Digital Pulp Research Articles

Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique.

Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes. We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed. The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zoneIII level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6months (range, 6 to 18months). The fracture successfully underwent healing at 9.2weeks (range, 8 to 13weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72mm (range 4.0 to 7.0mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes. The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction.

Sensory re-education after free neurovascular toe pulp flap for digital pulp reconstruction

PurposeTo evaluate the effectiveness of a sensory re-education (SR) program after free neurovascular toe pulp flap for finger or thumb pulp defect reconstruction. MethodsFrom January 2015 to January 2020, 49 patients with finger or thumb pulp defects treated with free fibular side flaps of the great toe or tibial side flaps of the second toe were recruited. The patients were randomly divided into two groups one month after surgery. The training group received the SR program and the control group underwent the traditional rehabilitation program. Clinical evaluation included Semmes-Weinstein Monofilament (SWM) tests, static two-point discrimination (2-PD), and sensibility grading, measured at 1, 3, 6, 9 and 12 months postoperatively. ResultsA total of 42 patients completed the follow-up, including 22 (16 males) patients in the training group and 20 patients (12 males) in the control group. Compared with 1 month after the operation, significant improvements in sensory recovery were observed at 3, 6, 9, and 12 months postoperatively in both groups. In addition, earlier sensory recovery was seen in the SR group compared to the control group, showing significant differences at 3 and 6 months but not at 9 and 12 months postoperatively. ConclusionAlthough SR seemed to accelerate preliminary sensory recovery after free neurovascular toe pulp flaps for digital defect reconstruction, the program should be reconsidered as it offers no significant improvement over the control group at later follow-up stages.

High-Fidelity Perforator Visualization for Cadaver Dissection in Surgical Training.

In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body. For subsequent centuries, these cadaveric dissections were key to the advancement of anatomical knowledge and surgical techniques. To this day, despite various instructional methods, cadaver dissection remained the best way for surgical training. To improve the quality of education and research through cadaveric dissection, our institution has developed a unique method of perforator-preserving cadaver injection, allowing us to achieve high-fidelity perforator visualization for dissection studies, at low cost and high efficacy. Ten full body cadavers were sectioned through the base of neck, bilateral shoulder, and hip joints. The key was to dissect multiple perfusing arteries and draining veins for each section, to increase "capture" of vascular territories. The vessels were carefully flushed, insufflated, and then filled with latex dye. Our injection dye comprised of liquid latex, formalin, and acrylic paint in the ratio of 1:2:1. Different endpoints were used to assess adequacy of injection, such as reconstitution of eyeball volume, skin turgor, visible dye in subcutaneous veins, and seepage of dye through stab incisions in digital pulps. Dissections demonstrated the effectiveness of the dye, outlining even the small osseous perforators of the medial femoral condyle flap and subconjunctival plexuses. Our technique emphasized atraumatic preparation, recreation of luminal space through insufflation, and finally careful injection of latex dye with adequate curing. This has allowed high-fidelity perforator visualization for dissection studies.

P027 Immune checkpoint inhibitor associated vasculitis: a limitation to cancer therapy

