness and finger tingling, and the search period was from database inception to December 2021. The quality of cross-sectional studies was assessed using the criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), and the quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). NoteExpress 3.2 was used for literature management, and Excel 2003 was used for data collection and extraction. RevMan 5.4.1 software was used for statistical analysis, and random effect model was used to calculate the OR value of pooled effects and to draw forest plots. Subgroup analysis was carried out according to the working years with vibration exposure. At the same time, sensitivity analysis was performed after excluding studies with the largest weight and funnel plots were generated to evaluate publication bias. Results A total of 3619 articles were retrieved, and 39 articles were finally included, including 29 Chinese articles and 10 English articles; 36 cross-sectional studies and 3 cohort studies. In total, 8399 subjects were studied, including 5673 cases in the vibration exposure group and 2726 cases in the control group. Random effect model was used to merge the included literature. The results of meta-analysis showed that compared with the control group, hand-transmitted vibration was significantly associated with the self-reported occurrence of finger numbness (OR=8.29, 95%CI: 5.43-12.66), finger tingling (OR=7.50, 95%CI: 4.78-11.77), finger swelling (OR=8.25, 95%CI: 4.06-16.76), finger stiffness (OR=10.71, 95%CI: 3.60-31.87), finger trembling (OR=5.11, 95%CI: 2.60-10.04), hand weakness (OR=11.05, 95%CI: 3.98-30.68), hand sweating (OR=2.70, 95%CI: 1.64-4.43), hand coldness (OR=3.54, 95%CI: 2.42-5.18) (P<0.01). The subgroup analysis showed that the odds ratios of both finger numbness and finger tingling increased in the early and middle stages of vibration exposure (<5 years and 5-10 years of exposure duration）(finger numbness: OR=11.11, 19.07; finger tingling: OR=4.70, 16.55, respectively)(P<0.01), and decreased in the late stage of vibration exposure (10-15 years and ≥15 years of exposure duration) (finger numbness: OR=9.57, 2.30; finger tingling: OR=5.71, 6.00, respectively) (P<0.01). The results of sensitivity analysis showed a stable pooled effect (OR=13.96, 95%CI: 4.85-40.13, Z=4.89, P<0.01). The funnel plot results showed positive publication bias. Conclusion Occupational exposure to hand-transmitted vibration can cause finger numbness, finger tingling, finger swelling, finger stiffness, finger trembling, hand weakness, hand sweating, and hand coldness.

Repair of fingertip defect with lateral V-Y advancement flap with one side palmar proper digital artery: Report of 27 cases / 中华显微外科杂志

Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

Background: Finger injuries are becoming more common with the increasing use of mechanical, industrial, and household appliances. There are six main types of repair for this injury. The replacement of skin loss in digital injuries, particularly on the volar aspects, is an important part of hand-injury management. It would be of value to know the best type of cover, especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications. The objective of this study was to measure incidence of age, sex, site, pattern of injury as well as to evaluate and compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.Methods: In a prospective study between May 2014 to October 2018 consisting of 50 patients (43 males, 7 females), aged between 2 years and 54 years, with soft tissue loss distal to metacarpophalangeal joint were treated with either free split-thickness skin grafts, palmar flaps, cross-finger flap or pedicle flaps from the abdomen. The follow-up period ranged from 10 days to 15 months from the date of surgery. Subjective and objective evaluation was done and graded as excellent, good, fair and poor.Results: In this series there were 2 good and 6 fair results for split skin grafting; 9 good and 6 fair results for v-y plasty; 5 excellent, 12 good and 4 fair results for cross finger flap; 1 good and 1 fair result for radial artery based flap; 1 excellent and 1 good for first metacarpal artery based flap and 2 good results for abdominal flap. Overall 6(12%) had excellent, 27(54%) had good and 17(34%) had fair results. None of them had poor results.Conclusions: The group of patients with cross-finger flaps had less subjective complaints and more normal objective testing results than the other groups. When an extensive tactile pad avulsion exists, the cross-finger pedicle flap offers the best long-term result with fewer secondary problems. The exclusive use of any one method cannot be advocated since each serves an useful purpose under proper conditions.

