We present two clinical cases with complete amputation of multiple digits that were salvaged after having been successfully implanted on ectopic sites. The first case concerns a 73-year-old patient, who suffered a severe crush injury of his right hand that resulted in amputation of all four long fingers and an extensive tissue loss of the palm and the dorsum of the hand. Two of the amputated digits, that were considered to be replantable, were implanted on the dorsum of the left foot. The hand defect was covered with a pedicle groin flap. After six weeks, the two ectopically implanted fingers were transferred to their proper anatomical site. Several reconstructive procedures were performed later, in order to lengthen the first ray of the injured hand, and to deepen the first web space. Satisfactory functional results were recorded after eighteen months of follow-up. The second patient concerns a 45-year-old male patient, who had a gun shot accident of his right hand. The injury resulted in a composite tissue loss of the hand with complete amputation of his four long fingers. All fingers were implanted on the left forearm, while the hand defect was reconstructed using an osteocutaneous free flap of the iliac crest. Six weeks after the initial procedure, the ectopically implanted digits were transferred - as a single free flap - to the hand. We described with details the local conditions of the injured hands in both cases, and discuss the reasons we decided to perform this sophisticated method in order to preserve the viability and function of those totally amputated fingers. The recipient sites were selected in a distance from the injured area, always considering the availability and size of appropriate recipient vessels, and the safety of the surgical procedure. We agree that the whole concept of this procedure is very demanding, and requires several microsurgical operations with high risk of complications. However, it does deserve special consideration in reconstructive microsurgery, since it offers the possibility to salvage multiple amputated digits, by preserving the anatomy and restoring the function of severely injured hands.
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http://dx.doi.org/10.1016/j.anplas.2004.11.014 | DOI Listing |
J Clin Med
January 2025
Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
: Tactile gnosis derives from the interplay between the hand's tactile input and the memory systems of the brain. It is the prerequisite for complex hand functions. Impaired sensation leads to profound disability.
View Article and Find Full Text PDFInt J Surg Case Rep
January 2025
Department of Plastic and Reconstructive Surgery, University Hospital North Durham, Durham DH1 5TW, United Kingdom. Electronic address:
Introduction: Digital papillary adenocarcinoma (DPAC) is a rare malignant tumour of the sweat glands, usually in the digits. It has a high rate of recurrence and metastasis, yet there's a lack of guidelines for its diagnosis and management. Therefore, this report aims to evaluate procedures that provide the best outcomes, which will help create a consensus for its management.
View Article and Find Full Text PDFEur J Trauma Emerg Surg
January 2025
Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 place d'Arsonval, Lyon, 69003, France.
Purpose: To report the radiological outcomes and complications of the Masquelet induced membrane technique (IMT) for acute bone reconstruction in complex hand injuries.
Methods: We retrospectively reviewed 22 patients treated primarily by the IMT for bone defect of the phalanx and/or metacarpals bones in 26 injured digits. The median bone defect length was 17 mm (IQR 13-25).
J Am Acad Dermatol
January 2025
Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address:
Background: Nail unit melanoma (NUM) is increasingly treated with digit-sparing surgery, but few published case series describe Mohs micrographic surgery (MMS) for NUM.
Objective: To describe the surgical technique, local recurrence rates, and reconstruction method for a large series of NUM treated with MMS using MART-1 immunostaining.
Methods: Biopsy-proven NUM treated with MMS-MART-1 were identified from a prospectively maintained database (2008-2023).
Cureus
December 2024
Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Raynaud's phenomenon (RP) is characterized by episodic vasospasm of the small blood vessels, primarily affecting the fingers and toes. Management includes lifestyle modifications, pharmacological treatments, and in severe cases, surgical interventions. Here we report a case of an 80-year-old male patient with a history of hypertension, dyslipidemia, obesity, and atrial fibrillation who presented to the emergency department with edema, cyanosis, and intense pain in the fingers of both hands following a mild COVID-19 infection (no dyspnea or hypoxemia).
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