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Objective:To explore the clinical effect of using great toe fibular flaps of both feet on reconstruction of pulp defects of two neighbouring digits.Methods:A total of 14 digit pulp defects in 7 cases were repaired in Zhoukou Huaihai Hospital using great toe fibular flaps of both feet from August 2020 to January 2023. Of the 7 cases, there were 4 males and 3 females, with an average of 28 years old, ranging from 19 to 45 years old. Meanwhile, there were 4 cases in left hand and 3 cases in right hand. There were 3 cases of digit pulp defects in index and middle fingers, 2 in middle and ring fingers, and 2 in thumb and index fingers. The area of soft tissue defect in 1.2 cm×1.5 cm-3.0 cm×2.5 cm, and flap was 1.5 cm ×1.8 cm-3.2 cm×2.8 cm. Furthermore, 1 case underwent emergency surgery and 5 were repaired in elective surgery. The donor site of the flap was closed directly, and an intermediate-thickness skin graft was prepared from the medial plantar area for transfer in the case of high suture tension at the wound edge. After surgery, patients received postoperative by outpatient clinic and WeChat to observe the appearance, sensation, functional recovery and flap contracture of digits, as well as the movement of the great toes of both feet.Results:After the surgery, all flaps in the 7 cases survived smoothly and the donor sites healed. All patients entered scheduled follow-ups postoperatively for 6 months to 2 years, with an average of 9 months. The flap showed an aesthetic appearance and excellent sensation, with a TPD of 3-6 mm, and satisfactory digit function. The donor site of the great toe fibular flap left linear scars only, without abnormality in range of motion and gait in walking. In addition, there were 5 in excellent and 2 in good according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:Application of great toe fibular flaps of both feet is an ideal option for the simultaneous repair of pulp defects of two neighbouring digits, which can achieve good reconstructive results.
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Objective:To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux.Methods:From January 2019 to June 2022, 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux, with the first dorsal metatarsal artery as the pedicle, in the Department of Upper Limb Repair and Reconstruction Surgery, Guizhou Hospital of Beijing Jishuitan Hospital. The patients were 10 males and 5 females and aged 20 to 45 years old. Eight patients had the defects of thumbs and index fingers, 4 of thumbs and middle fingers, 2 of thumb, index and middle fingers and 1 of thumb, index and ring fingers. All the 15 digit injuries had nail bed defects to which reconstructive surgery were required. For the flaps of dorsal artery, flaps were 1.8 cm×2.0 cm-2.0 cm×3.1 cm in size and for those of plantar artery, the flaps sized 1.5 cm×2.0 cm-2.5 cm×3.0 cm. Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps. Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic, WeChat and telephone reviews to assess the appearance, function and sensation recovery of the digits.Results:All the 15 flaps survived. During the 6 to 24 months (16 months in average) of postoperative follow-up, the appearance and texture of all flaps were found close to the healthy digits, with good nail growth and without deformity. TPD were found between 8.0 mm and 12.0 mm. The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well, and the incisions were satisfactorily healed without the functions of walking, running or jumping being significantly affected.Conclusion:The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy, ease with flap harvest, similarity in the normal digital skin texture, and the capability to include a nail bed with the flap. A single donor from the hallux can simultaneously reconstruct two defects of digit-tip, making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits.
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Objective:To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects.Methods:From January 2020 to September 2022, 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics, Suzhou Ruihua Orthopaedic Hospital. All the injury planes were distal to the nail root. All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0.15 mm to 0.35 mm. The superior arch arteries of the digital arterial arch were successfully anastomosed. After surgery, a significant blood flux to the replanted digit body were observed. Postoperative necroses or failures were analysed for the causes. All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews. Postoperative follow-up included digit body fullness, motion of distal interphalangeal joint, nail growth, scarring, and response of the replanted digit-tips to needling. Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function.Results:Of the 62 replanted digit-tips, 56 survived after replantation. Two digits had wound infection after surgery, and survived by dressing change and applying sensitive antibiotics. Necrosis occurred in 6 replanted digit-tips, of which 2 necrotic digit bodies were amputated, and the stumps at the distal interphalangeal joint were repaired. The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body. A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis). The follow-up period ranged from 2 to 30 months, with an average of 6 months. The shape and function of replanted digit-tips recovered well. According to the evaluation criteria for finger replantation function, 44 digits were of excellent, 6 of good, and 2 of fair.Conclusion:In children, the superior arch arteries of digital arterial arches of the digit-tips are small in diameter. However, the vessels in smaller calibres can be anastomosed, should proper surgical techniques are applied. Therefore, due to the satisfactory outcomes, microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip.
