Amputation Of Distal Phalanx Research Articles

A 3D-Printed Dummy for Training Distal Phalanx Amputation in Mice.

The development of realistic dummies for training the distal phalanx amputation (DPA) technique in mouse pups is a promising alternative to reduce and replace animals in training for research and teaching. To test this, we obtained micro-CT data from postnatal day-five mouse pups, meticulously segmented them, and converted them into a 3D mesh format suitable for 3D printing. Once the dummy was printed, it was evaluated during actual training courses in two different groups: in the first group, users received no dummies to train the DPA, and in the second group, users were trained with three dummies. To assess the effectiveness of the dummy, we conducted a survey followed by an expert veterinarian evaluation. Our results showed that DPA is a complex procedure, and it is commonly poorly performed. When implementing the dummies, users who were not provided with dummies to practice only had an 8.3% success rate in DPA, while users provided with three dummies had a 45.5% success rate, respectively. Despite additional research being needed, our dummy offered improved practical training by providing a safe and effective alternative in line with ethical considerations while demonstrating the feasibility of using 3D printing technology to promote the 3Rs in experimental research.

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.

A CASE OF SYSTEMIC SCLEROSIS SINE SCLERODERMA

Systemic sclerosis is an uncommon connective tissue disorder with multisystem involvement, heterogenous clinical manifestations and have a chronic, progressive course. Autoimmune damage, vasculopathy and extensive brosis are the key etiopathogenic factors. Patients have clinical manifestations ranging from skin thickening limited to distal extremities/face to widespread multiorgan involvement. All typical features of systemic sclerosis without skin thickening is dened as SYSTEMIC SCLEROSIS SINE SCLREODERMA Case presentation: We report a case of A 40 year old female patient presented to us with the chief complaints of ulcers at the tip of right index and middle ngers associated with pain and swelling over a period of 10 days.Past history of amputation of left distal phalanx 1year back for similar complaint. She had a history suggestive of Reynaud's phenomenon. She was diagnosed as hypothyroid 5 years back with irregular treatment and with GERD 2ys back. CT CHEST-bilateral ground glass opacities,Paratracheal lymphadenopathy,Mild thyromegaly ,Mild dilatation of oesophagus,COLOUR DOPPLER-Right upper limb -normal study ,ANA PROFILE -Anti scl -70 –positive ,Anti jo 1- borderline positive Systemic sclerosis sine scleroderma (ssSSc) is an CONCLUSION : infrequent SSc variant characterized by visceral and immunological manifestations of SSc in the absence of clinically detectable skin involvement with good prognosis compared to other variants

Regional recurrence of digital papillary carcinoma in ipsilateral axillary lymph nodes 12 years after digital amputation – a case report

Digital papillary adenocarcinoma (DPA) is a rare malignant adnexal tumour that affects 0.08 per 1,000,000 people/year.1 It often presents as a solitary painless mass in the digital extremities where eccrine sweat glands are abundant. It is reported to have a recurrence rate of 50% and 14% rate of metastasis.2 Due to its rarity and vague clinical presentation, it has frequently been misdiagnosed as a benign adnexal tumour, pyogenic granuloma and ganglion cyst. We report a rare case of regional recurrence of DPA in an ipsilateral axillary node of a 66- year-old male, 12 years after a right ring finger distal phalanx amputation.

Subungual melanoma with blue naevus-like morphological features: a clinicopathological retrospective analysis of nine cases

Melanocytic lesions in the nail apparatus are often challenging. Both subungual melanomas (SUM) and blue naevus of the nail are very rare. Occasionally, melanomas may mimic blue naevus histologically. Benign and malignant blue melanocytic lesions are commonly associated with G protein mutations, a distinct abnormality not associated with conventional subungual melanomas. We describe the clinical, histological and immunohistochemical features of nine cases of SUM with blue naevus-like morphological features. Mutations in exon 4 and 5 of GNAQ and GNA11 were investigated in two cases, which showed no mutations. RNA-seq of one case revealed unknown mutations along with mutations in ATM, METK and ARID1A. Our study delineates a variant of SUM that mimics blue naevus. Awareness of this pitfall is important when evaluating heavily pigmented lesions around the nail in order to avoid misdiagnosis. Appropriate sampling of subungual lesions and clinicopathological correlation are paramount to reach the correct diagnosis.