Use of partial nail carried by great toe fibular flap for repairing the defect of fingertip soft tissue and nail bed: 12 cases report / 中华显微外科杂志

Objective To investigate the method and clinical outcome of partial nail carried by great toe fibular flap for repairing the defect of fingertip soft tissue and nail bed.Methods From June,2016 to October,2017,12 cases suffered the defect of fingertip soft tissue and nail bed.The injury fingers included 5 index fingers,6 mindle fingers and 1 ring finger.All cases were complicated with nail bed defect of different degrees.The nail matrix was intact.The area of fingertip defect ranged from 1.0 cm×1.0 cm to 1.5 cm×2.5 cm.The area of nail bed defect ranged from 0.2 cm×0.8 cm to 0.5 cm×1.5 cm.Great toe fibular flap combine with partial nail was harvested.Donor site was directly sutured or skin grafting according to the size.The regular preoperative followed-up was performed.Results All flaps survived with donor sites healing good.The average followed-up time was 7 (ranging from 2 to 10) months,and cosmetically acceptable results were achieved for all patients.The mean static 2-PD in the flaps was 7.5 (range,6.0 to 8.0) mm.No obvious deformity of the great toe nail.Conclusion Findings proved that using partial nail carried by great toe fibular flap is a beneficial microsurgical alternative for reconstructing defect of fingertip soft tissue and nail bed.

Clinical effect analysis of palmar venous anastomosis in fingertip replantation / 中华显微外科杂志

Objective To investigate the feasibility and clinical effect of palmar venous anastomosis in fingertip replantation.Methods From October,2008 to May,2017,the clinical data of 15 patients with 24 finger replantation were retrospectively analyzed by outpatient,telephone and WeChat followed-up.One artery was anastomosed for revascularization with or without nerve repair,and 1 palmar venous anastomosis was performed to reestablish the outflow system.The finger nerve was sutured randomly according to the injury.Results The patients were followed-up for 18-65 (mean,39.9) months.Except for 1 replantation finger with rotation avulsed injury failed,the remaining 14 cases with 23 fingers survived completely.Excellent restoration of finger motion was observed during the follow-up.The mean regained static 2-point discrimination sensation was 3.6 (2.8-4.0) mm.All patients were satisfied with the treatment effect.Conclusion Successful palmar venous anastomosis can improve the survival rate of replanted fingertips,simplify postoperative care,reduce postoperative complications,and improve the treatment effect.

Preliminary study on functional and aesthetic reconstruction by using a small artery-only free medial flap of the second toe for fingertip injuries

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.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the re鄄lationship between the incidence of vein crisis and superficial vein anastomosis. Methods A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed.The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anasto鄄mosis was compared by Chi-square test. The difference was considered as statistically significant when P＜0.05. The regular postoperative followed-up was performed. Results The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The dif鄄ference was statistically significant ( χ2=4.217, P＜0.05). There was no significant difference in the superior rate be鄄tween the 2 groups after operation(96.8% and 90.0% respectively, χ2=0.596, P＞0.05). The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm. Con鄄clusion DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective@#To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the relationship between the incidence of vein crisis and superficial vein anastomosis.@*Methods@#A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed. The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anastomosis was compared by Chi-square test. The difference was considered as statistically significant when P<0.05. The regular postoperative followed-up was performed.@*Results@#The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The difference was statistically significant (χ2=4.217, P<0.05) . There was no significant difference in the superior rate between the 2 groups after operation (96.8% and 90.0% respectively, χ2=0.596, P>0.05) . The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm.@*Conclusion@#DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Dermatoglyphic Pattern On Fingertips Of Thalassemia Patients: A Case Control Study In North Indian Population