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Objective:To explore the clinical effect of a modified surgical procedure for replantation of severed digit-tips in Tamai zones I-II.Methods:From November 2019 to October 2022, the Department of Hand and Foot Microsurgery of the First Affiliated Hospital of Bengbu Medical College employed a modified procedure (to abandon the anatomically labelling of blood vessels and nerves after naked-eye debridement and fracture fixation, then perform the microscopic dissections and anastomoses of blood vessels and nerves, and the anastomosis of dorsal veins though an auxiliary small incision by the lateral nail fold of the severed digit-tip) to replant severed digit-tips in Tamai zones I-II of 26 patients (29 digits). The patients were 20 males (23 digits) and 6 females (6 digits), aged 3-66 years old, with mean age at 28 years old. Nineteen digit-tips were severed in Tamai zone I and 10 in Tamai zone II. The severed digit-tips were 7 of thumbs, 9 of index fingers, 5 of middle fingers, 5 of ring fingers and 3 of little fingers. Causes of injury were 12 of cut, 8 of crush and 6 of avulsion. Postoperative management included infection prevention, antispasmodic for 3 days and keeping in bed for 5 days. The time of surgery was recorded on all patients. Postoperative follow-ups were conducted at outpatient clinics for 6 to 12 months to observe the survival of digit-tips and the appearance, recovery of sensation and motor functions, strength of digits and patient satisfaction.Results:(1)The surgical time was about 1.0 hour for replantation of a severed digit-tip in Tamai zone I, while it took about 1.5 hours for those in Tamai zone II. (2)Survival rate and appearance: all 29 replanted digit-tips survived, except 2 in Tamai zone I which encountered venous occlusion and survived after small incision for bloodletting. Twenty-two digit-tips gained pulp fat pads with full digit pulps. Four avulsed digit-tips had mild atrophy of pulp. The 15 digit-tips severed in Tamai zone I were about 2 mm shorter than the healthy sides, but without deformity. One digit-tip had poor nail appearance due to preoperative fungal infection of nail bed. (3)Sensory recovery: with the British Medical Research Council (BMRC), 23 digit-tips recovered to S 3+, and 2 digit-tips of avulsion and 1 digit-tip of crush recovered to S 3. TPD of the replanted digit-tips were: 4-7 mm in those of cut injury; 6-8 mm in those of crush and 9-11 mm in those of avulsion. (4)Motion and digit strength: results of functional assessment according to the total active mobility standard promoted by China's Society for Surgery of the Hand were: 21 cases of excellent and 5 of good, without pain in digit pulp when pinching and griping. The mobility of the digits with replanted digit-tips of both Tamai zones I and II were close to that of the healthy sides. The motions of the digits with replanted digit-tips in Tamai zone I were close to the healthy sides and the 5 of those in Tamai zone II had 0° in extension and 2°-3° in flexion, due to the severed plane at distal interphalangeal joint. (5)Patient satisfaction: 25 patients were satisfied, however 1 patient was dissatisfied to the poor function of the distal interphalangeal joint due to the severed thumb-tip in Tamai zone II. Conclusion:Modified replantation procedure for severed digit-tip in Tamai zones I-II has significant achievement in cutting down the surgical time through a modified procedure of debridement and fracture fixation (tendon suture) by naked-eyes operation first, followed by dissections and anastomoses of the blood vessels and nerves under the surgical microscope. The auxiliary small incision by the lateral nail fold of digit-tip in Tamai zone I facilitates an exposure of a constant, healthy lateral nail fold vein. It enables the anastomosis with a high-quality vein, hence improves the success rate of replantation. The appearance and function of the replanted digit-tip are found better in the severed digit-tips of cut injury than those with injuries of avulsion and crush.
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Objective To investigate the association between the index finger and ring finger length ratio (2D ∶ 4D) and of four loci (rs6461992‚ rs6968828‚ rs7801581‚ rs17427875) polymorphism of homeobox (HOX) A11 gene among Ningxia college students. Methods Digit camera was used to collect frontal hand photos of 667 Han college students (348 males and 319 females) from Ningxia province; Image analysis software was used to mark the anatomical points and measure finger lengths of the index and ring fingers of both hands; multiplex PCR was used to detect each locus polymorphisms of HOXA11 gene; statistical software was used to compare and analyze the differences and associations of 2D ∶4D and gene polymorphisms between different genders. Results Among Ningxia Han college students‚ both left hand and right hand 2D ∶ 4D were significantly higher in females than those of in males (all P< 0. 05)‚ and there were no significant sex differences in right-left hand 2D ∶4D; the genotypes and allele frequencies of rs7801581 locus of HOXA11 gene differed significantly between genders (all P < 0. 05)‚ and none of the other locus polymorphisms showed any significant sex differences; only female left hand 2D ∶4D was significantly associated with rs6461992 locus genotype in the relationship between 2D ∶4D and HOXA11 polymorphisms (P<0. 05). Conclusion There were significant sex differences in 2D ∶ 4D among Han college students in Ningxia‚ and the rs6461992 locus polymorphism of HOXA11 gene may be associated with the formation of 2D ∶4D in females.
