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ObjectiveTo explore the occupational needs of hand injury patients and the effects of activity-based analysis and occupation-based interventions. MethodsFrom January, 2021 to June, 2022, 212 patients who accepted occupational therapy for wrist-hand injury in Rehabilitation Center of the First Affiliated Hospital of Nanjing Medical University were interviewed using Canadian Occupational Performance Measure (COPM) to collect the activities that they wanted to do, needed to do, were expected to do, but unable to do. Two senior occupational therapists conducted the activity analysis of the summarized needs, identified occupational components, designed a purposeful occupation-based intervention program, and evaluated the performance and satisfaction using COPM. ResultsA cumulative total of 84 occupational needs were proposed, covering five major domains: work, basic activities of daily living, instrumental activities of daily living, leisure and sleep. The activities mostly impaired involved using computer (8.28%), using chopsticks (6.42%), wringing towels (6.25%), travelling on transport (4.90%) and lifting heavy objects (4.73%). The performance and satisfaction improved after treatment (t > 16.572, P < 0.001). ConclusionThe occupational needs are culturally specific for local hand injury patients; the use of an activity-based analysis and occupation-based intervention is effective on meeting the occupational needs.
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Abstract Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.
Resumo O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.
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Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.
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Objective:To investigate the clinical value of digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap.Methods:From January 2015 to February 2021, 9 patients with soft tissue defects in hand were repaired with anterior tibial artery perforator flap assisted by digital technology in flap design, including 6 males and 3 females aged from 19 to 63 years with a mean age of 33 years. The size of defects varied from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm, with exposed bones or tendons. Preoperative CTA scan of lower limb was performed and three-dimensional image was reconstructed with Mimics 20.0. The anterior tibial artery perforator flap was designed according to the shape and size of the defect, then the resection of flap was digitally simulated. The flap based on the digital design was harvested and the defect was repaired in the operation. The size of flap was 2.5 cm×2.0 cm~4.5 cm×3.5 cm. Outpatient clinic follow-up was performed to evaluate the survival of flaps. Disability of Arm, Shoulder and Hand(DASH) was used for function evaluation.Results:All flaps were harvested successfully and all donor sites were closed directly. After surgery, 8 flaps survived completely. One flap developed venous occlusion that showed partial necrosis of the flap, and it was rescued after exploration and re-anastomosis. The follow-up period ranged from 6 to 21 months, with an average of 13 months. The DASH scores of the affected limb were 2 to 15 points at the last follow-up, with an average of 6.4 points. Mild scar hyperplasia occurred at donor site in 1 case without sensory abnormality.Conclusion:The digital technology is able to accurately locate the perforators by allowing an individualised design of the anterior tibial artery perforator flap. The flap is suitable for repair of small and medium-sized soft tissue defect in hand, and the digital technology has certain value in clinical application.
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Objective: To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction. Methods: Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases). Results: All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion: Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
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Objective To develop a data glove evaluation system to assist rehabilitation physicians and therapists in assessing the degree of rehabilitation of hand-wounded patients. Methods A data glove containing 136-axis inertial sensors was designed and produced. It was tested on 10 healthy subjects and 3 hand trauma pa-tients admitted to the Department of Rehabilitation Medicine at Run Run Shaw Hospital. The glove transmitted ac-celeration and angular velocity components in the X, Y and Z directions to a computer terminal, allowing the ben-ding angles of the subject′s finger joints to be calculated. Traditional protractor measurements were used to verify to what extent the data glove accurately reflected the hand and joint activity. Results Compared with the traditional protractor measurement method, the data glove quickly gave accurate maximum bending angles both in healthy and hand-wounded subjects . Such data can facilitate the rehabilitation of hand injuries. Conclusions The data glove produced in this study can effectively assist rehabilitation doctors and therapists in assessing the recovery of hand-injured patients.
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Objective To investigate the effect of finger exercises on recovery of hand function and daily life ability in postoperative patients with bone trauma. Methods Ninety-eight phalanx trauma patients were equally divided into the treatment and control groups, those with odd admission number in the treatment group and those with even numbers in the control group: the control group was given postoperative routine care and the treatment group took finger exercises besides the routine nursing. The two groups were compared in terms of the treatment effect and the ability of daily life . Result The effective rate of the treatment group was higher than that of the control group and the ability of daily life was significantly better than that of the control group (all P < 0.05). Conclusion The postoperative finger exercises of the patients with bone trauma can increase the recovery of hand function , which is beneficial for the improvement their daily life ability.
