Finger Amputation Research Articles

Partial hand and finger amputations in Sweden: an observational study of 6918 patients

BackgroundWe aimed to use open source data to understand the incidence, trends, and regional differences of finger and partial hand amputations on a national level in individuals aged 15 or older in Sweden.MethodsWe analyzed 6,918 patients aged 15 and older who had experienced finger and partial hand amputations. Incidence rates, trends, and regional disparities were assessed using negative binomial regression models and Student’s t-tests. Future trend prediction was performed using Poisson regression.ResultsFinger amputations declined most, followed by partial hand and thumb amputations. Regional variations existed, with Stockholm having the lowest and Gotland highest incidence respectively. Overall, the incidence of finger, thumb and partial hand amputations in Sweden decreased slightly. Future trend analysis indicated decreasing incidence.ConclusionAlthough, lacking in definition, publicly available data can be used for monitoring of finger, thumb, and partial hand amputation incidence on a national level. Sex, age, and regional differences were observed, suggesting the need for targeted interventions to address disparities and mitigate the burden of finger and partial hand amputations on affected individuals.

The Lobster Claw-A Handy Outcome of Post Trap Gun Injury with Amputation of Index, Middle and Ring Fingers

The Lobster Claw-A Handy Outcome of Post Trap Gun Injury with Amputation of Index, Middle and Ring Fingers

Hospital Transfers for Digit Replants as Cost Saving and Safe While Access to Replantation Procedures Remains Limited.

Finger replantation outcomes are influenced both by injury characteristics and by hospital and patient factors, such as hospital type/location and patient gender or insurance. Finger replantation success rates have been shown to be higher at hospitals with higher volumes of finger replants. This study examines the hospital and patient factors that influence hospital transfer and successful replantation in patients experiencing traumatic finger amputation. A total of 5219 patients were identified in the 2008-2015 National Inpatient Sample (NIS) as having experienced traumatic finger amputation with attempted replantation. Hospital transfer and replant outcomes were compared with variables such as patient demographics and hospital characteristics using χ2 tests, t tests, ANOVA, and logistic regression. Traumatic digit amputation patients were most likely to be transferred to medium or large hospitals in urban areas. Hospital transfer was 1.5 times more likely in White patients than Black or Hispanic patients and 1.6 times more likely in middle income quartile patients than the top income quartile. Postreplant amputation was more likely in patients in the lower three income quartiles, on Medicare, of older age, or with more chronic conditions. Hospital transfer was not associated with changes in the probability of requiring amputation after replantation but was associated with a decreased cost of $5000. Hospital transfers for finger replants are safe with respect to replant failure rates and cost-effective, saving $5000 per procedure. Gaps in equitable access to care remain, warranting further study to improve health equity.

Health Behaviours after Returning to Work in Patients Who Experienced Hand Finger Amputation as a Result of Work Accidents

Background: Many organizations face health behavior related issues such as anxiety, depression, traumatic stress disorder in their employee performance, particularly in those who had experienced hand-finger amputation as a result of work accidents. Such issues reduce their overall productivity when they return to work. Aim: The objective of this research was to measure the impact of rehabilitation program participation, psychological support, workplace accommodations and self-efficacy in daily tasks on the health behaviour of patients who experienced hand finger amputation as a result of work accidents. Method: The study used cross-sectional data, collected from 210 respondents across organizations in Adana, Turkey. The empirical results were checked using Statistical Package for Social Science (SPSS) version 21. Results: The findings of this study confirmed that rehabilitation participation program, psychological support, and self-efficacy in daily tasks had a significant and direct impact on the health behaviour of patients who experienced hand-finger amputation as a result of work accidents. However, the study also reported there was no significant and direct impact of workplace accommodations on the health behaviour of patients who experienced hand-finger amputation as a result of work accidents. Conclusion: The findings of this research would contribute to the body of literature in the form of new rationale development and would provide practical solutions to improve employees' health behaviour.

