Cross-finger Flap to the Thumb: Quest for an Alternate Donor.

Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.

Modeling the Effective Conductance Drop Due to a Particle in a Solid State Nanopore Towards Optimized Design.

An understanding of the current change in a solid state nanopore due to particle movement or capture is crucial for improvement of nanopore based sensing technologies. For lower aspect ratio pores, which are gaining importance due to their high sensitivity, there is interplay between access and pore resistance and the existing theories for computation of access resistance cannot explain most of the experimental observations. Hence, there is a need to develop a comprehensive model for calculating the effective conductance drop in presence of particles in a solid state nanopore. In this paper, we develop analytical models to calculate both the access and pore resistance in presence of particle at different positions during translocation and also when captured by receptors in functionalized nanopores. A wide range of pore geometry and molar strength has been investigated. Taking into consideration the positional uncertainty during particle translocation, the effective resistance sensitivity has been found to agree very well with the experimental observations in low aspect ratio pore. Additionally, we observe that in functionalized nanopores, a pore of higher diameter results in around 50% increase in sensitivity compared to a pore with half its diameter, which indicates the scope of design optimization in such systems.

Rare Hernias Presenting as Acute Abdomen- A Case Series.

Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. It can be divided into internal, external and diaphragmatic hernias. Most of them can be asymptomatic. If they become symptomatic they can present with features of intestinal obstruction, incarceration or strangulation. In this case series we compare the incidence of these rare presentations of hernias with world literature and to warn surgeons not to cut the obstructing band in cases of internal hernias. In this case series, we review the clinical details of 7 rare presentations of hernia, who presented with various types of hernias to a tertiary care centre in Kerala over a period of one year. Of these 7 cases 6 cases were internal hernias (3 left paraduodenal hernias, 2 transmesentric hernias, and 1 pericaecal hernia) and a case of spigelian hernia above the level of umbilicus. All of them presented as acute abdomen in the emergency department. Among these 7 cases, only one case was diagnosed preoperatively. Three patients had bowel gangrene and had to undergo resection- anastomosis of the bowel. The survival rate among these cases was 100% as compared to 50% in the world literature if they had been left untreated. Even though internal hernias are a rare entity, we need to have it as a differential diagnosis in case of intestinal obstruction, in a previously non-operated abdomen.