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SUMMARY: This study investigates the relationship between the second and fourth finger ratio (2D:4D), physicians' propensity to choose an internal or surgical branch, and sex differences. On a voluntary basis, 177 physicians working in Elazig, 122 men and 55 women were enrolled in the study. Their hands were measured for 2D and 4D lengths, and the 2D:4D ratio was computed. In female doctors, the left hand's 2D:4D ratio is 1.01, compared to the right hand's 1.00. Male doctors' right 2D:4D ratio is 0.99, while their left 2D:4D ratio is 1.00. Male physicians' 2D:4D ratios were different from those of men in the general population, whereas female physicians' 2D:4D ratios were comparable to those of women in the general population. As a result, this study was the first to examine the relationship between the ratio of the second and fourth fingers (2D:4D), physicians' tendency to choose an internal medicine or surgical branch, and sex differences. While the 2D:4D ratio was higher than 0.98 in all physicians, it was low in women who disliked their profession and branch. Since there aren't many studies on this subject, data from in-depth studies that will be conducted in the future will help physicians who choose internal medicine and surgery make more informed decisions.
Este estudio investiga la relación entre la proporción de los dedos segundo y cuarto (2D:4D), la propensión de los médicos a elegir una rama interna o quirúrgica y las diferencias de género. De forma voluntaria, se inscribieron en el estudio 177 médicos que trabajaban en Elazig, 122 hombres y 55 mujeres. Sus manos se midieron en longitudes 2D y 4D, y se calculó la relación 2D:4D. En las médicos mujeres, la relación 2D:4D de la mano izquierda es 1,01, en comparación con 1,00 de la mano derecha. La relación 2D:4D derecha de los médicos hombres fue 0,99, mientras que la relación 2D:4D izquierda fye 1,00. Las proporciones 2D:4D de los médicos hombres fueron diferentes de las de los hombres en la población general, mientras que las proporciones 2D:4D de las mujeres médicas fueron comparables a las de las mujeres en la población general. Como resultado, este estudio fue el primero en examinar la relación entre la proporción del segundo y cuarto dedo (2D:4D), la tendencia de los médicos a elegir una rama de medicina interna o quirúrgica y las diferencias de sexo. Mientras que la relación 2D:4D fue superior a 0,98 en todos los médicos, fue baja en las mujeres que no les gustaba su profesión y rama. Dado que no hay muchos estudios sobre este tema, los datos de estudios en profundidad que se realizarán en el futuro ayudarán a los médicos que eligen medicina interna y cirugía a tomar decisiones más informadas.
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Humanos , Masculino , Feminino , Médicos/psicologia , Comportamento de Escolha , Dedos/anatomia & histologia , Razão Digital , Cirurgia Geral , Fatores Sexuais , Antropometria , Caracteres Sexuais , Medicina InternaRESUMO
Background: The second to fourth digit ratio (2D:4D ratio) is derived by dividing the length of the index finger (2D) by the length of the ring finger (4D). It has been considered as an index of how much the fetus is exposed to testosterone in utero. Research has suggested that high levels of testosterone are associated with low 2D:4D ratio. The relationship between 2D:4D ratio and physical performance is still an unexplored field in badminton players. Aims and Objectives: This study intends to assess the digit ratio 2D:4D in non-elite male badminton players in comparison to their sedentary controls. Materials and Methods: The study included 30 male badminton players in the age group of 19–23 years who were practicing badminton for more than 3 years and 30 age, body mass index-matched sedentary controls. The second and fourth finger measurements were taken from scanned printouts using Vernier calipers. Results: The 2D:4D ratio was significantly lower in the left hand of badminton players when compared to their controls (P = 0.0001). There was no significant difference in 2D:4D ratios of the right hand and 2D:4D (? r–l) between badminton players and controls. Conclusion: There was significant difference in the ratio of 2nd–4th digit between badminton players and controls in the left hand but not in the right hand. The reason for no difference in 2D:4D ratio and controls in the right hand could be due to the fact that badminton is a moderate intensity sport, and also, the study participants were non-elite players.