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@# Objective To observe the effect of Valpar 4 system on hand injury. Methods 40 patients with hand injury were randomly divided into control group and observation group with 20 patients in each group. Routine treatment was applied in both groups while Valpar 4 system was added in the observation group. Then total active motion (TAM) of finger joints, Disability of Arm Shoulder and Hand (DASH), and Upper Extremity Function Test (UEFT) were carried out before, 2 weeks and 4 weeks after treatment. Results The TAM improved significantly in the control group 2 weeks after treatment (P<0.001). The TAM, DASH and UEFT improved significantly in the observation group (P<0.001), and the DASH and UEFT were better in the observation group than in the control group (P<0.001). 4 weeks after treatment, the TAM and UEFT improved significantly (P<0.001) in the control group, the TAM, DASH, UEFT significantly improved in the observation group (P<0.001), and were better in the observation group than in the control group (P<0.05). Conclusion Valpar 4 system can effectively improve the TAM of fingers, function of hands and upper limb, especially in terms of activities of daily living of upper limbs.
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Objective To investigate the nursing of replantation methods of sea-water soaked rotated avulsion amputated fingers.Methods There were 8 cases (16 fingers) with sea-water soaked rotated avulsion amputated fingers.5 cases were replanted by synchronic replantation method,the other 3 cases were replanted by traditional replantation method.We adopted complete debridement and high quality vascular anastomosis during the operation,and give hyperbaric oxygen therapy and anticoagulant treatment post-operation.Results There were 15 survival fingers in 16 replanted fingers.The survival rate was 93.75％.After follow-up for three months to two years,the total good rate was 87.5％.No wound infection and nonunion of fracture occurred.The outline of the fingers was satisfying and patients felt well.The twopoint discrimination was 3～6 mm after 3～24 months follow-up.Conclusions The injury of sea-water soaked rotated avulsion amputated fingers is complicated and the replantation operation is difficult.but if we can adopt individual measure according to the actual circumstance,it is possible that the sea-water soaked rotated avulsion amputated fingers can survive.
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PURPOSE: We used the retroauricular area skin as an alternative full-thickness skin donor site in the hand reconstruction surgery. METHODS: From January 2006 to March 2013, 55 patients observed more than 1 year, were recruited for the study. In case of requiring the skin graft on hand, we grafted skins were harvested from the retroauricular area on hand. To assess the subjective and objective satisfaction, the patients themselves and three doctors compared the skin graft area's color with adjacent skin and estimated the donor site scar on a five-point scale. RESULTS: A partial necrosis was seen in one case who received skin graft because of a burn scar contracture, but it was cured with conservative treatment. In other cases, the skin graft was well taken without any specific problems. The retroauricular skin graft showed good color match with adjacent skin and less pigmentation. Donor site scar was not noticeable. As a result, the patient's subjective satisfaction (4.07) and doctor's objective satisfaction (4.18) about skin graft were very good. And the patient's subjective satisfaction (4.93) and doctor's objective satisfaction (4.98) about donor site scar were also very good. CONCLUSION: We obtained the favorable result and the patients satisfaction by using the retroauricular area as a full thickness skin graft donor site in hand.
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Humans , Burns , Cicatrix , Contracture , Hand Injuries , Hand , Hyperpigmentation , Necrosis , Pigmentation , Skin , Tissue Donors , TransplantsABSTRACT
PURPOSE: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. MATERIALS AND METHODS: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. RESULTS: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. CONCLUSION: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.
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Humans , Alopecia , Follow-Up Studies , Free Tissue Flaps , Hand , Hand Injuries , Hyperpigmentation , Joints , Radial Artery , Range of Motion, Articular , Retrospective Studies , Skin , Tendons , Tissue Donors , Transplants , Ulnar Artery , WristABSTRACT
Hands are essential organs and their agility and dexterity are vital to our daily lives. In the present study, we analysed 107 patients who presented at the local hospital with hand injuries sustained in the oil fields, oil industries and related employment sectors from the surrounding regions. All the patients were male and the mean age was 37.89 years (range,21-61y). Forty-seven (43.93%) patients had simple cut injuries, 14 patients (13.08%) had tendon injuries, 13 patients (12.14%) had amputation of the digit (30.84%) had bone fractures (including 20 (66.66%) open fractures). Only 19 (17.75%) patients were admitted in hospital for further treatment. Ninety-one (85.04%) patients injured within one year of employment and 57(53.27%) patients were not satisfied with instructions and orientation before starting their job. Hand injury is one of the most common injuries in the oil industry and overtime work further increases incidence of this injury.
