Adjacent Digits Research Articles

A Study on the Formal Syntax-Semantics Interface of the Particle for Numerical Approximation <i>Lai</i>

As the subsystem of human natural language, numeral is not only an important window to pry into the mindset and culture of a nation, meanwhile, due to its specialty in morphological, syntax and semantics, it has always been drawing the high attention of linguists. As the organic part of numeral system, particles for numerical approximation are frequently used in Mandarin Chinese, and their usage is rather complicated. There have been fruitful achievements about the research on such linguistic phenomenon, but controversies have also never ceased. Under the theoretical framework of formal linguistics, this paper mainly explores the syntactic distribution and semantic interpretation of the particle for numeral approximation<i> lai </i>in modern Mandarin Chinese. It is demonstrated that syntactically, whether suffixed behind numerals, numeral-classifier, or just classifier, <i>lai, </i>as a bound morpheme, always functions upon the whole phrase ahead, but it just semantically associates with its immediately adjacent digit word or classifier. Semantically, this paper ascertains the value of <i>lai</i> as λxλy[(x-10^y×20%)~(x+10^y×20%)] when it follows a numeral, which is evidenced by various kinds of numerals and adequate explanation, and in the meantime, it verifies that the aforementioned semantic model is also in accordance with the case when <i>lai</i> suffixes a numeral-classifier or classifier by analogy. Through the syntactic-semantic interface analysis on the particle for numeral approximation<i> lai, </i>this research is likely to deepen people’s understanding about the whole numeral system, thereby facilitating the study on the ontology of human natural language, and at the meantime, it may play a positive role in the enhancement of Chinese-foreign language teaching and artificial intelligence.

Novel Heterozygous Sequence Variant in the HOXD13 Gene Underlie Non-syndromic Syndactyly

Background: The term &amp;quot;Syndactyly&amp;quot; referred to an inherited deformity of the hand or foot marked by persistence of the webbing between adjacent digits that are more or less completely attached and mostly inherited in an autosomal dominant manner. Pathogenic variants in the HOXD13 (Homeobox D13) gene, located on chromosome 2q31.1, have been associated with syndactyly type 5, brachydactyly type D, E and synpolydactyly type 1 phenotypes. Objectives: A Pakistani inbreed was recruited from the remote area of the country was added in the study and aimed to clinically and genetically characterize the syndactyly as marked abnormal feature observed. Methodology: Whole exome sequencing coupled with Sanger sequencing was carried out to uncover the disease associated variant/s followed by 3D protein modeling to check variant related effect on protein level. Results: WES data analysis revealed a novel-HOXD13 gene missense variant (c.969G&amp;gt;T; p.Trp323Cys) that might explain the disease phenogenesis. 3D protein modeling of the normal and mutant protein predicated high level changes that might compromise the ultimate function of the protein. Conclusion: Our findings extend the mutation spectrum of HOXD13 gene and also provided additional evidence that HOXD13 play an important role in limbs development.

240 Flexor Digitorum Profundus Tendon Segment Length Estimation via Measurement of Adjacent Landmarks in the Secondary Repair of Jersey Finger

Abstract Aim Jersey finger describes injury involving the rupture of a Flexor Digitorum Profundus (FDP) tendon. The rupture occurs at its point of insertion, at the base of the distal phalanx. Cause of injury is forced hyperextension of FDP. Correct tendon tensioning correlates with tendon length during repair and is vital to optimise restoration of function. No evidence-based approach to tendon tensioning exists hitherto. We used cadaveric dissection to measure anatomical landmarks associated with the FDP tendon and assess whether these can be used to estimate the length of the adjacent tendon segments. Method Eight cadaveric hands were dissected (four fresh-frozen and four formalin-fixed). Lumbrical muscles, A1 pulley and distal FDP insertion for digits II-IV were identified. Lengths between the most distal point of the lumbrical origin; proximal and distal ends of the A1 pulley and FDP insertion were recorded. Results Measurements involving the A1 pulley showed a great degree of variation and no clear trend across the digits studied. Conversely, lumbrical origin to FDP insertion lengths were consistent relative to the adjacent digit measurements across all cadavers for digits II, II and IV. This was confirmed by a linear regression analysis (R2 &amp;gt;0.97). Conclusions This study demonstrates how distal lumbrical origin to FDP tendon insertion measurements in digit III can be used to estimate the length of the tendon graft required in digit II or IV, during repair. This injury manifests most commonly in digit IV. Therefore, our finding furthers surgical knowledge and is likely to improve patient outcomes.

Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials

Local anesthesia is an effective method to perform digital nerve blocks. In this study, we compare the effectiveness of single-volar subcutaneous and double-dorsal injection through a systematic review and meta-analysis of randomized controlled trials (RCTs). A systematic search of PubMed, Embase, and the Cochrane Library from inception to 7 April 2021 was performed. RCTs with the effects of single-volar subcutaneous and double-dorsal injection were eligible. Meta-analysis was performed using random effect models with pooled standardized mean differences (SMDs) and 95% confidence intervals (CI). RoB 2.0 and GRADE of Recommendation Assessment, Development, and Evaluation criteria were applied for evaluating the bias. A total of 2484 studies were initially identified, with 11 eligible RCTs finally included in the meta-analysis (1363 patients). The pooled data of nine studies showed single-volar injection had a statistically significantly lower pain score (pooled SMD: 0.20, 95% CI, 0.01 to 0.39, p = 0.041, I2 = 58%, N = 1187) and higher patient preference but invalid anesthesia at the dorsal proximal digit. No significant differences were observed in the onset of anesthesia, adjacent digit invalid numbness, distal phalanx invalid anesthesia, additional injection rate, and adverse effects. In conclusion, this meta-analysis of RCTs showed that the single-volar injection was associated with a lower pain sensation during injection and higher patient satisfaction with a reduced anesthetic effect over the proximal dorsal phalanx. Further high-quality RCTs with a higher number of cases are needed to validate our results.

Nonpathological phalangeal fractures in cattle: 17 cases (2004-2020).

To characterize clinical findings and outcomes for cattle with nonpathological phalangeal fractures. 17 cattle with nonpathological phalangeal fractures. Medical records of a teaching hospital were reviewed to identify cattle treated for nonpathological phalangeal fracture between May 2004 and May 2020. Information extracted from the records of study-eligible animals included signalment, history, clinical and diagnostic imaging findings, treatment, and survival to hospital discharge. Long-term outcome was assessed by telephone communication with owners. 9 bulls and 8 heifers or cows (age range, 1 to 7 years) of various breeds and uses were evaluated. Five of the 9 bulls were bucking stock, which were overrepresented in the study population. Seven animals had 8 distal phalanx fractures; 10 animals had 11 proximal phalanx fractures. Eight animals were treated by application of a hoof block on the unaffected adjacent digit, 7 animals were treated with a distal limb (n = 6) or transfixation pin (1) cast in addition to a hoof block, 1 animal was treated with a hoof trim to elevate and alleviate weight bearing on the affected digit, and 1 animal was euthanized immediately after diagnosis. Sixteen animals survived to hospital discharge. Follow-up was obtained for 12 animals, of which 9 returned to functionable use and 3 were culled. Results suggested cattle with a nonpathological phalangeal fracture have a favorable prognosis for return to function following application of a hoof block to the unaffected adjacent digit with or without a distal limb cast.

Prosthetic fitting in a double-digit amputation with concomitant postoperative shortening and contracture of the adjacent digits: optimizing aesthetic and functional outcomes.

This report discusses the considerations behind the special modifications made on the finger prostheses fitted for a patient with crushed index, middle, ring, and little fingers resulting in a double-digit amputation with significant postoperative scarring, discoloration, shortening, and contracture of the salvaged index and middle fingers. The deformity and discoloration of the salvaged fingers were factored into the approach taken in the planning, fabrication, and fitting of prosthesis for the amputated digits. Length reduction with increased flexion planned into the prostheses, in addition to color matching them in two different shades, contributed to good aesthetic and functional outcomes.

Traumatic exungulation in cattle: ten cases (1993-2018).

