BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy th...BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment.Herein,we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station.The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger.The fingertip was pale,numb,and characterized by severe swelling and a limited range of motion.Finger radiography showed that there was no fracture in the finger.Digital decompression was performed through finger fasciotomy by bilateral midline incision.On the second day after surgery,the color of the fingertip returned to pink,swelling was resolved,and the range of motion returned to normal.The sensation of the fingertip was completely restored,and the capillary refill test and pinprick test were positive.CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station.To avoid finger necrosis,rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.展开更多
Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomo...Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.展开更多
Objective： To explore the measures and methods for improving distal phalanx replantation. Methods： One hundred and forty-eight cases with distal phalanx replantation from Sep 2004 to Sep 2007 were investigated. The ...Objective： To explore the measures and methods for improving distal phalanx replantation. Methods： One hundred and forty-eight cases with distal phalanx replantation from Sep 2004 to Sep 2007 were investigated. The indication for surgery and the operative program was determined by the trauma type and the degree of injury. As many microcirculation pathways as possible were reconstructed during the operation, and postoperative tissue decompression was also performed. Results： The survival rate of distal phalanx replantation was 89.9% （169/148）. Conclusion： To improve the survival rate of distal phalanx replantation it is essential to reconstruct an effective local blood circulation, determine the degree of injury in cases with ecchymosis, and employ comprehensive postoperative measures.展开更多
Objective： To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities. Methods： From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers ...Objective： To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities. Methods： From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation. Results： All patients were followed up for 6-12 months, mean 7 months. According to the Patel＇s evaluation criteria, 2 cases （17%） obtained excellent results, 7 good （58%）, 2 fair （17%） and 1 poor （8%）. The overall rate of the cases with excellent and good outcomes was 75%. Conclusion： Buried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.展开更多
The degloving injuries of the digits and palm remain a persistent challenge. We used an anterolateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring ...The degloving injuries of the digits and palm remain a persistent challenge. We used an anterolateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring fingers. The flap was designated to wrap the entire circumference of three fingers sustaining degloving injury and to form mitten-hand. The total lengths of the distal phalanxes of three fingers were retained almost complete. The donor defect was covered with split-thickness skin graft. Three months after the first operation, roentgenograms revealed terminal phalanxex resorption in three injured fingers, and the surgical syndactyly between the middle and ring finger was separated at the same time. One month later, the syndactyly between the index and middle fingers was also separated. Good coverage of the soft tissue defects with good function and appearance was achieved. Therefore, we considered that the length of the degloved finger could be preserved using free flap.展开更多
Purpose:Fingertip injuries are common in industrial production activities as well as in domestic work.Loss of pulp hampers daily life activities.Functional and aesthetic aspects are important in fingertip reconstructi...Purpose:Fingertip injuries are common in industrial production activities as well as in domestic work.Loss of pulp hampers daily life activities.Functional and aesthetic aspects are important in fingertip reconstruction.The bone is usually exposed along with soft tissue loss.Therefore to reconstruct the pulp flap with adequate bulk is required.Methods:We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger.In all cases,laterally based thenar flap was chosen.The flap donor site was closed primarily in most of cases,while 4 patients required skin graft.The flap was detached between 2e3 weeks.Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint.The aesthetic outcome was assessed through questionnaire.The results were analyzed using the unpaired t-test(SPSS version 21).Results:Partial necrosis occurred in 2 cases while rest of flaps survived successfully.Static 2-point discrimination ranged from 6e10 mm,mean 8.6 mm;and dynamic 2-point discrimination ranged from 8e10 mm,mean 8.9 mm.The mean satisfaction score was(4.0±0.55).Conclusion:Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.展开更多
Injuries to the hand secondary to high pressure paint guns are considered to be true hand emergencies.These rare injuries may have serious outcomes,and a critical step in their management is extensive debridement perf...Injuries to the hand secondary to high pressure paint guns are considered to be true hand emergencies.These rare injuries may have serious outcomes,and a critical step in their management is extensive debridement performed within the first six hours following injury.For this reason,their diagnosis should not be delayed,and the hand surgeon should be informed immediately to initiate appropriate treatment.In this report,the authors describe a patient who was injured with a chemical paint gun,and whose injury was not diagnosed in the emergency department.The patient subsequently developed tenosynovitis.His treatment is reported herein.展开更多
Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the d...Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures： Kirschner wire fixation with extension block pinning （EBP） of the distal interphalangeal joint, Kirschner wires used as joysticks （KWJ） and interfragmentary miniscrews for open reduction and internal fixation （ORIF）. Methods： Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old （average 42 years） were operated upon by EBP, 16 patients 22 to 56 years old （average 56 years） were operated upon using KWJ and 22 patients 22 to 54 years old （average 36 years） received OR/F. Follow-up time was 6 to 58 months （average 21 months）. The following intraoperative parameters were considered： intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion （ROM） test with a goniometer. Based on these measurements, a functional Crawford score was established. Results： All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider （72° vs 58° and 54 °）; in the ORIF group, return to work was faster （2.7 weeks vs 7.2 weeks and 6 weeks） but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions： We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding （longer intraoperative time and more complications） but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.展开更多
文摘BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment.Herein,we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station.The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger.The fingertip was pale,numb,and characterized by severe swelling and a limited range of motion.Finger radiography showed that there was no fracture in the finger.Digital decompression was performed through finger fasciotomy by bilateral midline incision.On the second day after surgery,the color of the fingertip returned to pink,swelling was resolved,and the range of motion returned to normal.The sensation of the fingertip was completely restored,and the capillary refill test and pinprick test were positive.CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station.To avoid finger necrosis,rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.