A Prospective Comparative Study of Ray Resection versus Amputation through Proximal Phalanx for Nonviable Digits of Upper Limb

Abstract Background Finger amputations aim at preserving function and optimizing cosmesis. The crucial decision here is whether to preserve a stump or to do a ray amputation. The present study aimed to compare the functional outcome and postoperative quality of life after ray amputation or amputation through the proximal phalanx. Methods A prospective study was conducted from January 2019 to June 2020 in patients requiring single-finger amputation through the proximal phalanx or metacarpal. Patients were divided into two groups; Group A: amputation through the proximal phalanx and Group B: ray amputation of the finger. The following functional parameters were assessed: grip strength, hand circumference, palmar volume, and webspace span. The Michigan Hand Outcomes Questionnaire (MHQ) score was employed to score hand function and aesthesis at 6 months in both hands. Results Thirty patients were enrolled. Findings in 26 patients (52 hands) were subjected to further analysis, 12 in Group A and 14 in Group B. Patients in both groups lost grip strength significantly compared with their contralateral normal hands (29.22 ± 14.88 [Group A] and 34.57 ± 19.12 [Group B]); however, it was statistically nonsignificant between the two groups. There was reduced mean palmar circumference in both groups' involved hands, but the decrease in circumference was statistically significant, only for Group B. Group B patients scored better in all the six subscales of the MHQ; however, only the Aesthetics score was significantly superior. The operated hand's webspace span increased significantly with respect to the normal contralateral web by a mean of 4.55 mm. Conclusion The study concluded that both the surgical options for the level of amputation should be discussed with the patients in detail, taking into account their occupational and personal requirements. Our study findings will help to objectively counsel the patients regarding expectations in functional and aesthetic outcomes following either technique.

Use of an Osseointegrated Intraosseous Transcutaneous Amputation Prosthesis for Amputated Fingers Is Followed by Frequent Infection and Implant Removal

ABSTRACT Introduction We report on the outcomes of using a custom-built osseointegrated (OI) intraosseous transcutaneous amputation prosthesis (ITAP) as a bone anchor for prosthetic reconstruction of a series of amputated fingers. The aim of ITAP was to reduce the risk of failure due to infection by creating a biological seal at the skin-implant interface. Methods and Results A total of 14 patients who suffered from amputations of their digits at a variety of different levels were recruited. Eleven patients (20 implants) underwent treatment with an implant based on the ITAP principle. With the exception of one patient (1 implant), all implants were removed by 9 years after insertion. Patients requested removal because of recurrent infections, exposure of the flange structure (unique to ITAP), loosening of the implant, and inability to secure a prosthesis to the implant. Conclusions The ITAP principle does not work when used as part of the design of an OI bone anchor for prosthetic reconstruction after finger amputation. Clinical Relevance Statement This study suggests that there are major problems with the principles underlying the design of the ITAP implant when used in humans. Future studies of OI implants using the principles of ITAP may be at risk of similar problems.

Long-Term Outcome of Digital Defect Reconstruction using Cross-Finger Flaps

Although multiple advances have been made in finger defect reconstruction, cross-finger flaps remain an important reconstructive tool. However, data on long-term results are scarce in the literature. This study aimed to assess the clinical and subjective long-term outcomes of patients who underwent cross-finger flap reconstruction for palmar digital and fingertip defects. Between January 2003 and July 2022, 35 patients (31 male, 4 female, mean age: 59.0 years±20.1) were screened and included in the study. The data were obtained through a clinical examination, a Quick-DASH score and a self-designed questionnaire. Clinical outcomes were assessed by evaluating the range of motion (ROM) of the reconstructed finger and the donor finger compared with the contralateral uninjured hand. In addition to ROM, a static two-point separation test was performed to assess the sensory function of the reconstructed finger. The follow-up period was between 1 year and 19 years (mean: 12.6 years±6.1). There was no significant difference in terms of ROM between the reconstructed finger and the donor finger compared with the contralateral uninjured hand. All patients reported normal discrimination between sharp and blunt objects. However, there was a significant difference in two-point discrimination between the reconstructed finger and the healthy contralateral finger (p<0.05). The average Quick-DASH score was 5.1 points. Satisfaction with the functional outcome in terms of mobility and load-bearing capacity of the cross-finger flap averaged 8.1 out of 10 points. Satisfaction with the aesthetic outcome of the reconstructed finger averaged 7.7 out of 10 points. In 4 cases, persistent pain was reported when the reconstructed finger was under stress. No cases of pain at rest were reported. In the long run, cross-finger flaps are a safe and effective reconstructive procedure for covering defects in palmar injuries of the finger and fingertip amputation. They represent a simple, reliable, long-lasting reconstructive technique. The necessary temporary iatrogenic syndactyly does not lead to long-term limitations in the range of motion.

