Treatment of Fingertip Injuries by Specialists in Hand Surgery in Brazil (original) (raw)
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Finger ? tip injuries are one of the most common injuries faced in the Emergency department of any hospital. This article deals with the experience of our hospital, over a period of 2 Years ? From September 2014 to September 2016 done as a prospective study. Ninety Patients that underwent some form of surgical Procedure were included and followed up over a period of six month. The analysis focused on factors such as mode of injury ? viz. Domestic, Industrial, Road traffic accidents etc, Hand Dominance, Digit involved, Surface involved, Procedure employed, Time taken to return to work, functional outcome and aesthetics. Out of Ninety, Thirty eight patients could be followed up fully. Choice of surgical procedure was made based on the orientation and configuration of the wound. Most of the patients were right handed. Index finger was the commonest digit involved followed by middle, ring, little fingers and thumb. Return to work time was delayed in patients with heterodigital flaps. Most of the patients were satisfied with the aesthetic outcome.
The use of flaps in the treatment of fingertip injuries
World Journal of Surgery, 1991
Fingertip injuries constitute a large portion of the traumatic injuries sustained to the hand and are frequently associated with significant disability for the patient. While many methods are available for the treatment of such injuries, quite often only certain procedures are appropriate for a particular digit in any given patient. The use of flaps in such instances provides an important tool for coverage of the exposed fingertip bone when more simple measures are inadequate. Herein follows a discussion of the indications and potential pitfalls for a variety of flaps which may be employed in the treatment of fingertip injuries. Les lésions de la pulpe constituent une proportion importante des lésions traumatiques de la main, et sont souvent responsables d'une incapacité de travail non négligeable. Alors qu'il existe de nombreuse méthodes pour traiter ces lésions, très souvent, un nombre plus restreint de procédés de reconstruction sied parfaitement à tel ou tel doigt chez un patient donné. L'utilisation d'un lambeau dans cette situation constitue un outil capital pour couvrir la pulpe ainsi exposée alors des techniques beaucoup plus simples ne sont pas suffisantes. On présente alors les indications et les écueils potentiels d'une large gamme de lambeaux qui trouvent leurs indications dans le traitement des lésions de la pulpe digitale. Las amputationes distales de los dedos representan una proporción considerable de las lesiones taumáticas de la mano y con frecuencia aparecen asociadas con incapacidad importante para el paciente. Aunque existen muchos métodos disponibles para el tratamiento de tales lesiones, es frecuente que sólo algunos procedimientos resulten apropiados para el manejo de un dedo en particular en un determinado paciente. El uso de colgajos en tales circunstancias constituye un método importante de cobertura del hueso expuesto del dedo, en aquellos casos en que otros métodos más sencillos resulten inadecuados. Se incluye una discusión sobre las indicaciones y potenciales fallas de una variedad de colgajos que pueden ser utilizados en el tratamiento de las lesiones de las puntas de los dedos.
Mechanisms and management of fingertip amputations in a teaching hospital, South-South, Nigeria
International Research Journal of Medicine and Medical Sciences, 2018
Injuries to the fingertip are common in our Accident and Emergency Department. The goal of treatment is restoration of a painless, functional digit with protective sensation. In other words, it involves the provision of sensate and durable fingertip and bone support for nail growth. When selecting a treatment option the amount of soft-tissue loss, the integrity of the nail bed, the age and physical demands of the patient should be considered. The study seeks to evaluate the mechanisms and management of fingertip amputations including the treatment modalities used and its impact on patient outcomes. This is a prospective study of 37 patients with 43 cases of fingertip amputations. Patient ages ranged from 5 to 56 years. Data was collected from January, 2016 to December, 2017. Various reconstructive options were considered for the fingertip amputations such as skin grafting, cross finger flap, thenar flap, hypothenar flap, louvers flap and groin flap in multiple digital injuries. The total duration of treatment varied from two to seven weeks with follow-up of two to eight months. The results showed preservation of finger length and contour, retention of sensation and healing minimal complication. About 40% of the patients had well formed fingertip pulps which were aesthetically acceptable. In conclusion, fingertip amputation is a common injury. Treatment depends on how much skin, soft tissue, bone and nail were damaged and how much of the finger or thumb was cut off. A good knowledge of the mechanism of injury, type of injury, occupation of patient and hand dominance would help in deciding the surgical technique to use. A satisfactory reconstruction is ascertained if the patient has durable, sensate, fingertip length preservation and a fairly formed pulp.
Fingertip Injuries and Amputations: A Review of the Literature
Cureus, 2020
The fingertip is defined as the part of the digit distal to the insertion of the extensor and flexor tendons on the distal phalanx. Devastating injuries to the hand occur every year that lead fingertip amputations in thousands of people. The highest incidence rates are usually seen in children less than five years old and in adults over the age of 65. There are various presentations of injury that may end up with post-traumatic fingertip amputation, including lacerations, avulsions, and crush injuries. The fingertip is vital for sensation, as it has a high concentration of sensory receptors, and hence the restoration of sensation is the most important focus of treatment. The three main goals of treatment are the restoration of sensation and durability in the tip and assuring proper bone support to allow for nail growth. Many complications can arise after fingertip amputation, including delayed wound healing, nail deformities with poor aesthetics, hypersensitivity, residual pain, cold intolerance, scar retraction, flexion contractures, chronic ulceration, infection, and flap loss. The objective of this study is to provide an overview of the anatomy of the fingertip, the presentation of fingertip injuries and their management, and complications that might arise after surgery.