Abstract Background/Aims The increasing use of immune checkpoint inhibitors (ICIs) underlies the importance of close monitoring and recognition of associated adverse events. We report a rare case of nivolumab-related peripheral vasculitis with digital gangrene and auto-amputation in a patient treated for mesothelioma. Methods A 69-year-old male with T4M0N0 pulmonary sarcoid mesothelioma was commenced on second-line Nivolumab therapy. 11 days later, he presented with worsening dyspnoea and dry cough. CTPA demonstrated new bilateral lower zone and peripheral predominant ground glass patchy consolidation consistent with acute pneumonitis. He sustained a significant clinical benefit from IV methylprednisolone and cessation of Nivolumab. 20 days after the pneumonitis episode, the patient re-presented with extremely tender, blue-black discoloration of the 2nd, 3rd and 4th fingers bilaterally, accompanied by localised sensory loss. Petechiae were also seen distributed across the digital pulp and nailbeds. Although bilateral, the left side was notably worse, with clear evidence of digital ischaemia and dry gangrene. Urine dipstix was bland. Immunology revealed normal C3/C4, ANCA and dsDNA serology, but mildly raised ANA (1.5). An echocardiogram excluded infective emboli. High dose IV methylprednisolone and iloprost infusion was commenced to treat ICI-associated peripheral vasculitis. Concurrently, dalteparin was required for a non-occlusive right subclavian venous thrombus. Nevertheless, his digital ischaemia progressed proximally to the left middle distal phalanx. MDT decision was made to avoid Cyclophosphamide given the infection risk. Sildenafil was introduced alongside a reduction regime of oral prednisolone. Unfortunately, the patient was subsequently hospitalised for acute PCP infection requiring high flow oxygen and intravenous antimicrobials. Following this stormy course, a slow but consistent and substantial clinical improvement was noted with respect to his digital ischaemia with minimal tissue loss. 7 months on, the patient’s digits remain free from ischaemia, infection and pain with good functional ability on Sildenafil treatment. Results Reports of PD-1 blockade-associated vasculitides mention ANCA-vasculitis, IgA vasculitis, leukocytoclastic vasculitis, eGPA and granulomatous vasculitis; however, drug-induced digit necrosis and auto-amputation is not widely reported. In this rare presentation of digital gangrene, immediate discontinuation of nivolumab treatment with initiation of high dose steroids and sildenafil, allowed eventual recovery of digits with limited auto-amputation and minimal sequelae. Management of nivolumab-associated vasculitis and pneumonitis required a multidisciplinary approach involving oncology, rheumatology, plastics and respiratory medicine. In the context of nivolumab discontinuation, the patient remains only on symptomatic treatment and follow up with no active cancer therapy meaning that prognosis is poor, in keeping with other reports of vasculitic reactions to nivolumab in cancer patients. Conclusion ICIs have revolutionised the management and outcomes across a range of malignancies. However, their mechanism can inadvertently induce undesired toxicity, the awareness of which is paramount. Disclosure M. Au: None. A. Faher: None. E. Htut: None.

Evaluation of precooling methods for shelf-life enhancement of pear (Pyrus spp.) fruits under ambient storage

Patharnakh pear fruits were freshly harvested at the physiological maturity during second week of July and subjected to different precooling treatments, viz. Hydrocooling (HC), Forced Air Cooling (FAC) and Evaporative Cooling (EC). The effect of these methods on fruit shelf-life and quality attributes under ambient conditions was investigated during the year 2021–22 at Punjab Horticultural Post harvest Technology Centre, Punjab Agricultural University, Ludhiana, Punjab. In all treatments, temperature of fruit pulp was regularly checked with digital pulp thermometer until a constant temperature was accomplished. Thereafter, the fruits were packed in corrugated fibre board boxes of 2 kg capacity and stored at ambient conditions (28–32°C and 70–80% relative humidity). The stored samples were assessed, periodically, at 5 days interval till 20 days for physiological and biochemical parameters. The results of the study revealed that FAC maintained lower physiological weight loss, spoilage and retained higher fruit firmness, sensory quality score, juice TSS, total sugars, acidity, vitamin C and total phenolic content during storage compared to the control. This method is an effective approach for maintaining the post-harvest shelf-life of perishable pear fruits for about 15 days in comparison to 10 days in the untreated control fruits.