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SUMMARY: Digit ratio established in utero is positivelly correlated with intrauterine level of estrogen. Since the breast cancer is related to excessive and prolonged exposure to estrogen, digit ratio might be considered as useful marker in breast cancer risk assessment. The aim of the present study was to compare digit ratios in breast cancer patients and healthy controls. The study group consisted of 98 breast cancer patients aged between 29 to 84 years while the control group included 141 healthy women aged between 21 and 67 years. After collecting anamnestic data concerning menopausal status, the length of second and fourth fingers were measured and the digit ratios were calculated for both hands, as well as the difference between right and left digit ratio. Digit ratio was significantly higher on right hand in breast cancer patients compaired to healthy controls (1.003±0.05 vs. 0.990±0.03). Right digit ratio showed better predictive capacity for the breast cancer development then the left (AUC:0.609 vs. 0.541). Negative statistically significant correlation between right digit ratio and the age of breast cancer diagnosis was observed (r=-0.271). Higher values of right digit ratio in women with breast cancer when compared to healthy women suggest their higher prenatal estrogen exposure that confirms the importance of digit ratio determination in breast cancer risk assessment.
La proporción de dígitos establecida en el útero, se correlaciona positivamente con el nivel intrauterino de estrógeno. Dado que el cáncer de mama está relacionado con una exposición excesiva y prolongada a los estrógenos, la proporción de dígitos podría considerarse un marcador útil en la evaluación del riesgo de cáncer de mama. El objetivo del presente estudio fue comparar proporciones de dígitos en pacientes con cáncer de mama y controles sanos. El grupo de estudio consistió en 98 pacientes con cáncer de mama con edades comprendidas entre los 29 y los 84 años, mientras que el grupo de control incluyó a 141 mujeres sanas con edades comprendidas entre los 21 y los 67 años. Después de recopilar datos anamnésticos sobre el estado menopáusico, se midió la longitud de los dedos segundo y anular y se calcularon las proporciones de los dedos para ambas manos, así como la diferencia entre la proporción de los dedos derecho e izquierdo. La proporción de dígitos fue significativamente mayor en la mano derecha en pacientes con cáncer de mama en comparación con controles sanos (1,003 ± 0,05 frente a 0,990 ± 0,03). La proporción del dígito derecho mostró una mejor capacidad predictiva para el desarrollo de cáncer de mama que el izquierdo (AUC: 0.609 vs. 0.541). Se observó una correlación estadísticamente significativa negativa entre la proporción de dígitos derechos y la edad del diagnóstico de cáncer de mama (r=-0,271). Los valores más altos de la proporción de dígitos derechos en mujeres con cáncer de mama en comparación con mujeres sanas sugieren una mayor exposición prenatal a estrógenos que confirma la importancia de la determinación de la proporción de dígitos en la evaluación del riesgo de cáncer de mama.
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Dedos/anatomia & histologia , Curva ROC , Sensibilidade e Especificidade , Fatores Etários , Razão DigitalRESUMO
Objective:To compare the difference in clinical efficacy between a free wrist crease flap pedicled with superficial palmar branch of the radial artery flap (SPBRAF) and a traditional free toe flap (TFTF) in reconstruction of hand soft tissue defects, and to provide reference for the treatment of small-to medium-sized hand soft tissue defects.Methods:Data of 37 patients who received hand surgery in Department of Hand Surgery, No.971 Hospital of the PLA Navy from December 2016 to December 2019 for small-to medium-sized hand soft tissue defects were retrospectively studied. Among the 37 patients, there were 32 males and 5 females, aged between 18 and 65 years old, with 41.5 years old in average. According to the reconstructive surgical procedure, patients were divided into SPBRAF group (22 cases) and TFTF group (15 cases). Regular follow-ups were conducted after surgery. The difference in curative effect at the last follow-up between the 2 groups was evaluated by the comparison of data acquired in follow-up. SPSS 25.0 was used to analyse the data statistically. The evaluation indicators included flap survival, long-term recovery of flap, recovery effect at donor site, total active movement(TAM) of the affected digit, time of hospital stay and the time return to work. P<0.05 was considered a statistically significant. Results:All free flaps survived. All patients were entered 6-18 (mean, 10) months of postoperative follow-up to comprehensively evaluate the therapeutic effect. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, in the SPBRAF group, 20 flaps were found in excellent, and 2 in good; in the TFTF group, 14 flaps were found in excellent, 1 in good. There was no statistical difference between the 2 groups( P>0.05). The colour, texture and thickness of flaps between the 2 groups were either in excellent or good. There was no statistical difference between the 2 groups( P>0.05). TPD in the TFTF group (5-6 mm) was better than that in SPBRAF group (6-7 mm) with statistical difference between the 2 groups ( P<0.05). Texture at donor sites between the 2 groups was either in excellent or good ( P>0.05). In terms of appearance, sensation and recovery time of donor site, it was found that the SPBRAF group(mean, 6 weeks) was significantly better than those in the TFTF group(mean, 8 weeks) and there was statistical difference between the 2 groups ( P<0.05). In terms of recovery of TAM in single-digit, excellent or good were shown in both groups and there was no statistical difference between the 2 groups ( P>0.05). In terms of hospitalisation and time for return to work, the SPBRAF group(mean, 8 days and 17 weeks) was significantly better than that of TFTF group(mean, 12 days and 24 weeks), and there was statistical difference between the 2 groups ( P<0.05). Conclusion:SPBRAF has an ideal effect on reconstruction of small-to medium-sized hand soft tissue defects in hand. Although the flap is still inferior in sensation and appearance compared with the TFTF, the advantages in terms of donor site recovery, patient satisfaction of the donor site and reduced time of hospitalisation and return to original work are more obvious. SPBRAF provides a good complement to surgical procedures reconstructing a digit defect.
