Missing fingers

No disponible

The Untold Story of the First Hand Transplant: Dedicated to the Memory of one of the Great Minds of the Ecuadorian Medical Community and the World.

BACKGROUND: In 1964, faced with the challenge of traumatic amputation, a team of surgeons at Clinica Guayaquil was convinced that the transplantation of a hand could significantly improve function and quality of life for the recipient. With a current but basic understanding of immunosuppression, the surgeons identified a recipient and waited for the correct donor. A human hand transplant had never been performed to date. METHODS: The surgeons' criteria for the recipient included a young healthy individual who had sustained a traumatic amputation at the distal forearm level with full motion of the proximal joints. Communication with receiving hospitals and military facilities identified what they perceived to be a feasible donor for an allograft transplantation. Consent was obtained from the family in conjunction with the local military medical authorities and the clergy. Iced saline solution and Heparin irrigation were to be used to prepare the donor extremity. The immunosuppression regimen, limited at the time, consisted only of intravenous cortisone, Imuran, and a single dose of radiation. RESULTS: A member of the Ecuadorian marine sustained a limited blast injury that amputated his dominant hand but spared the forearm. He was transferred to the emergency department of Clinica Guayaquil. A donor who had recently died in a nearby hospital was identified not long after. A successful technical surgical transplantation was achieved. Consultants from major hospitals around the world (including Peter Bent Brigham Hospital) convened at the patient's bedside to observe the results. Despite all efforts, the patient suffered an irreversible rejection at 21 days post-transplant. CONCLUSION: This was the first allograft transplantation of a hand. The surgeons embarked on an intervention never tried before, firmly believing that better function and quality of life would result. The bravery of this surgical team was commendable. This early surgical endeavor opened the way for future successes in transplant surgery today.

Computed Tomography Study of the Feet of Mummy of Ramesses III: New Insights on the Harem Conspiracy.

OBJECTIVE: A previous study of the computed tomography (CT) of the neck of mummified Ramesses III (1190-1070 BC) suggested that an assailant slit the Pharaoh's throat with a knife in the plot known as Harem conspiracy. We hypothesized the presence of other injuries in the Pharaoh's body as a result of this fatal attack. METHODS: We analyzed CT images of mummified Ramesses III and reported any finding suggestive of trauma in correlation with archeologic literature. RESULTS: Computed tomographic images show partially amputated left big toe. The bony edges are sharp without signs of attempted healing. The ancient embalmers replaced the missing toe with a linen-made prosthesis and placed 6 metallic amulets (eye of Horus) at the feet region. CONCLUSIONS: The Pharaoh's left big toe was likely chopped perimortem by an assailant using a heavy sharp instrument as an ax. This additional injury supports the plot and gives more information about the death scene.

Digit Replantation The First 50 Years.

Since the first successful digit replantation by Japanese surgeons Komatsu and Tamai, the past half century has seen the field of digit replantation in the USA experience exponential growth followed by a steady decline in volume of cases and percentage of successful viable digits. The initial enthusiasm and technical progress of digital replantation has been tempered by mediocre functional outcomes, rising healthcare costs, and limited healthcare resources. The history and approach to digit replantation is reviewed and highlights the likely push toward the development of regional replant centers staffed by highly skilled teams to improve the functional outcomes following these complex procedures. More than 50 years have passed since the first successful digit replantation by Komatsu and Tamai who replanted a sharply amputated thumb in a 28-year-old male at the metacarpal-phalangeal joint level in a 4.5 hour procedure. Two arteries and 2 veins were anastomosed using 8-0 monofilament nylon and 7-0 braided silk suture. The patient remained in the hospital for 40 days and did not return to work for 4 months. News of this triumph of microvascular skill was heralded throughout the world as the first successful replantation of a completely amputated digit. Over the past half century, the field of digit replantation in the USA experienced exponential growth followed by a steady decline in volume of cases and percentage of successful viable digits. The initial enthusiasm and technical progress of digital replantation has been tempered by mediocre functional outcomes, rising healthcare costs, and limited healthcare resources. In the next 50 years, it is possible that the majority of digit replantation procedures in the USA may be performed in tertiary centers or regional replant centers by highly skilled teams.