Background: Dermatoglyphics is the scientific study of fingerprints. Fingerprint is a multifactorial trait. Largenumber of genes play their role along with environmental influence. Chromosomal aberration affect these genesand produce variation in dermatoglyphic pattern in various chromosomal syndromes.Materials and methods: The present study was conducted in the Department of Anatomy, Government MedicalCollege and Rajindra Hospital,Patiala and is based on digital dermatoglyphics of 100 Thalassemic patientsfrom Thalassemia Ward of Rajindra Hospital, Patiala hailing from Northern region of India. The control groupcomprises of 50 individuals of similar origin. Fingertip dermatoglyphic patterns of both hands of Thalassemiapatients and control group were recorded by INK method.The fingertip pattern type was recorded by using Henry’sclassification method. The data so obtained was compiled and analysed statistically.Results: It was found that whorls were most frequent pattern on digit IV in patients and controls, with statisticalsignificance in both hands, right hand (p value .042) and left hand (p value .010). Ulnar loops had preponderanceover other patterns on digit V in both the groups but the difference was statistically significant in left hand (pvalue .033).Conclusion: From our study it can be concluded that dermatoglyphics can prove to be an extremely useful tool forthe preliminary investigations into conditions with a suspected genetic base and dermatoglyphic abnormalitiesshould prove of considerable value in preliminary mass screening.

Effect comparison of anterograde and reverse digital artery island flap in repairing of fingertip defects / 局解手术学杂志

Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects.Methods From January 2015 to December 2016,there were 35 patients with fingertip defects underwent surgical treat-ment in our hospital,including 14 cases underwent surgery with anterograde digital artery island flap(anterograde group)and 21 cases under-went surgery with reverse digital artery island flap(reverse group).The anterograde group used proper palmar digital artery and nerve as the pedicle of flap,then took forward the finger pulp flap to the injured site.The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx.Results All the flaps of the 35 cases were survived.In the anterograde group,reflux obstacle of vein appeared in 1 case,and it was cured with scarification procedures.In the reverse group,there were 3 cases of vascular crisis.After dressing release and partial remove of the stitching,2 cases of them return to normal.The other 1 case suffered from flap edge necrosis,and then the wound healed after dressing change.The operation time of anterograde group was(107.5 ±18.4)min and it was(139.5 ±18.0)min in the reverse group, which showed significant difference between the two groups(P<0.05).All the 35 cases were followed up for 6 to 12 months,with an average of 8.5 months.At the last follow-up,it showed that patients in both of the two groups had ruddy color,good texture and no significant bloated flap appearance.In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3.Meanwhile,in re-verse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1.The two-points discrimination of the antero-grade group was(4.22 ±0.67)mm,and it was(7.04 ±1.25)mm in the reverse group,which was significantly different(P<0.05).The in-terphalangeal joint motion was(102.67 ±7.35)°at the distal end and(64.46 ±8.37)°at the proximal end in anterograde group.And it was (100.64 ±10.29)°and(60.81 ±10.80)°respectively in the reverse group,with no significant difference between the two groups (P>0.05).The excellent and good rate was 92.8%in the anterograde group and 80.9%in the reverse group by the criteria for functional evaluation,and there was no statistically significant difference(P>0.05).Conclusion For fingertip defects(IshikawaⅠ~Ⅲ)treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy.But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.

Propeller flap based on the terminal dorsal perforator of proper palmar digital artery for reconstruction of fingertip defects / 中华显微外科杂志