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Objective:To explore indications for replantation of proximal proper digital artery and establishing extrinsic arterial perfusion pressure in the treatment of special type of severed digits with avulsion over 12.0 hours of warm ischemia, and to analyse the factors that affected the survival rate of the replanted digits.Methods:From September 2014 to January 2022, 8 patients with severed digits and prolonged warm ischemia were treated by transposition of adjacent digital artery together with the technique of extrinsic arterial perfusion pressure in the Department of Wrist and Hand Surgery, the Orthopaedic Hospital in Sichuan Province. During the operation, the defected proximal proper digital artery was reconstructed and repaired with vein graft, one side of the digital artery was repaired with an inverted "Y" vein graft, and one side of "Y" vein was bridged and anastomosed to repair the original digital artery. On the other side, the adjacent proximal proper digital arteries were transpositioned and anastomosed to gain an extrinsic arterial perfusion pressure, which increased the distal haemodynamic and reconstituted the blood supply. Of the 8 patients (9 severed digits) : 1 had severed index and middle fingers, 2 had severed index fingers, 4 had severed thumbs and 1 had severed little finger. All the patients were males, aged 16-63 years old, at 37.6 years old in average. Warm ischemia time of the severed digits were 12.3-20.6 hours, with 17.4 hours in average. The survival rate of replanted digits was observed after surgery. Postoperative follow-ups were conducted through telephone or WeChat reviews.Results:Follow-up time was 6-26 months, at 8.3 months in average. Retrospective analysis was performed. Vascular compromises occurred in 3 patients 4 digits (arterial insufficiency in 1 digit, venous congestion in 3 digits), skin necrosis occurred in 1 patient (1 digit) and digit necrosis in 1 patient (1 digit). Overall, 8 of the 9 replanted digits survived. According to the Replantation Function Evaluation Standard of Hand Surgery Association of Chinese Medical Association, the digit function after replantation was evaluated at excellent in 6 digits, good in 1 digit and poor in 1 digit.Conclusion:For a severed digit with an ischemia time over 12.0 hours, the survival rate can be improved by transposition of an adjacent digital artery to provided extrinsic arterial perfusion pressure.
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Objective:To explore the surgical procedure and clinical effect of a free transverse carpal flap based on the superficial palmar branch of radial artery in reconstruction of soft tissue defect of digits.Methods:From February 2014 to May 2022, 17 cases of soft tissue defects with tendon or phalanges in digits were treated in the Department of Hand and Foot Surgery, Hainan Zhongde Orthopaedic Hospital. All 17 cases were treated by the free transverse carpal flap based on the superficial palmar branch of radial artery. The flap size was 2.0 cm×2.0 cm-4.5 cm×2.0 cm. The anastomosed artery was digital artery or common digital artery, and the vein was the accompanying vein or superficial subcutaneous vein. All donor sites were directly sutured. Preventive measures of anti-infection, anticoagulation, anti-vasospasm and symptomatic treatment were given after surgery. After discharge of patients, scheduled follow-ups were conducted through outpatient clinic, telephone or WeChat interviews to observe the clinical effects. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, hand functional recovery was good in 14 cases and good in 1 case.Results:All 17 flaps had survived with 16 completed the postoperative follow-up. Follow-ups ranged from 6 to 18 months, with a mean of 14 months. At the last follow-up, the flaps were good in shape, soft texture, in normal flexion and extension and with good protective sensation. Two-point discrimination (TPD) was 8-12 mm, with an average of 8 mm. There was no other adverse effect in the donor sites except a linear scar.Conclusion:Application of transverse carpal flap based on the superficial palmar branch of radial artery from same limb to restore the digit function is feasible. It is an ideal surgical procedure of flap transfer.