Systematic literature review to inform the Portuguese recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.

To perform a systematic literature review (SLR) aimed at evaluating the efficacy and safety of pharmacological and non-pharmacological treatments for Raynaud's phenomenon (RP) and digital ulcers (DU) in patients with systemic sclerosis (SSc) and other connective tissue diseases (CTD), in order to inform the Portuguese recommendations for managing RP and DU in these patients. A SLR was conducted until May 2022 to identify studies assessing the efficacy and safety of pharmacological and non-pharmacological interventions for RP and DU in SSc and other CTD. Eligible study designs included randomized controlled trials (RCTs), controlled clinical trials, and their extensions for assessing efficacy and safety of interventions. Observational studies with a comparator were included for evaluating the efficacy and safety of non-pharmacological interventions and safety of pharmacological interventions. The risk of bias of each study was assessed using standard tools. Out of 71 publications meeting the inclusion criteria, 59 evaluated pharmacological and 12 non-pharmacological interventions. We found moderate quality evidence supporting the efficacy of calcium channel blockers, phosphodiesterase-5 inhibitors, and intravenous prostacyclin analogues in reducing RP frequency, severity, and duration. Intravenous iloprost had a small to moderate effect size in improving DU healing. Phosphodiesterase-5 inhibitors were effective in reducing total DU count, new DU occurrence, and enhancing DU healing. Bosentan effectively prevented new DU in SSc patients. No new safety concerns were associated with these treatments. The studies on non-pharmacological interventions were, in general, of low quality, and had a small sample size. Warming measures decreased frequency and duration of RP attacks; laser therapy improved RP-related outcomes; local oxygen-ozone therapy improved RP outcomes as an add-on therapy; bone marrow mononuclear cell implantation improved DU-associated pain; periarterial sympathectomy and vascular bypass reduced DU number and finger amputation risk. The available evidence supports the efficacy and safety of pharmacological interventions, namely nifedipine, sildenafil, iloprost, and bosentan in treating RP and DU in patients with SSc and other CTD. Scarce and low-quality evidence does support the use of some non-pharmacological interventions but with only a modest effect size. This SLR underscores the limited availability of high-quality evidence for determining the optimal treatment.

Indexalization of the Medius using the Chase technique in squamous cell carcinoma of the index finger: report of a case and review of the literature

Introduction: Squamous cell carcinoma is a rare and aggressive lesion. Bone localization is exceptional both in current practice and in the literature. The Chase technique, a surgical technique involving amputation of the index finger with indexing of the middle finger, is used both in oncological surgery and in traumatic surgery. Material and method: We report the observation of a sixty-year-old patient, with no medical or surgical history, who presented for consultation for swelling of the index finger that had been developing for almost four months associated with pain. Technique: The intervention performed was the Chase technique, (amputation of the 2nd ray) which took place successively in a skin phase, a tendon phase and a bone phase. Result: Early rehabilitation was required with good aesthetic and functional results for the hand. Conclusion: Indexing the middle finger has the advantage of ensuring maximum opening of the first corner, minimizing functional discomfort and maintaining good hand strength.

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

PurposeComplex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem. MethodsThis study retrospectively reviews 4 cases who underwent single or multiple fingers reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented. ResultsAll the patients were males, aged between 21 and 45 (median age 31.75). One of them injured the left dominant hand, and the other three their right dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range, 3 months-36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (2nd and 4th); and one patient had three fingers amputated (2nd, 3rd, and 4th). In the first patient, a true flow-through flap and a second toe transfer was done, and in the other three patients multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients. ConclusionsToe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods are very useful, especially in cases with few vascular resources.