Objective To investigate the feasibility and efficacy of using the propeller flaps based on the terminal dorsal branch of proper palmar digital arteries for fingertip reconstruction.Methods From September,2013 to September,2016,25 fingers (25 patients) underwent fingertip reconstruction by using propeller flaps pedicled with the terminal dorsal branch of digital arteries.There were 18 males and 7 females with mean age of 33 years.The injured fingers requiring reconstruction included 13 index,6 middle,5 ring and 1 little fingers.The size of the propeller flaps:small paddles were 0.6 cm×0.4 cm-2.1 cm×0.4 cm;big paddles were 3.0 cm×1.3 cm-5.5 cm ×2.0 cm.The donor sites were closed directly in 16 cases,and skin graft appiled in 9 cases.Results Twenty-three cases fingertip defects were successfully reconstructed with this flap.One case of flap necrosis occurred,requiring secondary revision using a cross-finger flap.Donor sites healed without any complication.The mean follow-up period was 11.5 months (range:7-29 months).Fingers restored good shape and function.At 6 months after surgery,the 2-point discrimination value was 6.5 mm (range,6-10 mm).In 2 cases,protective sensation was successfully restored.The postoperative extension and flexion function was evaluated by the total active movement (TAM) system of finger joints:excellent in 20 fingers,good in 4 fingers and fair in 1 finger.The excellent and good rate was 96％.Conclusion The propeller flap based on the terminal dorsal branch of the proper palmar digital arteries to repair fingertip defect has advantages of achieving good function,appearance and minimized damage to the donor site,which is a effective method in reconstructing the fingertip defect.

Immediate Nail Lengthening with the Eponychial Folding Procedure in Acute Finger Tip Injury

PURPOSE: We present the clinical results and operative method of the immediate eponychium of nail fold set back for lengthening of nails caused by acute fingertip injuries. METHODS: The research was conducted with a total of 172 patients during the period from January 2014 to June 2016. The operation method was performed in a way to fold down the two sides of the nail eponychium and had suture. A survey of the patients' subjective satisfaction was conducted and the relative nail length was compared before and after the operation as well as the nail length of the uninjured contralateral finger. The mean follow-up period was 18.2 weeks. RESULTS: In all cases, the operation time was under 3 minutes. There were no specific complications such as nail eponychium's necrosis or congestion. The new nail did not have any additional deformation. On average, the extended nail length was 3.2 mm. Compared with preoperation, the average extension ratio of the nail length was 48%, even with 75% of nail length recovery in comparison with the uninjured contralateral finger. The subjective self-satisfaction score was 92.5 on average. The satisfaction score was higher for patients who had greater remnant nail length. CONCLUSION: Immediate nail lengthening with the eponychial folding is a simple, safe and useful method with high subjective satisfaction in aesthetics for the patients with acute fingertip injuries.

Factual Survey of Patient Compliance Instructions by Finger-Tip Units for the Purpose of Proper Usage of Adrenocorticosteroid Ointments and Use-Related Evaluation of Such Pharmaceutics / 医薬品情報学

<b>Objective: </b>Finger-tip unit (FTU) has been used in Western countries to apply a specific amount of steroid ointment available in tube form.  Although prescription ointments for treating skin disorders are available in Japan, there are no indications for patients regarding the amount to be used.  Therefore, we investigated the factual assessment of patient compliance instructions on using the ointments given by pharmacists and conducted a comparative test on the amount of ointment in 1 FTU using commercially available ointment tube products.<br><b>Methods: </b>We conducted a questionnaire survey for 21 hospital pharmacists on patient compliance instructions for ointments.  Using six types of ointments, we measured the aperture area of ointment tube, weight of 1 FTU and squeezing number of tube.<br><b>Results: </b>Fewer than 50% of pharmacists explained the application methods and amounts for one-time use when they provided patient compliance instructions.  There were many patients who used an ointment inadequately.  The most were problems about the quantity of application.  Wide variations were found among the amount of ointment in 1 FTU weight and number of available uses.<br><b>Conclusion: </b>The survey results demonstrated that the methods used to apply the ointments are items that must also be emphasized by pharmacists when providing patients compliance instructions.  Furthermore, the patient compliance instructions should include the amount of ointment in 1 FTU and number of available uses within pharmaceutical products.

