Treatment of Fingertip Injuries

Neustein, Thomas M.; Payne, Samuel H.; Seiler, John G.

doi:10.2106/jbjs.rvw.19.00182

Cited by 16 publications

(13 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Allen type III and four amputations can be treated with secondary healing, but there is a strong likelihood that nail deformity would develop. [ 2 , 14 , 18 , 19 ] Upon the patient request or due to other conditions (e.g., severely contaminated injury, economic reasons), bone shortening and stump closure may be selected. Stump closure provides short operation time and early recovery, but results in more shortness.…”

Section: Discussionmentioning

confidence: 99%

Are cross finger and thenar flaps effective in the treatment of distal finger amputations with the reposition-flap method?

Cam

Kanar

2022

Jt Dis Relat Surg

View full text Add to dashboard Cite

Finger distal tip amputation due to upper extremity injuries is frequently encountered in the emergency setting. Methods such as wound care, replantation, flap or composite graft applications and stump closure are frequently used in treatment. The method to be chosen depends on the type of injury, the level of amputation, factors related to the patient, the surgeon, and the center where treatment is applied. [1] The main goal of treatment should be to restore the length, appearance, sensation and function of the finger. Although protecting the nail bed and providing length can provide a good aesthetic appearance, it is also of utmost importance to provide the patient with a painless and functional finger. [2,3] Replantation is an important treatment option which can meet all these expectations. [3][4][5][6][7][8][9][10] Unfortunately, replantation cannot be applied to every patient for many reasons. [1,3] Objectives: The aim of this study was to evaluate the effectiveness of using cross finger and thenar flaps in treatment of distal fingers amputations with reposition-flap method.Patients and methods: Between September 2017 and January 2020, a total of 20 fingers of 19 patients (15 males, 4 females; mean age: 31.6±10.4 years; range, 19 to 52 years) who were treated with repositioning using a cross finger or thenar flap were retrospectively analyzed. Finger length, flap status, pain, cold intolerance, two-point discrimination, bone healing and appearance of the nail were recorded. Functional evaluation was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score and range of motion. Results:The mean follow-up was 19.5±5.2 months. A poor result was seen in one patient with the development of necrosis in the flap. With the exception of one finger with necrosis in the flap, no major complications were observed. Union was achieved in all other bones. The mean shortness was 3.7±1.9 mm. The mean Quick-DASH score was 4.5±5.0 and the mean two-point discrimination test was measured as 6.8±0.9. Conclusion:In fingertip amputations repositioning with a cross finger or thenar flap can achieve a near-normal fingertip appearance with the advantages for the surgeon of a short learning curve and no requirement for microsurgery experience. If replantation cannot be applied in fingertip amputations, this method should be considered among the treatment options, particularly for patients with high aesthetic expectations.

show abstract

Section: Discussionmentioning

confidence: 99%

Are cross finger and thenar flaps effective in the treatment of distal finger amputations with the reposition-flap method?

Cam

Kanar

2022

Jt Dis Relat Surg

View full text Add to dashboard Cite

show abstract

“…For example, the reference values generated here could aid diagnoses by establishing whether an individual’s finger tapering falls within or outside of the bounds of normal variation. Moreover, the general approach and norms described here may also serve as a reference for reconstructive hand surgery [ 8 , 9 ], aid in forensic investigations [ 10 , 11 ], and inform design and ergonomic applications [ 12 , 13 ]. For example, sex determination from the hand and digits can help with the identification of partial remains.…”

Section: Discussionmentioning

confidence: 99%

Objective assessment of tapering of the fingers in adults

Weinberg

2022

PLoS ONE

View full text Add to dashboard Cite

Mild proximal-to-distal tapering of the fingers is a relatively common trait in humans. When more extreme, finger tapering is a feature observed in many genetic syndromes. The range of variation for finger tapering in the general population is not well understood, and sex differences in the degree of tapering, while suspected, have not been documented. Part of the difficulty is a lack of objective methods to evaluate finger tapering. In the present report, we developed a tapering index based on linear measures derived from digital hand scans. We measured this index in a sample of 166 male and 166 age-matched female adults. We then looked at correlations both among fingers and with demographic and anthropometric variables, followed by tests for sex differences. We observed weak correlations between tapering and age, height and weight. Correlations between pairs of fingers tended to be more in the moderate range and were highest among the middle three fingers (ranging from 0.34 to 0.64). Tapering tended to increase slightly moving radially across the hand from the fifth finger to the second finger. Males showed less tapering than females for all fingers, with statistically significant differences involving the left second finger (p = 0.003), left fifth finger (p< 0.001), right second finger (p = 0.038), and right fourth finger (p = 0.021). Finally, we established baseline norms for both males and females out to three standard deviations. Our results indicate that finger tapering is present, to some degree, in most of the population and that the trait can be measured using a relatively simple and non-invasive method. These findings may have relevance for fields as diverse as medical genetics, forensics, and industrial design.

show abstract

“…The dorsoradial artery, with an average diameter of 0.4 mm, arises from the radial artery at the level of the anatomical snuffbox and passes on the palmar aspect of the extensor pollicis brevis tendon. 2 4 5 7 It travels in the same plane as the dorsoulnar artery, on the radial side of the thumb, adjacent to a superficial radial nerve branch, running at an approximate 1-cm average distance from the medial axis. 4 This flap is thought to be drained by tiny venules contained in the perivascular fascia adipose tissue 8 rather than specific veins that follow the dorsoradial artery.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review

Goh

Kulkarni

Moura

et al. 2024

Journal of Hand and Microsurgery

View full text Add to dashboard Cite

Introduction Soft-tissue thumb defects are common reconstructive challenges, the main goals being restoration of tactile sensibility, range of movement, pulp padding, length, and cosmesis. The reverse-flow dorsoulnar and dorsoradial collateral artery flaps are homodigital flaps used to cover both distal dorsal and volar thumb defects. These flaps can be used as compound flaps including skin, fat, and/or nerves. As there is no critical analysis of these studies, this study aims to create a synthesized comprehensive systematic review. Methods Systematic review was performed using the databases PubMed, Embase, and Medline. Eligible studies followed the inclusion criteria: English language and all studies published to date. The primary outcome was flap survival. Other data collected included anatomical area of the defect, flap constituents and dimensions, donor-site closure and complications, transfer method, reoperation, revision, and functional outcomes. Results A total of 19 articles incorporating 189 flaps met the inclusion criteria. These flaps were categorized and analyzed as dorsoradial (50%), dorsoulnar (39%), and turnover flaps (11%). Dorsoradial flaps were used in fasciocutaneous fashion alone. Partial flap failures occurred in five cases. Dorsoulnar flaps were used as fasciocutaneous or as osteocutaneous flaps. Complete flap failure was reported in one patient alone, whereas partial necrosis was reported in four patients. Adipofascial turnover flaps had two partial flap failures reported but no complete failures. The overall complete and partial flap failure rates were 0.5 and 6.5%, respectively. Conclusion Reverse-flow homodigital random or axial-based flaps provide a reliable means of reconstruction for soft-tissue defects with reasonable success rate and good functional outcomes. They have a consistent anatomy with a good potential for personalization and therefore increased versatility.

show abstract

Treatment of Fingertip Injuries

Cited by 16 publications

References 42 publications

Are cross finger and thenar flaps effective in the treatment of distal finger amputations with the reposition-flap method?

Are cross finger and thenar flaps effective in the treatment of distal finger amputations with the reposition-flap method?

Objective assessment of tapering of the fingers in adults

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review

Contact Info

Product

Resources

About