Glomus Tumor of Finger Pulp - A Case Report

Glomus tumors are rare, vascular,benign, painfulneoplasm, originating from glomus bodies and comprise just 1% of tumors arising in the hand, with fewer than 10% in the volar pulp of digits. Hallmark symptoms of glomus tumors include hypersensitivity to cold, heightened pinprick sensitivity and paroxysmal pain. We report this case due to its rarity and it’s potentialto be included among the differential diagnosis if the lesion is painful. We report here a rare case of a 59-years male presenting with08-years history of pain in the palmer surface of distal phalanx of right little finger. The fingertip was incredibly sensitive to touchand the pain increased at night. He could not recollect any history of trauma. Palpation of the finger revealed tenderness with feeling of no lump. Magnetic resonance imaging(MRI) of the right little finger revealed a small altered signal intensity lesion measuring about 8.0x4.0mm at the ventral aspect of distal phalanx ofright little finger. After I/V contrast- moderate enhancement of the lesion is seen. An incision was made in the mid-axial plane. A circumscribed mass removed with careful &blunt dissection. It was a tan-yellow, soft tissue nodule of about 1- cm in diameter without stalk or adherences to joint capsule or bone. Histopathological examination revealed the mass as a glomus tumor. Symptoms improved on removal and the wound healed without complications. Glomus tumors in the volar digital pulp can be difficult to diagnose. Complete surgical excision of the tumor is the only effective treatment to achieve pain relief and low recurrence.We also emphasize the importance of keeping this tumor in mind among the possibilities of differential diagnosis of painful digital nodules. J Bangladesh Coll Phys Surg 2022; 40: 306-309

Prevalence of and factors independently associated with digital ischemic complications in patients with systemic sclerosis.

To investigate the prevalence of and independent predictors for digital ischemic complications in patients with systemic sclerosis. Patients enrolled in the Siriraj Systemic Sclerosis Cohort registry during 2013-2019 were classified as having or not having digital ischemic complications at the baseline and 1-year timepoints. A total of 171 patients with systemic sclerosis were included. The prevalence of digital pulp loss, digital pitting scar, digital ulcer, and digital amputation at baseline and 1 year was 41.5%, 39.8%, 3.5%, 7.6% and 37.4%, 43.9%, 14.1%, 6.4%, respectively. Over half (58.5%) of overall systemic sclerosis had developed new digital ischemic complications during the 1-year follow-up. Those with digital ischemic complications at baseline were at high risk for developing new digital ischemic complications (odds ratio: 15.9). Diffuse cutaneous systemic sclerosis is associated with digital ischemic complications (odds ratio: 6.0), digital pitting scar (odds ratio: 4.9), and digital pulp loss (odds ratio: 6.4). Tendon friction rub is associated with digital pitting scar (odds ratio: 5.0). Salt-and-pepper skin appearance is associated with digital pulp loss (odds ratio: 3.0) and digital ulcer (odds ratio: 6.9). Disease duration > 3 years is associated with digital ulcer (odds ratio: 4.4). Male gender is associated with digital ulcer (odds ratio: 5.4). Digital pulp loss, digital pitting scar, digital ulcer, and digital amputation were common manifestations of digital ischemic complications, and diffuse cutaneous systemic sclerosis was the strongest of the six independent predictors.

Genital ulcers caused by sexually transmitted agents

Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.