Nonbacterial thrombotic endocarditis of mitral valve associated with a lymphoproliferative malignancy: case report and literature review

BackgroundNon-bacterial thrombotic endocarditis (NBTE) is a rare condition marked by sterile vegetations on cardiac valves, often linked to rheumatologic diseases, autoimmune disorders, and advanced solid malignancies. An early diagnosis and treatment of the associated clinical condition are mandatory, although they do not usually eliminate valvular vegetations, making anticoagulation essential to prevent embolic events. Despite variability, the prognosis of NBTE is usually unfavorable due to recurrent embolic events and the severity of the primary condition, typically advanced cancer.Case presentationWe present a case of a 57 years-old male who presented to the emergency department with a 5-day history of painful bilateral digital edema and color change episodes (from pallor to cyanosis). Physical examination revealed erythrocyanosis in the distal extremities, prompting consideration of secondary Raynaud syndrome.Despite medical therapy, progressive digital ischemia led to multiple finger amputations. During etiological investigation, anticoagulation tests and autoimmune analysis yielded negative results. A transesophageal echocardiogram was performed, revealing an irregular hyperechogenic mass on the anterior leaflet of the mitral valve without valve dysfunction, and a thoracic computed tomography scan with contrast showed an enlarged right paratracheal lymph node. Histopathological analysis from a transthoracic needle biopsy of the paratracheal lymph node revealed diffuse large B-cell lymphoma. The patient underwent aggressive R-CHOP chemotherapy, achieving a favorable complete response.ConclusionThis is a particular case involving the occurrence of NBTE and Raynaud phenomenon as the initial paraneoplastic manifestations in a previously healthy young man. Reports of NBTE associated with lymphoproliferative conditions are quite rare, with fewer than ten cases described in the literature. To our knowledge, this is the first case of NBTE specifically associated with diffuse large B-cell lymphoma.

Enhancing pain control in elbow rehabilitation; A case report of variable ropivacaine dosages through Brachial Plexus Catheter

Managing postoperative pain and discomfort during physiotherapy for upper arm injuries, including complex fractures or traumatic amputations, is crucial. Challenges include severe pain, stiffness, and limited range of motion. Physiotherapy is vital for preventing muscle atrophy, promoting joint mobility, and facilitating functional recovery.The successful management of postoperative pain and pain during physiotherapy in a 27-year-old female, who sustained multiple injuries including a displaced distal humerus fracture and a traumatic right-hand amputation, was achieved through the utilization of a continuous brachial plexus block with variable doses of ropivacaine. The patient’s history revealed a complex array of injuries, including a displaced distal humerus fracture and traumatic right-hand amputation, necessitating open reduction and internal fixation for the fracture and subsequent hand debridement. Despite addressing stiffness through capsulectomy, persistent concerns arose regarding postoperative pain and discomfort during physiotherapy sessions. To address these concerns, a continuous supraclavicular catheter was placed under ultrasound guidance, providing effective pain relief and facilitating physiotherapy interventions for optimal recovery. The patient underwent open reduction and internal fixation for the humerus fracture which was subsequently managed with amputation of several fingers and a hand debridement procedure. Following the surgeries, the patient complained of a stiff elbow, which was addressed through capsulectomy. However, concerns persisted regarding postoperative pain and pain during physiotherapy sessions, leading to the decision to place a continuous supraclavicular catheter. The catheter was accurately positioned under ultrasound guidance and tunneled under the skin, providing effective pain relief for seven days. Ropivacaine was administered as per the patient’s requirements, with a background infusion of 0.2% ropivacaine at 8-hour intervals, a 10 ml bolus of 0.2% ropivacaine administered half an hour before physiotherapy, and 10 ml of 0.5% ropivacaine during physiotherapy sessions if pain levels exceeded 4 on the numerical rating scale. This case highlights the utility of continuous brachial plexus blockade for prolonged postoperative analgesia and pain management during physiotherapy in patients with upper extremity injuries.

Cross finger flap with nail bed graft reposition on flap for allen type IV amputation in a 6 Year old child: A case report

We present a case of Allen type 4 traumatic amputation of the ring finger in a year old child for whom cross finger flap with gaft reposition on flap was done. The child was followed up for 2 years and presents with good cosmesis and no functional disability.The technique of harvesting the nail bed and repositioning over the distal phalanx along with cross finger flap is reliable and can be easily executed in such cases.