To describe clinical findings, treatments, and outcomes for cattle with complete traumatic exungulation. 10 bovines. Record databases of 2 teaching hospitals were searched to identify cattle treated for traumatic exungulation between January 1993 and December 2018. Information about signalment, clinical signs and findings, treatment, and outcome was extracted from the records or obtained by telephone communication with the owner. Records for 5 bulls, 4 heifers, and 1 cow with a median age of 2 years (range, 1 day to 10 years) and weight of 379.1 kg (range, 30 to 909.1 kg) were reviewed. Duration of clinical signs ranged from ≤ 24 hours to 3.5 days. Five of 7 animals had a lameness score > 3/5. Complete exungulation occurred in 6 medial digits (3 hind limbs and 3 forelimbs) and 5 lateral digits (1 hind limb and 4 forelimbs); 1 calf had complete exungulation of both digits of a forelimb. Treatments included bandaging (n = 9), antimicrobials (9), anti-inflammatories (8), hoof block application to the adjacent digit (7), regional anesthesia (6), cast application (4), curettage of the third phalanx (3), regional antimicrobial perfusion (1), and local application of antimicrobial-impregnated beads (1). All 7 cattle with long-term (≥ 9 months) information available returned to their intended function; 6 had no residual lameness, and 3 required regular corrective trimming of the affected digit. Results suggested the prognosis for long-term survival and return to intended function is fair to good for cattle with complete exungulation.

Results of central ray metacarpal resection after failure of digit replantation in children

Central ray amputation results severe esthetic blemish and functional and psychological sequelae. Three main reconstruction procedures have been reported in adults: digital translocation, intracarpal osteotomy, and metacarpal resection; none of these, however, have been studied in children. The aim of this study was to report medium-term results for treatment of central ray amputation by proximal metacarpal resection following failure of digit replantation in children (i.e., skeletally immature patients). All children consecutively operated on by metacarpal resection after failure of digit replantation for complete central ray amputation between 2012 and December 2017 were retrospectively included. The surgical procedure consisted in metacarpal resection through a palmar approach, with deep transverse metacarpal ligament reconstruction. At last follow-up, adjacent finger range of motion, pain, rotational deformity and grip strength were evaluated, as well as metacarpal laxity. Metacarpal migration index and metacarpal divergence were measured on standard X-ray. Eleven children with a mean age of 11 ± 8 years were included. At mean 18 ± 3 months’ follow-up, range of motion in adjacent digits was conserved in all cases, with no intermetacarpal laxity. Grip strength was 28% lower than for the contralateral side. Two patients showed rotational malalignment in extension, without functional impairment. In 4th ray amputation (n = 8), metacarpal migration index was decreased by 65% due to radial migration of the 5th metacarpal, but metacarpal divergence was conserved in all cases. Isolated metacarpal resection of the central ray for replantation failure is a reliable and safe procedure with good radiological and functional results in skeletally immature children.

Reconstruction of Tendon Sheath by a Vein Graft in Flexor Tendon Repair in Adjacent Digits

Background: Adhesion formation after tendon injury isa challenging clinical problem.Aim: We compare the outcome of reconstructing the flexortendon sheath after primary flexor tendon repair using anautogenous vein graft to reduce post-operative peritendiniousadhesions.Methods: Eight patients have acute flexor tendon injuriesof both FDS and FDP in zone II in more than one digit.Primary tenorrhaphy was done using traditional technique.In one-digit vein graft was used to reconstruct tendon sheathwindow, while in the other digit, the tendon sheath leftuntreated. Post-operative physiotherapy program of controlledactive motion is used for both group. All patients were assessedusing the second Buck-Gramcko scale at 2 and 6 months.Results: For the vein graft group, 2 patient had excellentresult, 2 had very good, and 4 patients had good result. Ingroup II, 2 patients had very good result, 2 patients had goodresult, and 4 patients had fair result.Conclusion: The use of autologous vein graft as a substituteof tendon sheath is a good treatment modality. Compared toconventional tendon repair technique, it was associated withless adhesion formation and less joint contracture.Evidence Based Medicine: Level IV, vase series.