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Objective:To explore an applicative value of a 5-type precise diagnostic technique in integrated precise repair and reconstruction of digit-tip injuries.Methods:From March 2012 to June 2022, 45 digit-tip injuries (38 patients, with an average age of 33 years old) were classified under microscope on the basis of effectiveness of blood vessels remained in the severed tissue. Among the injured digits, there were 15 thumbs, 9 index fingers, 16 middle fingers, 4 ring fingers and 1 little finger. The diagnosis was categorised into 5 types according to involvement of blood vessels: Type I, injury of proper palmar digital artery (10 digits) ; Type II, injury of small artery (5 digits) ; Type Ⅲ, injury of whole vein (4 digits) ; Type IV, injury of superficial palmar arch (4 digits) ; and Type V, vessels missing (22 digits). The timing and therapeutic method of surgery were selected based on the precise classification of 5 types of diagnosis: (1) For type Ⅰ-Ⅳ injuries, 16 patients (23 digits) received in situ tissue replantation after emergency classification. Of which, type Ⅰ-Ⅱ injuries received conventional replantation, type Ⅲ injuries had replantation with arterialised vein, and type IV injuries received replantation with artery-vein shunt. (2) For the type V injuries, 22 patients (22 digits), staged and categorised flap reconstruction with toe flaps were performed. Of which, 7 were performed in emergency surgery, 12 in subemergency surgery and 3 in elective surgery. Based on the severity of defects, small tissue flaps of toe were used in reconstruction of type V injuries and following toe flaps were employed: 9 hallux nail flaps, 3 hallux nail flaps (for reconstruction of distal phalanx), 5 hallux fibular flaps, 3 hallux abdominal flaps and 2 compound tissue flaps with nail bed of the second toe. The sizes of the 45 replanted/transferred tissues flaps were 1.0 cm×0.6 cm×0.4 cm-2.2 cm×1.5 cm×0.8 cm. Donor sites directly sutured. Medical APP was applied in the rehabilitation exercises. Functions of digits were assessed by scheduled follow-ups at outpatient clinic and via remote medical APP to evaluate the clinical efficacy.Results:All small tissue blocks and (or) tissue flaps survived after replantation and (or) flap reconstruction of 45 injured digits. Postoperative follow-up lasted for 6 months to 7 years, with 36 months in average. The appearances of the reconstructed digit-tips were close to normal digits, with TPD at 3-7 mm. According to the Michigan Hand Outcomes Questionnaire (MHQ), 32 patients (37 digits) were in excellent, 5 patients (7 digits) in good, and 1 patient (1 digit) in poor, with 97.78% of excellent and good rate.Conclusion:Five-type precise diagnostic technique is the key to the integrated and precise reconstruction of digit-tip injuries. This method has been clinically validated and achieved realistic recovery from the injured digits.
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Objective:To explore the application and clinical efficacy of an innervated arterialised venous flap of the first dorsal metacarpal in reconstruction of thumb and finger pulp defects.Methods:From December 2021 to August 2022, 17 patients received surgery for reconstruction of thumb and finger pulp defects in the Department of Hand Surgery of Sichuan Modern Hospital. All were carried out in emergency surgery. The affected digits included: 3 thumbs, 4 index fingers, 6 middle fingers, 1 ring finger and 3 little fingers. After emergency debridement, a flap of the first dorsal metacarpal carrying superficial radial nerve and arterialised vein was taken for reconstruction of the defect. Donor site of the flap was directly closed with sutures. The survival and functional recovery of the digits and flaps were evaluated through postoperative follow-ups via outpatient visit and telephone and WeChat interviews.Results:Seven flaps developed blisters after surgery, which gradually subsided and healed after dressing change. The rest of 10 flaps survived smoothly, without any vascular compromise. All of the 17 patients(17 digits) had postoperative follow-up for 3-15 months, with 8 months in average. Appearance of thumb and finger pulps were good, with sensation restored to S 1-S 3+, according to the sensory function evaluation criteria of the British Medical Research Council(BMRC). According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, all 17 patientswere in excellent of total active movement(TAM). Conclusion:Innervated arterialised venous flap of the first dorsal metacarpal is reliable in reconstruction of the defects of digit pulps with good function and appearance. The flap is easy to take and with a satisfactory recovery of sensation.