Tachycardiomyopathy Due To Hyperthyroidism: Case Report

Introduction High output heart failure (HF) is one of the complications of hyperthyroidism. Some patients may evolve with reduced ejection fraction HF (HFREF) due to tachycardiomyopathy. The most prevalent arrhythmias are atrial fibrillation and atrial flutter, which, when controlled, improve HF. Hypotheses: Tachycardiomyopathy resulting from hyperthyroidism. Methods Descriptive, qualitative, and documentary study of the “case report” type. Case report Male, 35 years old, with no previous comorbidities, sought emergency with signs of decompensated HF associated with palpitations, hyperthermia, sweating, anterior neck pain, and extremity tremors. Thyroid with increased volume resulting from multiple nodules, without murmurs; bilateral exophthalmos; propulsive ictus with two digital pulps, in the sixth left intercostal space, irregular heart rhythm, HR 140bpm, pathological jugular venous pressure, bilateral crackles up to middle third. Lower limbs with edema + 3 / + 4. EKG in high-response atrial fibrillation rhythm reversed during hospitalization with amiodarone. ECHO with severe global LV systolic dysfunction with Simpson's ejection fraction 12%. He was discharged from the hospital with carvedilol, furosemide, amiodarone, and oral anticoagulant, being referred to primary care. Doppler ultrasonography of the thyroid showing increased volume, lobulated contours with diffuse heterogeneous parenchyma of multinodular aspect, and increased vascularity. Laboratory tests confirmed hyperthyroidism (TSH 0.008 mU / L; T4L 2.22 ng / dL; TRAB 9.58 IU / L). Optimized treatment for HF (added enalapril and spironolactone), it evolved in NYHA I, with a new ECHO after 3 months showing mild LV dysfunction with 45% EF. In a joint follow-up with endocrinology, under treatment with Methimazole, awaiting thyroidectomy. Conclusion Hyperthyroidism increases metabolic demand and can lead to cardiovascular complications such as HF and atrial arrhythmias. This occurs by increasing blood volume, reducing systemic vascular resistance and reducing circulation time, triggering LV hypertrophy, and reducing myocardial contractile reserve. The hyperthyroidism with decompensated HF is a medical emergency with up to 30% mortality. It is a treatable entity, and its complications are potentially reversible. High output heart failure (HF) is one of the complications of hyperthyroidism. Some patients may evolve with reduced ejection fraction HF (HFREF) due to tachycardiomyopathy. The most prevalent arrhythmias are atrial fibrillation and atrial flutter, which, when controlled, improve HF. Hypotheses: Tachycardiomyopathy resulting from hyperthyroidism. Descriptive, qualitative, and documentary study of the “case report” type. Male, 35 years old, with no previous comorbidities, sought emergency with signs of decompensated HF associated with palpitations, hyperthermia, sweating, anterior neck pain, and extremity tremors. Thyroid with increased volume resulting from multiple nodules, without murmurs; bilateral exophthalmos; propulsive ictus with two digital pulps, in the sixth left intercostal space, irregular heart rhythm, HR 140bpm, pathological jugular venous pressure, bilateral crackles up to middle third. Lower limbs with edema + 3 / + 4. EKG in high-response atrial fibrillation rhythm reversed during hospitalization with amiodarone. ECHO with severe global LV systolic dysfunction with Simpson's ejection fraction 12%. He was discharged from the hospital with carvedilol, furosemide, amiodarone, and oral anticoagulant, being referred to primary care. Doppler ultrasonography of the thyroid showing increased volume, lobulated contours with diffuse heterogeneous parenchyma of multinodular aspect, and increased vascularity. Laboratory tests confirmed hyperthyroidism (TSH 0.008 mU / L; T4L 2.22 ng / dL; TRAB 9.58 IU / L). Optimized treatment for HF (added enalapril and spironolactone), it evolved in NYHA I, with a new ECHO after 3 months showing mild LV dysfunction with 45% EF. In a joint follow-up with endocrinology, under treatment with Methimazole, awaiting thyroidectomy. Hyperthyroidism increases metabolic demand and can lead to cardiovascular complications such as HF and atrial arrhythmias. This occurs by increasing blood volume, reducing systemic vascular resistance and reducing circulation time, triggering LV hypertrophy, and reducing myocardial contractile reserve. The hyperthyroidism with decompensated HF is a medical emergency with up to 30% mortality. It is a treatable entity, and its complications are potentially reversible.

Change in calcinosis over 1 year using the scleroderma clinical trials consortium radiologic scoring system for calcinosis of the hands in patients with systemic sclerosis