Intraosseous epidermoid cysts of adjacent digits in a dog

BackgroundIntraosseous epidermoid cyst (IEC) is a rare, non-neoplastic, pathology in animals and humans that most commonly affects the distal phalanx. In dogs, it is important to differentiate this lesion from malignant digital tumours causing bone lysis. In previous reports, IEC has been described to affect only a single digit at the time of diagnosis which is usually based on histopathology. This is the first case report to describe immunohistochemically confirmed IECs affecting simultaneously multiple digits.Case presentationA 4-and-a-half-year-old female spayed Great Dane was presented with a 2-month history of progressive swelling of the distal phalanx (PIII) of digits IV and V of the right pelvic limb. Eleven weeks prior to presentation, the dog had a low-grade cutaneous mast cell tumour completely excised from the craniolateral base of its left pinna. A history of trauma to 1 of the nails of the same pes 4 years prior to referral was also reported. Examination of the right pelvic limb identified firm non-painful swelling of PIII of digits IV and V, with concurrent deformation of the nails. Radiographs of the right pes obtained by the primary veterinarian identified an expansile lesion of PIII of digits IV and V. Computed tomography identified large expansile lesions of PIII of digits IV and V, with associated cortical thinning and soft tissue swelling. Neoplasia was considered the most likely radiographic diagnosis. Histopathology of Jamshidi bone biopsies was consistent with intraosseous epidermoid cyst, which was confirmed with immunohistochemistry. Amputation of PIII of digits IV and V at the level of mid-PII was performed as definitive treatment. No recurrence of the lesion occurred during the 10-month follow-up period.ConclusionsIntraosseous epidermoid cysts should be included in the differential diagnosis for expansile lesions affecting the canine digit. It is important to differentiate them from other digital lesions, with bone involvement, such as malignant digital tumours, which often require more extensive surgery for definitive treatment. The case herein highlights that this lesion can affect simultaneously multiple digits. Definitive diagnosis can be achieved by identification of keratin-producing epithelial cells on histopathology and confirmed by pancytokeratin labelling.

Fingerprint Ridge Count Difference of Adjacent Digits Reflects the Level of Masculinity in Hausa Population of Nigeria

Fingerprint ridge counts, which remain constant from the second trimester of pregnancy, are related to fingertip growth during early gestation. Once they are formed, the ridges do not transform anymore throughout the lifetime except in certain circumstances such as injury. Masculinity is one of the indices known to be associated with some chronic diseases. In other word, sexually dimorphic characters including masculinity play a vital role in personal identification. Despite all this, there is paucity of biological predictors of masculinity especially among Hausa population of Nigeria. The aim of the study was to evaluate the role of differences in fingerprint ridge count (dFRC) of adjacent digits in the determination of level of masculinity in Hausa population of Nigeria. This was a cross sectional study conducted on 300 adult Nigerians with mean age of 21.03±2.49 years (18–33 years). The percentage muscle mass (%mm) as a measure of masculinity was measured using bioelectric impedance machine. Direct sensing protocol was used to capture fingerprint for the determination of dFRC in radioulnar direction starting with thumb through little digit dFRC15. A significant difference was observed in dFRC12, dFRC13, dFRC15, dFRC24 and dFRC45 in both right and left sides. Increase in dFRC12, dFRC13, dFRC15, dFRC45 reflects increase in %mm in both hands whereas, reciprocal relationship was observed between dFRC24 and %mm. For the dFRC34 the significant difference was observed only in the right hand. In both hands, the dFRC12 was best predictor of the level of masculinity. In conclusion, dFRC exhibits potential as an index for the determination of level masculinity in Hausa population of Nigeria. Hence, the role of dFRC in health, disease and identification will be a promising tool for further exploration. Relationship of percentage muscle mass with adjacent digits fingerprint ridge counts in Hausa population of Nigeria Muscle Mass Pearson Correlation Sig. (2‐ tailed) N dFRC 1 300 Rd12 .299** 1.35E‐07 300 Rd13 .226** 8.08E‐05 300 Rd14 .119* 0.038594 300 Rd15 .282** 7.17E‐07 300 Rd23 −0.10477 0.069983 300 Rd24 −.202** 0.000417 300 Rd25 −0.06044 0.296767 300 Rd34 −0.11208 0.05246 300 Rd35 0.051534 0.373759 300 Rd45 .158** 0.006222 300 Ld12 .266** 2.91E‐06 300 Ld13 .145* 0.011673 300 Ld14 0.06131 0.289838 300 Ld15 .235** 3.92E‐05 300 Ld23 −.134* 0.019792 300 Ld24 −.215** 0.00018 300 Ld25 −0.04011 0.488886 300 Ld34 −0.08713 0.132139 300 Ld35 0.106957 0.064294 300 Ld45 .195** 0.00068 300 Comparison of adjacent digits fingerprint ridge count based on percentage muscle mass in Hausa Population of Nigeria dFRC Class I Class II T P Value 95% CI MD Mean SD Mean SD Lower Upper Rd12 −1.29 0.87 −0.71 1.20 −4.78 2.81E‐06 −0.81 −0.34 Rd13 −1.57 0.75 −1.11 1.09 −4.31 2.18E‐05 −0.68 −0.25 Rd14 −1.52 0.82 −1.35 1.07 −1.55 1.22E‐01 −0.39 0.05 Rd15 −1.89 0.80 −1.41 1.01 −4.54 8.25E‐06 −0.68 −0.27 Rd23 −0.28 0.92 −0.39 1.09 0.94 3.47E‐01 −0.12 0.34 Rd24 −0.23 0.98 −0.64 1.05 3.46 6.15E‐04 0.18 0.64 Rd25 −0.60 0.96 −0.70 0.99 0.89 3.76E‐01 −0.12 0.32 Rd34 0.05 0.90 −0.25 0.93 2.81 5.34E‐03 0.09 0.50 Rd35 −0.31 0.80 −0.30 1.01 −0.09 9.24E‐01 −0.22 0.20 Rd45 −0.36 0.94 −0.06 0.95 −2.81 5.28E‐03 −0.52 −0.09 Ld12 −1.21 1.00 −0.65 1.09 −4.64 5.16E‐06 −0.80 −0.32 Ld13 −1.53 0.80 −1.18 1.10 −3.16 1.76E‐03 −0.57 −0.13 Ld14 −1.46 0.83 −1.30 1.02 −1.46 1.46E‐01 −0.37 0.05 Ld15 −1.89 0.92 −1.37 1.10 −4.43 1.30E‐05 −0.75 −0.29 Ld23 −0.32 0.90 −0.53 1.23 1.68 9.35E‐02 −0.04 0.46 Ld24 −0.24 0.93 −0.65 1.17 3.31 1.05E‐03 0.16 0.64 Ld25 −0.67 0.96 −0.71 1.10 0.33 7.38E‐01 −0.20 0.28 Ld34 0.07 0.76 −0.12 1.13 1.73 8.43E‐02 −0.03 0.41 Ld35 −0.36 0.79 −0.19 1.13 −1.51 1.32E‐01 −0.39 0.05 Ld45 −0.43 0.84 −0.07 1.05 −3.30 1.07E‐03 −0.58 −0.15