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Objective:To explore the surgical procedure and effect of reconstruction of 2 adjacent soft tissue defects of digits with free twin-lobed flap of carpal cutaneous branch of ulnar artery.Methods:From January 2015 to February 2022, 6 patients (10 digits) with 2 adjacent soft tissue defects of digits were treated by free twin-lobed flap of the carpal cutaneous branch of ulnar artery in the Department of Hand and Wrist Surgery of Sichuan Orthopaedic Hospital. All patients were males, aged 35-53 years old, with an average age of 39.5 years old. Three patients were with soft tissue defects in palmar of index and middle fingers, 1 in palmar of middle and ring fingers, 1 in palmar and dorsal of thumb and 1 in palmar and radial of index finger. Nerves in 5 injured digits of 3 patients and the defected digital flexor tendons in 2 digits of 2 patients were reconstructed. The defects were 2.5 cm× 1.5 cm - 4.0 cm× 2.0 cm in size. The sizes of the flaps were 7.5 cm×2.0 cm-10.0 cm×3.0 cm. The donor sites were directly sutured. All of the defects were treated in emergency surgery. The survival rate of flaps was observed after surgery. All patients were included in postoperative follow-up via telephone or WeChat reviews after discharge to observe the flaps and function recovery of digits.Results:All flaps survived without complication. Venous occlusion occurred in 1 digit, which was relieved after suture removal and heparin dressing for 3 days. Follow-ups lasted 12-16 (mean 12.8) months. The texture and appearance of the flaps were satisfactory. Sensory recovery was at S 3-S 3+ with static two-point discriminations (TPD) at 7-12 mm in the digits with sensory reconstruction. In the digits without nerve repair, the flaps gradually regained protective sensation and the function of digits satisfactorily recovered at 6 months after surgery. According to the Evaluation Standard of Upper Limb Function of Hand Surgery Branch of the Chinese Medical Association, 5 patients were in excellent and 1 in good. Conclusion:Using a free twin-lobed flap with carpal cutaneous branch of ulnar artery to reconstruct 2 adjacent defects of digits can benefit from the thickness of flap being similar to the skin of hand and a hidden donor site together with satisfactory appearance, texture and function of the flap. It is an effective method in reconstruction of 2 adjacent soft tissue defects of digits.
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Objective To investigate the relationship between digit ratio and schizophrenia in men from Ningxia Han nationality. Methods Using anthropometry, digital camera was used to obtain finger photographs of both hands of 216 male subjects (nonnal control; 116, schizophrenia patient; 100). The anatomical points were marked and the length of each finger of both hands were measured by computer image analysis software (Image-Pro Plus 6 . 0 ) . Differences of the mean digit ratio of left and right hand 2D:3D, 2D:4D, 2D:5D, 3D:4D, 3D:5D, 4D:5D between the control group and the patient group were compared. The correlation between 2D :4D and onset age in the patient group were analyzed. Results Except for left and right hand 3D :4D, digit ratios in patient group were significantly higher than those in control group (2D :4D and 3D :5D in both hands, right hand 3D :5D, p all0. 05). Conclusion Digit ratio is related to the occurrence of schizophrenia in Ningxia Han male.
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Objective To investigate the association between 8 single-nucleotide polymorphisms (SNPs) of hydroxysteroid dehydrogenase (HSD) gene family and human digit ratio (2D ∶ 4D). Methods Randomly selected 808 college students (400 males and 408 females) as subjects, the digit ratio of left and right fingers were measured and calculated using computer image software. Eight SNPs (rs1000283, rs2236903, rs5479, rs56303414, rs676387, rs4445895, rs2066474, rs8190478) in HSD11B and HSD17B gene families were genotyped by multiplex PCR. The association between 2D ∶4D and different genotypes was analyzed by One-Way ANOVA. Results Female left hand(L)2D ∶ 3D, L2D ∶4D, L3D ∶4D, right hand(R)2D ∶4D, R2D ∶5D were significantly higher than male (P0. 05). The genotypes frequency of the 8 SNPs were not significantly associated with digit ratio (2D ∶4D) in both males and females (P>0. 05). Conclusion There are significant gender differences in digit ratio in Ningxia Han college students, but there is no correlation between digit ratio and 8 SNPs in HSD11B and HSD17B gene families, suggesting that HSD11B and HSD17B gene families may have nothing to do with the formation of human digit ratio.
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El signo del dedo azul (SDA) es una condición poco frecuente causada principalmente por la oclusión de la vasculatura periférica. Clínicamente puede manifestarse como una coloración azulada o eritrocianótica en uno o varios dedos en ausencia de traumatismo y condiciones propias de congelación. Las etiologías son múltiples e incluyen obstrucción del flujo arterial, disminución del flujo venoso y alteración en la viscosidad sanguínea. La importancia de reconocer el signo como motivo de consulta radica en encaminar un diagnóstico temprano e instaurar un tratamiento que evite la evolución natural de la enfermedad hacia la necrosis, amputación o muerte del paciente. Proponemos un algoritmo diagnóstico para reconocer los elementos de la historia clínica que guíen la etiología y los paraclínicos disponibles desde el Servicio de Urgencias.