IntroductionCalcinosis cutis is a debilitating complication of systemic sclerosis (SSc). We previously developed a radiographic scoring system to assess severity of calcinosis affecting the hands in patients with SSc. We sought to further validate our radiographic scoring system to assess for change over 1 year and to identify factors associated with improvement or progression. Materials and methodsBaseline and 1-year antero-posterior hand radiographs were obtained in 39 SSc patients with calcinosis prospectively enrolled at 6 centers within the US, Canada, Mexico and Australia. Two readers (one radiologist and one rheumatologist) scored all radiographs using the calcinosis scoring system and a 5-point Likert scale (1 = A lot better, 2 = A little better, 3=No change, 4 = A little worse, 5 = A lot worse) on follow-up. By maximizing the Kappa coefficient of agreement between grouped Likert scale (better/no change/worse) and the percentage of change of calcinosis in the radiographic scoring system, we defined progressive calcinosis as >25% increase in score from baseline at 1-year, stable calcinosis as change in score between -25% to 25%, and improvement of calcinosis as decrease in score by >25%. Nineteen SSc patients from an independent cohort were used for validation. ResultsInter-rater reliability of the calcinosis scoring system was high with intra-class correlation coefficient of 0.93 (0.89–0.95). The median percentage of change from baseline to 1 year was 12.8% (range -89.3 to 290.2%). Sixteen patients (41%) experienced progression of calcinosis over 1 year; 18 (46%) remained stable; and 5 (13%) had improvement. Patients with progressive calcinosis had lower T-score on bone densitometry (-3.3 vs -1.7, p = 0.044) and higher prevalence of loss of digital pulp on physical exam (56% vs 22%, p = 0.027), with a trend towards lower baseline modified Rodnan skin score (mRSS) (3.8 vs. 5.9, p = 0.057), than patients who did not progress. Patients who experienced improvement in calcinosis had lower prevalence of digital pitting scars (20% vs 71%, p = 0.047) than patients whose calcinosis did not improve. In multivariable analysis, loss of digital pulp remained a predictor of calcinosis progression (OR 5.8, p = 0.023, CI 1.27 - 26.36). In the validation cohort, 2 (11%) patients improved, 10 (53%) remained stable, and 7 (37%) progressed. ConclusionsWe confirmed the excellent inter-rater reliability of our radiographic calcinosis scoring system and demonstrated its usefulness to detect change over time. Approximately 40% of patients experienced progression of calcinosis over 1 year. Loss of digital pulp was predictive of progressive calcinosis providing further evidence that digital ischemia contributes to the progression of calcinosis.

One-stage coverage of multi-digital pulp defects with sensate flaps from the foot

BackgroundThe reconstruction of the digital pulp defects was a mix of the sensation, function, and aesthetics. As the conventional flaps became out of date, the sensate flaps were increasingly utilized in covering such defects. In this report, we present our experience with some novel flaps design, located on the foot. MethodFrom April 2015 to September 2018, nine patients received the free sensate flaps to resurface soft tissue defects in the multi-digital pulps. And all flaps were harvested from each aspect of the foot, which dimensions were tailored to the defects. The cutaneous nerve was preserved within the flap. Standardized assessment of outcome in terms of sensory, functional, and esthetic scores of the reconstructed pulps was completed. ResultsNineteen flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The free sensate flaps were performed for digital pulp reconstruction in 9 patients: 6 male and 3 female patients with a mean age of 49 years (ranged, 16 to 72 years). The defects involved 3 thumbs, 6 index fingers, 5 long fingers, 3 ring fingers, and 2 little fingers. All flaps were available for a mean follow-up of 30 months (ranged, 24 to 36 months). The functional and esthetic outcomes were satisfied for all flaps, as well as the sensory restoration. ConclusionThe sensate flap from the foot is a remarkable alternative for digital pulp reconstruction with less morbidity and better outcomes. Furthermore, the foot region presents a sensitive, glabrous skin with the proper bulkiness and allows for easy dissection.

Pulp sensibility tests responses in patients with anxiety and depression.

BackgroundIn view of the importance of pulp sensibility tests in clinical decision-making and the impact of psychological factors on test results, we evaluated in this study dental pulp responses to pulp sensibility tests (ie, cold and electric) in patients with anxiety and depression. Material and MethodsA number of 90 people age 20 to 30 participated in the study, including 30 healthy and 60 with anxiety and depression, whose disorder was approved by a psychiatrist based on the Symptom Checklist 90-R questionnaire. Pulp sensibility tests included electric and cold ones were performed on lateral mandibular teeth. The cold test results were recorded based on the visual analogue scale (VAS) pain scoring (0 no response, 10 worst pain). Electric pulp test was performed using a digital pulp tester. The lowest current that stimulated a pulp response was recorded. The data were analyzed using the Mann-Whitney and Kruskal-Wallis tests. ResultsThe cold test pain intensity was significantly higher in patients than in healthy subjects and was significantly associated with the severity of anxiety and depression. In addition, the electric pulp test current to evoke a response was significantly lower in patients than in healthy subjects and was also significantly associated with the severity of anxiety and depression. ConclusionsGiven the limitations of this study, anxiety and depression significantly affect the results of pulp sensibility tests. Key words:Anxiety, Cold pulp test, depression, electric pulp testing.