Otto Hilgenfeldt (1900-1983): tribute to an important pioneer of European hand surgery.

The German surgeon Otto Hilgenfeldt (1900-1983) was a great innovator in European hand surgery in the 20th century, particularly in respect of the tactile (sensate) thumb and grip reconstruction in amputation injuries. His experience, beginning in the 1930s, helped him to treat hundreds of soldiers with mutilating hand injuries from 1941 to 1945 during World War II. While totally isolated and without any access to international publications, he devised many innovative ideas such as a neurovascular middle finger transposition for pollicization (first case done in July 1943) and a sensory dorsoradial first metacarpal flap for thumb resurfacing. His book Operative thumb replacement and substitution of finger losses published in 1950 is regarded as one of the most important German contributions to modern hand surgery. Hilgenfeldt's life and work remain fascinating and exemplary from a historical and surgical point of view. Many of his pragmatic surgical solutions remain valid despite the advent of microsurgery.

[Otto Hilgenfeldt (1900 to 1983)--an unusual approach for finger reconstruction]. / Otto Hilgenfeldt (1900 bis 1983)--Ein ungewöhnliches Verfahren zum Fingerersatz.

Reconstructive surgery of detached extremities, especially fingers, has a long historical tradition. The first clinically correctly documented cases go back to the 19th century. During the first and second world wars numerous reports appeared about the surgical care of war victims. Pioneering innovative surgical methods were developed by especially motivated surgeons for the reconstruction of these disfiguring war injuries in Europe. Because of these particular circumstances and the prevailing revolutionary spirit, many innovations in surgery were developed. The report of Otto Hilgenfeldt (1950) described his unusual approach in reconstructing a finger by using the great toe.

The military upper extremity amputee.

Throughout the course of military history, soldiers have continued to sustain amputation injuries during war times and during peacetime and training missions. What has changed over time is the etiology of, indication for, and management of the amputations. Technology has advanced significantly, often with some military connection. More work still needs to be done, especially in the areas of greater prosthetic limb function and usage as well as phantom pain and sensation management. Collaborative efforts among physiatrists, surgeons, prosthetists, and therapists can only benefit the patient.

Military lower extremity amputee rehabilitation.

The role of the military has changed over the past eight decades. Although the threat of global warfare still exists, the military of today faces new challenges as a peacekeeper in countries under turmoil. Despite these changes, the fear of bodily injury, such as limb loss and even the possibility of death, are real concerns for our active duty personnel. The military physician must be aware of the appropriate surgical, rehabilitative, and psychosocial needs of the lower extremity traumatic amputee. The physical medicine and rehabilitation specialist is a physician particularly suited to provide direction for and to oversee the overall care of the amputee's condition. An amputee center providing a multidisciplinary team approach has worked well for the military during war and peacetimes. The physical medicine and rehabilitation inpatient service at WRAMC continues the tradition and philosophy of the military amputee centers dating back to WWI. By growing with the fast-paced technologic advances in prosthetic devices, yet keeping true to the fundamentals of prosthetic prescription and design, physical medicine and rehabilitation in the military has remained at the forefront of amputee rehabilitation. Patient satisfaction with the rehabilitation process and his or her new artificial limb remain priorities whether the goal is to return to active duty or to resume an active lifestyle in the civilian world.

Replantation of completely amputated distal forearm--1965.

Although replantation of completely amputated wrists and forearms is now commonplace, in 1965 the replantation of this "wrist level" amputation was the first reported in the western world. The details of the technique used are contrasted with current standard of care.

Composite graft replacement of digital tips. 1. Before 1850 and after 1950.

The successes of composite grafting of fingertips in the early years of plastic surgery have been repeated in the few studies of this treatment which have been reported during the last 50 years. The early and recent history of this subject are reviewed in the light of the increasingly pessimistic view of composite graft replacement of fingertips taken by recent reviewers.

The iron hand from Slovenia.

The iron hand prosthesis now in the custody of the Rehabilitation Institute Ljubljana, was excavated some 80 years ago in the ruins of the Vransko castle. The hand, its form and function are described. It was manufactured somewhere in Europe between the years 1500-1650. The owner, probably one of the local nobles, has remained unknown.