Functional and Aesthetic Outcome of Fingertip Injuries' Management
The Egyptian Journal of Plastic and Reconstructive Surgery, 2020
Background: Fingertip injuries are the most common injuries that occur to the hand, accounting for 4.8 million Emergency Department visits per year. Fingertip injuries requires immediate intervention to avoid any complications or deformities. Several therapeutic modalities have been used for treatment; either surgical or conservative treatment and each of them has its own advantages and disadvantages. However, evidence is still lacking in the literature supporting either surgical or conservative lines of treatment. The purpose of the present study is to compare functional and aesthetic outcomes between surgical and conservative treatment of fingertip injuries. Methods: This prospective study included 50 patients with Allen's type II and III of fingertip injuries divided into two groups; Group I included 20 patients treated surgically and Group II included 30 patients treated conservatively which is further subdivided into subgroup I (Platelet Gel), subgroup II (Hyaluronic acid) and subgroup III (Fucidic acid). Results: The conservative treatment showed a significant improvement regarding the sensory outcome, the range of motion, rate of complications, the aesthetic outcome and the patients' satisfaction (p=0.002, 0.001, 0.021, 0.035, 0.026 respectively). The platelet gel in the conservative treatment showed a significantly shorter time of healing compared to other modalities of conservative treatment (p=0.004) thus a significant faster recovery and shorter time off-work (p=0.001). Conclusion: We concluded that the conservative treatment provides better functional and aesthetic outcome in treating fingertip injuries. The use of platelet gel in fingertip injuries is associated with decreased time of healing and early return to work.
Fingertip injury: A case report in emergency departments
International journal of health & medical sciences, 2023
Fingertip injury is one of the most common injuries to the hand. Injuries can include damage to the skin and soft tissue, bones (distal phalanx), nails and nailbeds. The fingertips are rich in nerves and very sensitive. Without prompt and precise treatment, finger injuries can interfere with the complex function of the hand and may result in permanent deformity and disability. This report aims to report management in patients with fingertip injuries. A 25-year-male patient with a fingertip injury in the area of the right index finger. The results of the local status examination found a laceration measuring 3x1,5 cm with uneven edges in the aspectus volar in the distal phalanx in the II digit along with tenderness and no limited finger movement. Patients treated with pharmacotherapy and operative measures for the reconstruction of fingertip injuries, with a local flap using the V-Y flap method.
Open treatment of fingertip amputations
Annals of Emergency Medicine, 1983
of Fingertip Amputations Twenty-five patients with fingertip injuries at or distal to the distal interphalangeal joint were treated with a thorough cleansing of the wound with application of bacitracin and a sterile dressing. Warm soaks were begun 48 hours after injury. Crush injury was the most common type of trauma, followed by cutting injuries. Bone involvement was present in six cases. The average healing time was 29 days. At the time of complete healing, sensation was normal in 22 patients (88%). Systemic antibiotics were not administered routinely. No patient developed a wound infection. Our study documents that fingertip amputations can be successfully treated by nonoperative methods that result in preservation of finger length and contour, retention of sensation, and healing without infection.
Hierarchy of evidence relating to hand surgery in Brazilian orthopedic journals
Sao Paulo Medical Journal, 2011
CONTEXT AND OBJECTIVE: There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid.
Indian J Orthop, 2007
Background: Fingertip injuries are extremely common. Out of the various available reconstructive options, one needs to select an option which achieves a painless fingertip with durable and sensate skin cover. The present analysis was conducted to evaluate history including patient's demographics, mechanism of 1cm without exposed bone or tendon, split-thickness injury, hand dominance, occupation, duration since injury grafting (n=20) was performed. Full-thickness grafting the management and outcome of fi ngertip injuries. Materials and Methods: This is a retrospective study of 150 cases of fingertip Injuries of patients aged six to 65 years managed over a period of two years. Various reconstructive options were considered for the fingertip lesions greater than or equal to 1 cm 2 The total duration of treatment varied from two to six weeks with follow-up from two months to one year. Results: The results showed preservation of finger length and contour, retention of sensation and healing without significant complication. Conclusion: The treatment needs to be individualized and all possible techniques of reconstruction must be known to achieve optimal recovery.
Objective This study evaluates the conditions for microvascular procedures found by hand surgeons in Brazilian clinical practices. Methodology A prospective, observational, and analytical primary clinical research conducted during the 37 th Brazilian Congress of Hand Surgery, from March 30 th to April 1 st , 2017, in Belo Horizonte, in which physicians answered 12 closed, objective, multiple-choice questions regarding their geographic region, type of institution (public or private), microsurgical training, time of experience, technical conditions, the availability of a standby team for emergencies and compensation. Results The study analyzed 143 hand surgeons; among them, 65.7% participants were based at the Southeast region, 13.3% in the Northeast region, 11.9% in the South region, 6.3% in the Central-West region and 2.8% in the North region. Regarding the time of experience, 43.4% of the hand surgeons had less than 5 years, 16.8% had 5 to 10 years, 23.8% 10 to 20 years, and 23% had more than 20 years of practice in microvascular surgery. Seven percent of the surgeons had no training in microvascular surgery; for 63.6%, training occurred during medical residency, whereas 30.8% were trained in another institution, and 7.7% in another country. Among these surgeons, 76.9% worked at both private and public hospitals, 14.7% at private hospitals and 5.6% at public hospitals. Regarding compensation, 1.8% of the surgeons considered it adequate, and 98.2%, inadequate in public hospitals, whereas 5.0% considered it adequate, and 95.0%, inadequate in private hospitals. Conclusion This research shows that most surgeons were trained in microsurgery, had never performed reattachments, and considered that compensation is inadequate; moreover, standby teams were not available. There are few, unevenly distributed hand surgeons with microsurgical ability in emergency settings, and their compensation is low.