The Use of Free Flaps as a Surgical Treatment for Chronic Refractory Pain in the Upper Extremity

Objective: The objective of this study is to present our experience with free flaps as a treatment for recalcitrant neuropathic pain in the upper extremity. Methods: The first case involved a woman who developed neuropathic pain following carpal tunnel release. After undergoing revision surgery, neurolysis, and Strickland's hypothenar fat pad flap, the patient still experienced persistent pain. Subsequently, after 8 years and 3 surgeries, a free sural flap was proposed. The second case involved a woman with partial amputation of the index finger. Following initial bone regularization and advancement flap, the patient developed refractory neuropathic pain. Three additional surgeries were performed, including resection of the remaining phalanx with denervation, metacarpal osteotomy with neurectomy, and resection of the neuroma followed by burying it into the metacarpal bone. After 3.5 years and 3 surgeries, a perforator artery fibular free flap was offered. The Visual Analog Scale (VAS), and Disabilities of Arm, Shoulder, and Hand (DASH) questionaries were used to evaluate the outcomes. Results: Both patients experienced pain following nerve injury. The sural free flap and the perforator artery peroneal free flap were anastomosed to the radial artery and the volar branch of the radial artery, respectively, using end-to-side and end-to-end techniques. Both patients demonstrated significant clinical improvement, with VAS scores improving by 6 and 8 points, and DASH scores improving to 41 and 36, respectively. The follow-up period was 2.5 years and 1 year, during which no complications were observed. Conclusions: Free flaps represent a viable option for the treatment of recalcitrant neuropathic pain in the upper extremity.

Management Of Physiotherapy Programs In Skin Flap For Thumb : Case Report

Skin flap is a skin graft procedure that will repair damaged skin by removing the soft tissue underneath. Objective: to determine Physiotherapy management in the form of giving electro therapy (ultrasound and Infrared) and exercise. Methods: The research method includes a "case report" case study conducted on 1 male patient with a diagnosis of Stiffness wrist digiti 1-5 manus dextra hand function disorders, ec. Amputation of fingers manus dextra post flap). The measuring instruments used are using the Numeric Rating Scale (NRS) for pain scale, Wrist Hand Disability Index (WHDI) to measure functional activity ability, Gonimeter to measure joint motion scope, Manual Muscle Testing (MMT) to measure muscle strength, mitline to measure odema segment circumference. Results: After 3 times of therapy, the patient's assessment results were obtained, namely a significant change in the level of joint scope of motion, muscle strength, skin integrity, motion pain in the wrist and fingers of the right hand, and functional ability. Conclusion: This case study shows that the administration of electrotepsy and exercises in the case of Skin Flap of the thumb of the hand, proved to be effective.

Systematic review on the centrocentral anastomosis technique for the surgical treatment of traumatic neuromas

Aim: Centrocentral anastomosis (CCA) can be applied in the treatment of painful neuromas, by connecting nerve ends or fascicles after neuroma resection, with or without an interposed nerve graft. While this technique was developed directly after the introduction of microsurgical techniques, it is currently not frequently applied in neuroma treatment. Methods: In this article, the literature on CCA was systematically reviewed, both for clinical and experimental studies. Specific attention was paid to the different surgical techniques, potential applications, and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation. Results: A total of 15 articles were found on this subject, 11 clinical and 4 experimental studies. In clinical studies, CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs. In experimental studies, different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model. Pain reduction in the clinical studies overall was good to excellent, but only in two studies control groups were used. Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft. Conclusion: Although CCA has shown promising results for neuroma treatment, there are only a few case series to date, one cohort and one randomized study, and in the latter two, no graft was used. More research is needed to investigate the outcome of CCA, especially for the option of an interposed nerve graft. This investigation should involve comparisons with alternative techniques, utilization of standardized outcome measures, and, preferably, inclusion of longer follow-up periods.

Nail bed trauma reconstruction and artificial nail replacement - a case report.

Nail bed reconstruction is crucial after fingertip trauma, impacting both function and aesthetics. In this article, the authors describe a case of partial distal phalanx amputation of the index finger with laceration of the nail bed's remaining part. A traumatically elevated skin-fat flap covered the exposed bone on the fingertip, preserving finger length and sensitivity on the radial side. A full-thickness skin graft from the forearm closed a secondary defect on the finger pulp. Nail bed suturing prevented scarring and nail deformity, and a temporary artificial plastic nail replacement maintained the nail bed's shape. Temporary artificial nail replacements protect the regenerating fingertip bed, promote healing, and prevent nail deformities. Proper adaptation of lacerated nail bed edges, supported by either the patient's own nail or a temporary artificial nail, is crucial for optimal fingertip restoration, including proper nail shape.