Treatment of congenital syndactyly

Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.

Recognition of Two Connected Handwritten Digits Based on User-Defined Algorithm

The present paper proposes a model for recognizing unconstrained offline two connected handwritten Numeral digit strings. The Numeral strings are segmented and isolated numerals are obtained using sliding window approach with user defined algorithm. Hence the present paper proposes a segmentation-recognition system using the sliding window approach with user defined classifier. The sliding window is used for discovery the interconnection spots and optimal angle for cutting the adjacent digits at the same time and a minimum of 5 features are extracted from each isolated digit for classification. The exploratory outcomes directed on a recently gathered database of manually written digits and got promising results. The overall efficiency obtained using the proposed method is about 98.51%.

Adjacent digit fingerprint white line count differences: a pointer to sexual dimorphism for forensic application

BackgroundSex determination is one of the leading criterion in identification and verification of an individual. However, the potential roles of differences in adjacent fingerprint white line count (FWLC) in sex inference are not well elucidated in the literature especially among Hausa population. The study was conducted to determine sexual dimorphism and predict sex using adjacent digit FWLC difference (adj. DFWLCD) among Hausa population of Kano state, Nigeria.MethodsThe study population involved 300 participants. FWLC was determined from a plain fingerprint captured using live scanner. The formula for adj. DFWLCD of thumb and fifth digit is dR15 for right hand. The same applied for possible combination in cephalocaudal direction. Mann-Whitney and t tests were used for comparison of variables between sexes. Binary logistic regression analyses were employed for determination of sex.ResultsWe observed a significantly larger adj. DFWLCD in males compared with females in most of the digit combination. A significant sexual dimorphism was observed in most of the adj. DFWLCD involving ring digit in both right (dR14, dR24, and dR34) and left (dL14, dL24, and dL34). The best discrimination was observed in adjacent FWLC difference of second and fourth digits in both right and left digits (dR24 and dL24). This was further supported by stepwise logistic regression analyses.ConclusionThe adj. DFWLCD exhibits sexual dimorphism. The best prediction potentials were found to be dR24 and dL24 for right and left hands respectively.

