Predictors of Hand Dexterity after Single-Digit Replantation

Nakanishi, Akito; Kawamura, Kenji; Omokawa, Shohei; Shimizu, Takamasa; Iida, Akio; Tanaka, Yasuhito

doi:10.1055/s-0038-1669446

Cited by 10 publications

(2 citation statements)

References 14 publications

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“…If hand dexterity is of primary clinical importance, our results suggest that patients should preferentially undergo replantation. This finding of improved dexterity in the replantation cohort compared with the revision amputation cohort is consistent with the study by Chung et al, although few prior studies have focused on dexterity as a key functional outcome. Hand dexterity is achieved through the interfacing of complex biomechanics of the hand and neurocircuitry in the central and peripheral nervous system, which is clinically challenging to measure and interpret.…”

Section: Discussionsupporting

confidence: 91%

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

et al. 2020

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IMPORTANCE Optimal treatment for traumatic finger amputation is unknown to date. OBJECTIVE To use statistical learning methods to estimate evidence-based treatment assignment rules to enhance long-term functional and patient-reported outcomes in patients after traumatic amputation of fingers distal to the metacarpophalangeal joint. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model used data from a retrospective cohort study of 338 consenting adult patients who underwent revision amputation or replantation at 19 centers in the United States and Asia from August 1, 2016, to April 12, 2018. Of those, data on 185 patients were included in the primary analysis. EXPOSURES Treatment with revision amputation or replantation. MAIN OUTCOMES AND MEASURES Outcome measures were hand strength, dexterity, handrelated quality of life, and pain. A tree-based statistical learning method was used to derive clinical decision rules for treatment of traumatic finger amputation. RESULTS Among 185 study participants (mean [SD] age, 45 [16] years; 156 [84%] male), the median number of fingers amputated per patient was 1 (range, 1-5); 115 amputations (62%) were distal to the proximal interphalangeal joint, and 110 (60%) affected the nondominant hand. On the basis of the tree-based statistical learning estimates, to maximize hand dexterity or to minimize patient-reported pain, replantation was found to be the best strategy. To maximize hand strength, revision amputation was the best strategy for patients with a single-finger amputation but replantation was preferred for all other injury patterns. To maximize patient-reported quality of life, revision amputation was the best approach for patients with dominant hand injuries, and replantation was the best strategy for patients with nondominant hand injuries. CONCLUSIONS AND RELEVANCE The findings suggest that the approach to treating traumatic finger amputations varies based on the patient's injury characteristics and functional needs.

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Section: Discussionsupporting

confidence: 91%

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

et al. 2020

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“…41 Patient age likely influences need for secondary procedures through age-dependent inflammatory responses, 14,42,43 compliance issues, and ability to remodel joints and regenerate nerves. 13,44,45 To this end, identifying preoperative risk factors for secondary procedures can be used to help educate patients and guide perioperative management.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Secondary Procedures following Digit and Hand Replantation

Shaterian

Sayadi

Anderson

et al. 2019

Journal of Hand and Microsurgery

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Introduction Secondary procedures following digit and hand replants are often necessary to optimize functional outcomes. To date, the incidence and characteristics of secondary procedures have yet to be fully defined. Materials and Methods A literature search was performed using the NCBI (National Center for Biotechnology Information) database for studies evaluating secondary procedures following digit and hand replantation/revascularization. Studies were evaluated for frequency and type of secondary procedure following replantation. Descriptive statistical analysis was conducted across the pooled dataset. Results Nineteen studies representing 1,485 replants were included in our analysis. A total of 1,124 secondary procedures were performed on the 1,485 replants. Secondary procedures most commonly addressed tendons (27.1%), bone/joints (16.1%), soft tissue coverage (15.4%), nerve (5.4%), and scar contractures (4.5%). A total of 12.7% of replants resulted in re-amputation (16.7% of secondary procedures). The details of secondary procedures are further described in the article. Conclusion Secondary procedures are often necessary following hand and digit replants. Patients should be informed of the possible need for subsequent surgery, including delayed amputation, to improve hand function. These data improve our understanding of replant outcomes and can help patients better comprehend the decision to undergo replantation.

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A Metamaterial Computational Multi‐Sensor of Grip‐Strength Properties with Point‐of‐Care Human‐Computer Interaction

Chen,

Li,

Wang

et al. 2023

Advanced Science

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Grip strength is a biomarker of frailty and an evaluation indicator of brain health, cardiovascular morbidity, and psychological health. Yet, the development of a reliable, interactive, and point‐of‐care device for comprehensive multi‐sensing of hand grip status is challenging. Here, a relation between soft buckling metamaterial deformations and built piezoelectric voltage signals is uncovered to achieve multiple sensing of maximal grip force, grip speed, grip impulse, and endurance indicators. A metamaterial computational sensor design is established by hyperelastic model that governs the mechanical characterization, machine learning models for computational sensing, and graphical user interface to provide visual cues. A exemplify grip measurement for left and right hands of seven elderly campus workers is conducted. By taking indicators of grip status as input parameters, human‐computer interactive games are incorporated into the computational sensor to improve the user compliance with measurement protocols. Two elderly female schizophrenic patients are participated in the real‐time interactive point‐of‐care grip assessment and training for potentially sarcopenia screening. The attractive features of this advanced intelligent metamaterial computational sensing system are crucial to establish a point‐of‐care biomechanical platform and advancing the human‐computer interactive healthcare, ultimately contributing to a global health ecosystem.

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Predictors of Hand Dexterity after Single-Digit Replantation

Abstract: Patient age was a risk factor for low hand dexterity after replantation surgery. Recovery of finger sensitivity enhanced dexterity of motor skill activities following finger replantation surgery.

Cited by 10 publications

References 14 publications

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

Characteristics of Secondary Procedures following Digit and Hand Replantation

A Metamaterial Computational Multi‐Sensor of Grip‐Strength Properties with Point‐of‐Care Human‐Computer Interaction

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