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Objective To study the effect of hand intrinsic muscle exercise on postoperative recovery of fine movement in children with hand injury.Methods From January 2009 to December 2011,64 children with hand injury were randomly divided to exercise group and control group equally.Hand intrinsic muscle exercise and rehabilitative care were conducted in the exercise group while traditional rehabilitative therapies in control group.After 3-month therapy,MMDT(Minnesota Manual Dexterity Test)and PPT(Purdue Pegboard Test)were conducted to evaluate the functional recovery of hands.Result The results of MMDT and PPT were obviously better in the exercise group than in the control group(P<0.01).Conclusion Hand intrinsic muscle exercise may be effectively in promoting the recovery of fine movement in children with hand injury.
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PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.
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Cicatrix , Collagen , Extremities , Fingers , Follow-Up Studies , Foot , Hand , Hand Injuries , Periosteum , Skin , Tendons , Transplants , Ulcer , Wound HealingABSTRACT
PURPOSE: The purpose of this study was to explore status of activity of daily living, interpersonal relationship, depression and health-related quality of life in patients with traumatic hand injury and identify factors that influence health-related quality of life. METHODS: The participants were 104 outpatients with impending hand microsurgery from D city. The data were analyed using Pearson's correlation, t-test, ANOVA, and hierarchical regression with SPSS/WIN 12.0. RESULTS: There were statistically significant differences in HRQoL to gender, age, marital state, and level of pain. HRQoL had significant correlations with ADL, IADL, relationship change, and depression. In regression analysis, depression, marital state, ADL, and level of pain explained 48% of the HRQoL. CONCLUSION: Findings of this study allow a comprehensive understanding of patients with traumatic hand injury. It is necessary to develop nursing intervention program for improving the health-related quality of life in patients with traumatic hand injury by considering psychological care for depression as well as physical care.
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Humans , Activities of Daily Living , Depression , Hand , Hand Injuries , Interpersonal Relations , Microsurgery , Outpatients , Quality of LifeABSTRACT
Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery (FDMCA) flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years (ranged, 18-65 years). The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years (ranged, 20 months to 3 years). Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings (33%) or ectopic sensory (62%). Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis.
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PURPOSE: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. METHODS: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. RESULTS: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. CONCLUSION: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged(zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.
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Humans , Amputation, Surgical , Arteries , Contracture , Diclofenac , Endothelium , Fingers , Follow-Up Studies , Formycins , Free Tissue Flaps , Glycosaminoglycans , Hand , Hand Injuries , Joints , Necrosis , Range of Motion, Articular , Replantation , Ribonucleotides , Skin , Tendons , Thumb , Transplants , VeinsABSTRACT
PURPOSE: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. MATERIALS AND METHODS: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. RESULTS: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. CONCLUSION: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.
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Female , Humans , Male , Discrimination, Psychological , Explosions , Groin , Hand , Hand Injuries , Imidazoles , Motor Vehicles , Nitro Compounds , ThumbABSTRACT
Objective To explore the application effect of comfortable nursing in patients with skin flap transplantation.Methods 140 patients with skin flap transplantation after hand injury were divided into the observation group and the control group with 70 cases in each group.The control group received routine numing while the observation group was given comfortable numing.The numing effect of the two groups was compared.Results The rehabilitation effect of the observation group was beuer than that of the control group(P＜0.01).Conclusion Comfortable nursing had evident promoting effect for the rehabilitation of patients with skin flap transplantation after hand injury.
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Objective To discuss the application effect of new physical therapy technique in the rehabilitation of patients with hand injury afte operation. Methods Patients with hand injury after operation (150 cases) were divided into the observation group (87 cases) and the control group (63 cases) randomly. The control group received routine treatment and nursing. The observation group was given irradiation by He-Ne laser therapeutic instrument, vinegar therapy and static electromagnetic field therapy. The rehabilitative effect after operation was compared between the two groups. Results The time for disappearance of pain and swelling in the obsevation group was shorter than that of the control group (P<0.05). Conclusions Application of new physical therapy technique in patients with hand injury afte operation could shorten time of rehabilitation and improve rehabilitative quality.