Resultados de la aplicación de colgajos homodigitales neurovascularizados en los defectos cutáneos del pulpejo digital / Résultats de l'utilisation du lambeau neurovasculaire homodigital dans les défauts de la pulpe digitale / Results of the Application of Neurovascular Homodigital Flaps on Cutaneous Defects of Digital Fingertips

Introducción: las lesiones traumáticas de las manos encabezan la lista de accidentes laborales industriales. El tratamiento de estas lesiones tiene como objetivo restablecer la función de la punta del dedo, mejorando la calidad de vida del paciente. Objetivo: evaluar resultados de la aplicación de colgajos homodigitales neurovascularizados en las lesiones con pérdida compleja de sustancia del pulpejo digital de los dedos largos de la mano . Método: se realizó una investigación de tipo observacional, descriptiva de serie de casos en 33 pacientes con lesión del pulpejo digital de los dedos largos de la mano en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período comprendido desde el 1ro. de octubre de 2013 hasta el 30 de enero de 2015; se aplicaron colgajos homodigitales neurovascularizados monopediculados de circulación directa (17 pacientes) o indirecta (16 pacientes). Resultados: el sexo más afectado fue el masculino, con una mayor frecuencia en los pacientes entre 36-41 y > 41 años edad. Se constataron 4 complicaciones (12 por ciento de la muestra en estudio). Con la aplicación de las técnicas quirúrgicas se logró 72,7 por ciento de resultados entre excelentes y buenos, así como una adecuada sensibilidad protectora y una cobertura cutánea satisfactoria. La satisfacción de los pacientes fue significativa (93,9 por ciento). Conclusiones: se demostró la eficacia de la aplicación de los colgajos homodigitales neurovascularizados en las pérdidas complejas de sustancia del pulpejo en los dedos largos de la mano(AU)

Introduction: traumatic injuries of the hand are in the top list of industrial working accidents. The treatment of these injuries has as goal to restore the function of fingertips, improving the patients' quality of life. Objective: evaluate results of the application of neurovascular homodigital flaps on cutaneous defects of digital fingertips of the hand large fingers. Method: an observational and descriptive investigation was conducted in a case chain of 33 patients at Hermanos Ameijeiras Hospital from October 2013 to January 2015. Neurovascular homodigital flaps were applied with direct circulation (17 patients) or indirect circulation (16 patients). Results: male sex was more affected, frequency higher was between 36 and 41 years old and over 41 years old. Four complications were confirmed representing 12 percent 72.7 percent obtained good and excellent results with the application of these surgical techniques receiving an appropriate protector of sensibility and satisfactory cutaneous covering. Application of these procedures was 93.9 percent satisfied. Conclusions: the application of neurovascular homodigital flaps was established on cutaneous defects of digital fingertip of the hand large fingers(AU)

Introduction: les lésions traumatiques de la main sont à l'avant-garde des accidents du travail. Le traitement de ces lésions est visé à restaurer la fonction de la pointe du doigt, améliorant ainsi la qualité de vie du patient. Objectif: l'objectif de cette étude est d'évaluer les résultats de l'utilisation du lambeau neurovasculaire homodigital dans le recouvrement des lésions avec une grande perte de substance pulpaire des doigts longs de la main. Méthode: une étude observationnelle et descriptive d'une série de 33 patients, souffrant des lésions pulpaires des doigts longs de la main, a été réalisée à l'hôpital Hermanos Ameijeiras pendant la période comprise entre le 1er octobre 2013 et le 30 janvier 2015; des lambeaux neurovasculaires homodigitaux et monopédiculaires à flux artériel antérograde ont été appliqués chez 17 patients et à flux artériel rétrograde chez 16 patients. Résultats: dans ce groupe, les hommes et les tranches d'âge de 36-41 et >41 ans ont été les plus souvent touchés. Quatre complications ont été constatées (dans 12 pourcent des cas). L'utilisation des techniques chirurgicales a obtenu d'excellents à bons résultats (72,7 pourcent), ainsi qu'une appropriée sensibilisation protectrice et une couverture cutanée satisfaisante. La satisfaction des patients a été significative (93,9 pourcent ). Conclusions: on a constaté l'efficacité du lambeau neurovasculaire homodigital pour le recouvrement des pertes de substance pulpaire des doigts longs de la main(AU)