Factors associated to amputation in pyogenic flexor tenosynovitis in a tertiary referral center in Mexico

Background: Pyogenic flexor tenosynovitis is an aggressive closed-space infection, which affects the flexor tendon sheath of the hand with disabling sequelae. The purpose of this study is to describe the patient demographic characteristics and identify factors associated with amputation in pyogenic flexor tenosynovitis. Methods: In this retrospective single-center study, included all adult patients who presented to the emergency department from 2015 to 2021 with PFT of the hand. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. The factors influencing amputation were identified and analyzed. Results: A total of 59 patients with PFT diagnosis were included. Most of the population was found to be immunosuppressed (34 patients). Moreover, the most common comorbidities were the combination of diabetes mellitus and systemic arterial hypertension. The third right finger was the most frequently affected region. Almost all patients were hospitalized, intravenous antibiotics, and at least one additional surgical intervention was required in 16 cases. Amputation of the infected finger occurred in 6 patients, associated with different factors: reintervention, age over forty, presence of diabetes mellitus and chronic arterial hypertension, penetrating trauma, and presence of Enterococcus faecalis in culture. Conclusions: Rapid and aggressive treatment is required to prevent devastating complications such as amputation. Adequate identification of the disease and risk factors is critical for a successful result. E. faecalis represents the most common pathogen in this study, unlike the reported literature. Thus, broad-spectrum antibiotics and surgical intervention are required.

Lucio’s Phenomenon in Lepromatous Leprosy Patient: A Rare Case Report

BACKGROUND: Lucio’s phenomenon is a rare leprosy reaction, characterized by severe necrotic cutaneous lesions that generally occur in patients with untreated or inadequately treated lepromatous leprosy (LL). OBJECTIVE: to describe and comprehend the diagnosis and management of Lucio’s phenomenon in leprosy patients CASE: Male, 34 years old with extensive wounds on both arms and legs. About 3 years earlier, the patient felt burning heat in both hands and feet followed by loss of eyebrows and eyelashes, and a change in the shape of the nose. The patient had not received previous therapy. Physical examination showed that the patient appeared anaemic, leonine facies, megalobuli, madarosis, saddle nose, thickening of the ulnar and posterior tibial nerves, deformities of the fingers and toes, and amputations of several fingers. The dermatological status showed multiple ulcers of irregular shape and varying sizes with pus and necrotic tissue. Reitz serum test revealed a bacterial index of +3 with a morphological index of 90%, and routine blood showed hypochromic microcytic anaemia and leucocytosis. The patient received corticosteroid therapy, anti-leprosy combination therapy, antibiotics, iron tablets and wound care. DISCUSSION: Lucio’s phenomenon consists of skin lesions that range from painful red-black patches to flaky blisters and ulcerations. These lesions usually occur on the lower extremities, and may extend proximally and distally. The lesions improved after administration of corticosteroids and anti-leprosy. Delayed diagnosis leads to significant disability and community transmission of the disease. The later the diagnosis, the more serious the disease becomes and can lead to death due to sepsis. Early diagnosis and appropriate treatment are important. CONCLUSION: Early detection is crucial in order to deliver therapy earlier and prevent disease worsening.

Zone I Revision Finger Amputations Performed in the Emergency Department Compared With Those Performed in the Operating Room.

Finger amputations are commonly encountered. These may be revised in the emergency department (ED) or the operating room (OR). Previous studies have demonstrated the cost-effectiveness associated with procedures performed in the ED. Patient outcomes have not been described. We retrospectively reviewed patients who presented to our level 1 trauma center with a traumatic partial or complete finger amputation through flexor tendon zone I. All were treated with revision amputation performed in either the ED or the OR between January 2012 and December 2017. A total of 172 patient charts were included. Ninety-three of the revision amputations were performed in the ED, while 79 were performed in the OR. There was no difference in age, race, sex, having a manual labor job, medical comorbidities, or mechanism of injury between the groups. Compared with procedures performed in the ED, procedures performed in the OR had a higher rate of delayed healing, a longer stay in the hospital, and a higher referral to therapy postoperatively. Length of follow-up and number of follow-up visits were not statistically different based on location of procedure. There was no difference in post-procedural infection rate or need for revision procedure between the groups. Our data support the efficacy of performing revision amputation procedures in the ED. Recorded patient complications and subsequent treatment after revision amputations performed in the ED vs the OR were comparable. Those performed in the ED potentially decrease the burden placed on the patient and the health care system. [Orthopedics. 2024;47(3):152-156.].