QS7: Digit Tip Regeneration Following Amputation Is Not True Regeneration

Purpose:Repair of distal phalanx amputation is widely studied and thought to occur through a regenerative process. Single-cell RNA sequencing (scRNA) has greatly improved the ability to characterize the cells that are involved in regeneration and abnormal healing of bone and soft tissue. Given the disorganized architecture of digit tip “regenerated” bone and its common progenitor cell to the pathologic process of heterotopic ossification, we hypothesized that digit tip repair after injury follows a program of aberrant wound repair rather than true regeneration of normal bone tissue.Methods:ScRNA data of mouse digit tip amputation (DTA) and embryonic limb development (EMB) was downloaded from NBCI GEO data base ascension number GSE135985. Additionally, scRNA data from heterotopic ossification (HO) was downloaded from GSE126060. HO, DTA, and EMB datasets were clustered individually. HO was merged and aligned with EMB and DT in separate analyses. Cells expressing the mesenchymal progenitor cell (MPC) marker Pdgfra, which we have shown to differentiate into HO and others have shown to differentiate into bone after DTA, were identified and analyzed in the HO-DTA and HO-EMB datasets. Monocle 2, Seurat 3.1.1, and Pearson correlation analysis were used for analysis and visualization. Immunostaining for markers present in DTA (ACAN, FBN-2, LTBP2) was performed on sections collected from a murine model of traumatic HO in Pdgfra-CreER;TdTomato mice induced with tamoxifen one-week prior to HO-forming injury.Results:MPC clusters from DTA and HO and from EMB and HO were aligned and projected using UMAP to compare transcription profiles. Across the timepoints, MPCs in the DTA and HO occupy similar regions of the UMAP plot, while MPCs in EMB and HO occupy largely independent regions, with only overlap at the latest time points. Using Monocle 2, cells were placed on a virtual timeline based on similarities in transcription. MPCs from DTA and HO meet at the same location on the trajectory following injury. In the EMB to HO comparison, cells only occupy similar regions of the trajectory at post-natal day 3 suggesting that bone is formed by different pathways. To understand correlations between time points, transcriptomes were also compared by Pearson analysis. MPCs following HO and DTA injuries occupy similar regions of the plot while MPCs in EMB and HO only occupy similar regions of the correlation plot at P3. Markers previously identified to be upregulated in MPCs in DTA were also upregulated in MPCs in HO by both scRNA and immunofluorescent histology.Conclusions:Cells responsible for bone repair following DTA show similar transcriptional profiles as MPCs in traumatic HO and dissimilar to MPCs in EMB. Furthermore, MPCs in both digit tip repair and HO follow trajectories that do not overlap with embryonic limb development. Thus, we demonstrate for the first time, that the process following DTA is not truly regeneration and follows programs of aberrant repair as seen in HO.

Prenatal Diagnosis and Postnatal Treatment in a Case of Abdominal Obstruction and Polyhydramnios Caused by Amniotic Band Sequence

Background: Amniotic band sequence (ABS) is a rare congenital disorder resulting from the entanglement of fetal parts by fibrous bands that may cause disruptions, deformations, or malformations that can range from mild to life threatening conditions. Prenatal diagnosis is usually based on ultrasounds visualization on amniotic bands attached to fetal parts, possibly causing fetal defects. Case Presentation: A 19-year-old woman with an unremarkable clinical history and a low-risk pregnancy was referred to our Fetal Therapy Unit for a suspected fetal clubfoot at 22 weeks gestational age. A chorioamniotic separation, together with unilateral clubfoot was diagnosed. Due to a high risk of premature rupture of membranes a decision was made not to perform amniocentesis for genetic investigation. At prenatal follow up progressive polyhydramnios developed with a preterm spontaneous rupture of the membranes at 34 weeks. After caesarean section – due to breech presentation – an amniotic band was observed at the abdominal level causing a circular skin lesion, constriction, and a sub-occlusive intestinal status. Moreover, a left clubfoot with amputation of distal phalanx of the second toe and a right foot amputation of 2nd and 3rd toes were evident. The neonate underwent abdominal plastic surgery on the second day of life with complete recovery. Following the postnatal diagnosis of ABS, we re-examined a stored fetal 3D ultrasound volume acquired at 22 weeks and, focusing on the fetal surface rendering, we could notice the deep abdominal skin furrow that was evident at birth. Discussion: This case represents an unusual antenatal presentation of an amniotic band sequence that escaped prenatal diagnosis with a progressive polyhydramnios as an indirect sign of fetal bowel obstruction caused by an abdominal constricting band. In the presence of chorioamniotic separation and additional ominous ultrasound findings, it is advisable to consider the possibility of an ABS.