A Data-Driven Multi-scale Technique for fMRI Mapping of the Human Somatosensory Cortex.

A previously introduced Bayesian non-parametric multi-scale technique, called iterated Multigrid Priors (iMGP) method, is used to map the topographic organization of human primary somatosensory cortex (S1). We analyze high spatial resolution fMRI data acquired at ultra-high field (UHF, 7T) in individual subjects during vibrotactile stimulation applied to each distal phalange of the left hand digits using both a travelling-wave (TW) and event-related (ER) paradigm design. We compare the somatotopic digit representations generated in S1 using the iMGP method with those obtained using established fMRI paradigms and analysis techniques: Fourier-based analysis of travelling-wave data and General Linear Model (GLM) analysis of event-related data. Maps derived with the iMGP method are similar to those derived with the standard analysis, but in contrast to the Fourier-based analysis, the iMGP method reveals overlap of activity from adjacent digit representations in S1. These findings validate the use of the iMGP method as an alternative to study digit representations in S1, particularly with the TW design as an attractive means to study cortical reorganization in patient populations such dystonia and carpal tunnel syndrome, where the degree of spatial overlap of cortical finger representations is of interest.

The FDP-FDS-FDP Dual Tendon Transfer: A Simple, Single-stage Reconstruction Technique for Chronic, Isolated Flexor Digitorum Profundus Tendon Injuries.

The reconstruction of chronic flexor tendon injuries remains one of the more challenging injuries facing the hand and upper extremity surgeon. In the setting of an intact flexor digitorum superficialis (FDS), there are few indications for isolated flexor digitorum profundus (FDP) reconstruction. Because of the interplay of the FDP system, the reestablishment of normal tension of the FDP tendons and lumbricals is particularly challenging, and postoperative stiffness, quadriga, or lumbrical plus phenomena can actually lead to a deterioration of digital function with surgery. We present a technique for single-stage reconstruction of chronic FDP lacerations, particularly in the setting of "lumbrical plus" fingers. The key features of this technique are: the FDS is detached from the middle phalanx and advanced to the distal FDP stump; and the proximal stump of the FDP is advanced to reestablish proper lumbrical tension and sewn to the FDS tendon proximally. Postoperative therapy is according to standard, well-accepted flexor tendon rehabilitation protocols. This procedure avoids the need for tendon autograft harvest, and avoids the tensioning challenges of other FDP reconstruction techniques; it addresses the potential paradoxical extension with lumbrical tension by eliminating the retraction of the lumbrical and eliminates the potential for quadriga by separating FDP function from the adjacent digit. An illustrative case is presented.Level of Evidence: Level V.

Using orthopedic shoeing for the treatment of cows with sole ulcers

Using orthopedic shoeing for the treatment of cows with sole ulcers

The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting.

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series.

Spare-part fillet cross-finger flaps: A series of two cases

IntroductionThe concept of ‘spare-part’ flaps in hand reconstruction is most commonly applied using finger fillet flaps to cover dorsal or volar hand defects. In this paper, we introduce the concept of utilization of spare-part finger fillet flaps in a cross-finger fashion. Case reportsThe technique is demonstrated in two case reports. In both cases, there was one finger that was severely crushed requiring amputation. The bones from that finger were removed and the fillet finger flap was utilized to reconstruct a complex defect in an adjacent digit. Immediate post-operative physiotherapy was employed and flap division was done 17–18 days later. Both patients were satisfied with the outcome and returned back to work as manual workers. DiscussionDifferences between previous techniques / types of cross-finger flaps and the current spare-part fillet cross-finger flap technique are discussed. ConclusionWe introduce the concept of utilization of spare-part finger fillet flaps in a cross-finger fashion.

Enthesitis and Dactylitis in Psoriatic Disease: A Guide for Dermatologists.

Psoriatic arthritis (PsA) is an inflammatory arthritis that is estimated to affect approximately 30% of patients with psoriasis. Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits. Both ultrasound and magnetic resonance imaging can be used to diagnose enthesitis and dactylitis, especially in patients in whom symptoms may be difficult to discern. Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life. Thus, it is recommended that dermatologists monitor patients with psoriasis for these two early and important manifestations of PsA.