Minimally Invasive Interphalangeal Arthrodesis.

Distal interphalangeal joint fusion is usually the surgical treatment for primary or posttraumatic osteoarthrosis when conservative measures fail. All fusion techniques aim for solid fusion with joint chondral resection, bone to bone contact and stable fixation in an adequate position. This is performed with an open dorsal approach considering the risks of soft tissue complications. We describe a technique of resecting bone cartilage and getting stable fixation with 2 mini incisions, 1 lateral and 1 in the digital pulp. Using a digital block anesthesia and under fluoroscopy, a small round burr is introduced into the joint by a lateral joint line stab incision. The joint space is enlarged by manual traction on the finger. After adequate cartilage resection, good bone to bone contact in an adequate position is fixed with a cannulated Herbert screw inserted percutaneously by the finger pulp. We describe 4 cases operated with this technique, 3 for pain and 1 for esthetics. All 4 demonstrated good results and were satisfied. X-rays showed solid fusion in 8 to 12 weeks. There was one complication with skin burning because of the burr heating and the authors describe how to avoid it. Minimally invasive distal interphalangeal joint fusion is a simple, reproducible technique that maintains the important steps for a solid arthrodesis with the advantage of preserving the soft tissue envelope.

Treatment of acute wounds in hand with Calendula officinalis L.: A randomized trial

ABSTRACT Most injuries in the hand and fingers, especially on the digital pulps, are suited for healing by secondary intention. Nevertheless, delay in epithelization seems to unfavorably restrict this technique. The purpose of this controlled randomized clinical trial is to analyze by means of photo planimetry the progression of the healing process by secondary intention in acute wounds of the hand using the standardized extract of Calendula officinalis L. (SEC). The cohort of eligible participants included two groups of 20 patients with skin loss in the hand and fingers treated by secondary intention. Control group (CG) used mineral oil and intervention group (IG) received SEC. Wound pictures were captured at each outpatient assessment until epithelization was achieved and measured with ImageJ. Intervention group (IG) and control group (CG) with 19 wounds each, primarily formed by men in their 40’s with wounds in their index and ring fingers on the left side, showed homogeneous variables and similar initial wound areas. Epithelization time was shorter and healing speed was faster in IG (IG = 8.6 ± 4.7 days and 9.5 ± 5.8%day versus CG = 13.2 ± 7.4 days and 6.2 ± 2.9%day, ƿ < 0.05), leading to the conclusion that healing by secondary intention in acute wounds of the hand and fingers with SEC led to a faster epithelization.

Bacterial growth on the hands of health care workers: implications for preventing nosocomial infections

Objective: to analyze bacterial growth in samples collected from the hands of health professionals after hygiene with soap and water. Methods: cross-sectional analytical study, carried out with healthcare professionals by collecting samples (print) from the digital pulp of the dominant hand on plates containing chromogenic culture medium for microbiological analysis regarding the presence of colonies. Fisher’s and Chi-square tests were used. Results: 73 samples were collected and 67 (91.8%) showed bacterial growth. Methicillin-resistant Staphylococcus aureus was detected in 19 (26.0%). A significant association between colonies with multidrug-resistance profile and the time of performance (p=0.030) and profession (p=0.041) was highlighted. Conclusion: there was bacterial growth in samples after hand hygiene, with higher growth of multidrug-resistant bacteria among nursing professionals and those with longer time of work. These results may contribute to detect the gaps about the measures adopted for infection prevention.