Blue finger sign (BFS) is a rare condition caused mainly by occlusion of peripheral vasculature. Clinically it may manifest as a bluish, or erythrocyanotic discoloration of one or more fingers in the absence of trauma and freezing conditions. The etiologies are multiple and include arterial flow obstruction, decreased venous flow, and altered blood viscosity. The importance of recognizing the sign as a reason for consultation lies in the early diagnosis and the establishment of a treatment that finally avoids the natural evolution of the disease towards necrosis and finally amputation or death of the patient. We propose a diagnostic algorithm based on recognizing elements of the clinical history that guide the etiology and paraclinical available from the Emergency Department.
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Sinais e Sintomas , Isquemia , Oclusão Vascular MesentéricaRESUMO
Introduction: Depression in the elderly can have a different pathophysiology and clinical profile, and studies have shown pathological changes in the brain on radio imaging. The present study aimed to find out the association of white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) with the severity of illness and cognition in elderly depressed patients. Methodology: This cross-sectional study included 68 elderly (>60 years of age) depressed patients who had undergone MRI at a tertiary care center, and based on the severity of WMH, they were divided into two groups: no or slight WMH group and moderate or severe WMH group. The severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D) scale, and neuropsychological assessments were made for testing attention, concentration and executive function. Results: HAM?D scores were found significantly higher in patients with moderate?to?severe WMH groups (22.6 ± 5.2) compared to those with no or slight WMH (16.3 ± 4.2). The cognitive performance evaluated by backward digit span test, Trail making Test A and B, and Color Stroop test was significantly poor in the moderate?to?severe WMH group. Conclusion: Elderly depressed patients having a greater WMH had more severe depression and poor cognitive performance, especially psychomotor and executive functioning. WMH could be a potential marker for the severity of illness and cognition in depression in elderly persons.
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Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.
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Objective:To explore the surgical technique and therapeutic effect of flap wrapping repair of soft tissue defect after digit degloving injury with free arm medial perforator flap.Methods:From October 2009 to December 2020, 15 patients with soft tissue defect after digit degloving injury were repaired with free arm medial perforator flaps. The patients were 9 males and 6 females aged 22 to 50 years old, with an average of 32 years old. Injury mechanism: 13 cases of machine strangulation and 2 cases of machine crushing. Plane of sleeve avulsion injury: at the distal metacarpophalangeal joint of thumb in 2 cases, at the middle and distal segment of single finger of 2nd to 5th fingers in 4 cases, and at distal metacarpophalangeal joint of 2nd to 5th fingers in 9 cases. Seven cases were in left hand and 8 in right hand. Emergency surgery was performed in 2 cases and scheduled surgery in 13 cases. The flap was designed in a shape of a long strip, and the size of the flap was 5.0 cm×2.5 cm-14.0 cm×3.5 cm. During the operation, the artery of the flap pedicle was anastomosed with the palmar digital proper artery or common digital artery of the recipient digit, the subcutaneous vein or the companion vein of the artery was anastomosed with the dorsal or palmar digital subcutaneous vein, and the medial brachial cutaneous nerve carried in the flap was anastomosed with the stump of palmar digital proper nerve. All the donor sites were directly sutured. After the surgery, follow-up visits were conducted regularly at outpatient clinic, or via telephone and WeChat review or by home visit. The flap appearance, sensation and function recovery of digital joints were observed together with the patient satisfaction. Results:All flaps survived successfully after surgery. Six patients with degloving defect of the whole digit had encountered poor wound healing caused by distal phalangeal necrosis. The second stage stump trimming was performed to keep the digit to the distal end of the middle segment. Two cases of thumb and 2 cases of middle finger suffered further burning and worn tears at 7-9 months after surgery and self-healed. The follow-up period was 6-28 (average 16) months. The flap was soft without bloating. The sensation recovered to S 2-S 3. The shape of fingers was good, and no secondary flap surgery was necessary. The overall movement of interphalangeal joints was poor. According to the evaluation standard of Michigan hand function questionnaire, 15 patients achieved very satisfactory with the overall appearance and function of hands. The linear scars at donor site were hidden without complications such as tenderness and contraction. Conclusion:The free medial perforator flap of the arm is easy to design and thin, hence does not affect the shape of a digit. So, it is ideal for the repair of soft tissue defect after digit degloving injury.