文摘Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.
基金supported by Jiangsu Natural and Science Foundation (BK2006249).
文摘Objective： To explore the measures and methods for improving distal phalanx replantation. Methods： One hundred and forty-eight cases with distal phalanx replantation from Sep 2004 to Sep 2007 were investigated. The indication for surgery and the operative program was determined by the trauma type and the degree of injury. As many microcirculation pathways as possible were reconstructed during the operation, and postoperative tissue decompression was also performed. Results： The survival rate of distal phalanx replantation was 89.9% （169/148）. Conclusion： To improve the survival rate of distal phalanx replantation it is essential to reconstruct an effective local blood circulation, determine the degree of injury in cases with ecchymosis, and employ comprehensive postoperative measures.
文摘Objective： To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities. Methods： From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation. Results： All patients were followed up for 6-12 months, mean 7 months. According to the Patel＇s evaluation criteria, 2 cases （17%） obtained excellent results, 7 good （58%）, 2 fair （17%） and 1 poor （8%）. The overall rate of the cases with excellent and good outcomes was 75%. Conclusion： Buried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.
文摘The degloving injuries of the digits and palm remain a persistent challenge. We used an anterolateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring fingers. The flap was designated to wrap the entire circumference of three fingers sustaining degloving injury and to form mitten-hand. The total lengths of the distal phalanxes of three fingers were retained almost complete. The donor defect was covered with split-thickness skin graft. Three months after the first operation, roentgenograms revealed terminal phalanxex resorption in three injured fingers, and the surgical syndactyly between the middle and ring finger was separated at the same time. One month later, the syndactyly between the index and middle fingers was also separated. Good coverage of the soft tissue defects with good function and appearance was achieved. Therefore, we considered that the length of the degloved finger could be preserved using free flap.
文摘Purpose:Fingertip injuries are common in industrial production activities as well as in domestic work.Loss of pulp hampers daily life activities.Functional and aesthetic aspects are important in fingertip reconstruction.The bone is usually exposed along with soft tissue loss.Therefore to reconstruct the pulp flap with adequate bulk is required.Methods:We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger.In all cases,laterally based thenar flap was chosen.The flap donor site was closed primarily in most of cases,while 4 patients required skin graft.The flap was detached between 2e3 weeks.Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint.The aesthetic outcome was assessed through questionnaire.The results were analyzed using the unpaired t-test(SPSS version 21).Results:Partial necrosis occurred in 2 cases while rest of flaps survived successfully.Static 2-point discrimination ranged from 6e10 mm,mean 8.6 mm;and dynamic 2-point discrimination ranged from 8e10 mm,mean 8.9 mm.The mean satisfaction score was(4.0±0.55).Conclusion:Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.
文摘Injuries to the hand secondary to high pressure paint guns are considered to be true hand emergencies.These rare injuries may have serious outcomes,and a critical step in their management is extensive debridement performed within the first six hours following injury.For this reason,their diagnosis should not be delayed,and the hand surgeon should be informed immediately to initiate appropriate treatment.In this report,the authors describe a patient who was injured with a chemical paint gun,and whose injury was not diagnosed in the emergency department.The patient subsequently developed tenosynovitis.His treatment is reported herein.
文摘Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures： Kirschner wire fixation with extension block pinning （EBP） of the distal interphalangeal joint, Kirschner wires used as joysticks （KWJ） and interfragmentary miniscrews for open reduction and internal fixation （ORIF）. Methods： Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old （average 42 years） were operated upon by EBP, 16 patients 22 to 56 years old （average 56 years） were operated upon using KWJ and 22 patients 22 to 54 years old （average 36 years） received OR/F. Follow-up time was 6 to 58 months （average 21 months）. The following intraoperative parameters were considered： intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion （ROM） test with a goniometer. Based on these measurements, a functional Crawford score was established. Results： All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider （72° vs 58° and 54 °）; in the ORIF group, return to work was faster （2.7 weeks vs 7.2 weeks and 6 weeks） but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions： We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding （longer intraoperative time and more complications） but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.