Trombose arterial em microcirculação pós-Covid 19: Relato de caso

O presente artigo tem como objetivo relatar o caso de um paciente do sexo masculino, com diagnóstico de COVID-19, e posterior apresentação de trombose arterial em microcirculação, assim como divulgar o manejo do caso. Paciente, 48 anos, do sexo masculino, foi internado com quadro de Síndrome Respiratória Aguda Grave (SRAG) após diagnóstico de COVID-19, havendo comprometimento de 60% da capacidade funcional dos pulmões. Após melhora do quadro respiratório, o paciente passou a apresentar dor súbita na mão esquerda, cianose não fixa, perfusão lentificada e hiperemia reativa, porém, ainda apresentando pulso ulnar e pulso radial palpáveis. Após o exame físico, foram solicitados novo exame de testagem de COVID-19, hemograma, leucograma, proteína C reativa, dímero D, tempo de protrombina e tempo de tromboplastina parcial ativado. A partir dos resultados de todos os exames foi fechado o diagnóstico de trombose da microcirculação arterial decorrente de infecção por SARS-CoV-2. A conduta adotada teve como objetivo tratar os problemas de circulação do paciente. Até o quarto dia após início do tratamento o paciente se apresentava sem queixas de dor, com melhoras na perfusão na região afetada, com a mão aquecida e com discretas áreas de necrose na região das polpas digitais.

18859 Cutaneous manifestations of drug abuse

Illicit drug use is considered a public health problem in many countries, with an estimated prevalence of 5% of the world’s population. In addition to the risks with regard to mental and life health the skin as the largest organ of the human being is home to many processes arising from the use of these substances. Thus, the objective of the study was to report the mucosal cutaneous manifestations observed in illicit drug users attended by the UEPA Dermatology Service from November 2015 to January 2018. The sample consisted of records of 20 users of various drugs illicit Epidemiologic data were collected, type of drug used, and all the information recorded in the protocol, as well as the dermatologic examination. It was observed that the most frequently used drugs were marijuana and cocaine. All patients used tobacco as a form of consumption and inhalation; and the main dermatologic conditions found were burns and ulcerations and scars in the digital pulps. Thus, it is imperative that these patients are submitted to dermatologic examination whenever possible and that dermatologists are aware of these changes to assist in the multidisciplinary care of these patients.

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction.

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field.Level of evidence: IV.

Disturbance of somatotopic spatial cognition and extra-territorial pain in carpal tunnel syndrome.

Several studies on carpal tunnel syndrome have reported pain that exists beyond the median nerve territory of the affected hand. However, the mechanism is unknown. We investigated the cause of extra-territorial pain by the analysis of clinical assessments and cortical activity using magnetoencephalography. To compare patients with and without extra-territorial pain, fourteen patients with carpal tunnel syndrome were assessed using clinical examination, such as patients' profile, paresthesia, physical tests, and psychological tests. The physical assessment included tactile threshold and static and moving two-point discrimination sensations on digital pulp. Neural activation in the cerebral cortex was also measured using z-scores calculated by magnetoencephalography. Among fourteen patients, ten patients had pain in the affected median nerve territory only and four patients had extra-territorial pain. When comparing the groups, the static and moving two-point discrimination sensation values in patients with extra-territorial pain were larger than those of patients without the pain (p < 0.05). The supra-marginal gyrus, mid-part of the precentral sulcus, angular gyrus in the left hemisphere, bilateral sensorimotor areas for legs, and bilateral isthmus-cingulate areas showed larger z-scores in patients with extra-territorial pain than in patients without the pain (p < 0.05). The static and moving two-point discrimination sensations signify the ability of tactile spatial acuity. Bilateral sensorimotor areas were activated in sites that were not the hand. Furthermore, the inferior parietal lobule in the left hemisphere, which synthesizes and integrates multiple sensations showed high activation. Our findings suggested that the mechanism of extra-territorial pain was associated with dysfunction of spatial cognition.

Herpetic Whitlow of the Hand in Infants

Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants.Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome.Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection.Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.