Neonatal acute limb ischemia

Abstract Acute limb ischemia is a rare disorder in the perinatal period. The etiology and management of acute limb ischemia is not well described. We report 4 cases of acute limb ischemia in the neonatal period. Observations We present the cases of four premature neonates aged between 6 and 15 days. The mothers of one of the neonates had a history of gestational diabetes. Three neonates were born by eutocic vaginal delivery and one, by cesarean section. Reasons for hospitalization of the neonates included infections (3 cases), hyaline membrane disease (2 cases) and congenital malaria (1 case).The neonates presented with cyanosis localized in the fingers (1 case), cyanosis on the fingers extending to the forearm (2 cases) and cyanosis localized in the toe (1 case). All patients had a peripheral intravenous catheter implanted in the affected limb. In three cases, there was an infectious syndrome and in one case, hemostasis was impaired. Doppler ultrasound of the blood vessels in the affected limb revealed arterial thrombosis in 2cases. Management involved antibiotics, heparin therapy and fasciotomy. During hospitalization, 1 patient had spontaneous distal phalanx amputation, 1 required surgery for forearm segmental gangrene and 2 died. Conclusion Neonatal acute limb ischemia is rare but can be fatal due to functional and vital repercussions. Treatment outcomes depend on early diagnosis, etiology and treatment.

Desmoid Tumors of the Foot: A Retrospective Study of Four Patients.

Desmoid-type fibromatosis (DF) is an aggressive (myo)fibroblastic neoplasm with an infiltrative growth pattern and a tendency for local recurrence. It is rarely seen at the foot. The aim of this retrospective study was to analyze clinical presentation, therapy, and outcomes in a consecutive series of four patients with DF at the foot. From 1994 to 2014, four patients had been surgically treated. The resection margin was marginal or even intralesional in all. One patient already had local recurrence at first presentation. The end point was either local recurrence or progression of residual disease. The mean patient age was 27 years. In one patient, marginal excision healed the disease. In another patient, local recurrence after marginal resection necessitated distal phalanx amputation. Two other patients showed stable disease after either adjuvant radiotherapy or treatment with nonsteroidal anti-inflammatory drugs and tamoxifen. If surgery is necessary, operative margins are less important than keeping function for the patient. Radiotherapy might be an option to avoid major amputation. The role of adjuvant radiotherapy is controversially discussed. A watchful wait-and-see policy seems to be justified by the published data but may be difficult for DF at the foot.

Intraosseous epidermal inclusion cyst of the right ring finger for 40 years

Introduction. Intraosseous epidermal inclusion cysts (IEpC) are benign bone lesions lined with squamous epithelium. Finger phalanges are the second most common site of predilection after the skull. Case report. We presented a case of a typical IEpC at the distal phalanx of the right ring finger following a remote history of a crush injury to the finger (40 years earlier). The patient experienced painful enlargement and progressive swelling of that finger during the previous month. On physical examination, the finger showed typical ?clubbing? with local tenderness. X-ray showed bone destruction, and magnetic resonance imaging (MRI) revealed abnormal signals in bone tissue in the distal phalanx of the right ring finger. The patient underwent distal phalanx amputation of the right ring finger. The diagnosis of IEpC was histopathologically confirmed. At follow-up 2 years later, the stump healed well and without recurrence. Conclusion. IEpC with a history of up to 40 years is very rare, and although the patient presents with a typical ?clubbing? finger, the diagnosis was eventually con-firmed by surgery and pathology.

Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation

In digital replantation, Kirschner wire (K-wire) fixation has commonly been used for osteosynthesis. On the other hand, K-wires are often obtrusive because of protrusion from the replanted digit. We describe a case series treated using hydroxyapatite/poly-L-lactide (HPLLA) threaded pins, which are not only bioabsorbable, but also osteoconductive, for osteosynthesis in crushed amputation or comminuted fracture, including distal phalanx amputation. Using an HPLLA threaded pin, 10 digital replantations were performed between July 2016 and April 2018. The precisely cut pin is manually pushed into the fracture site as an intramedullary nail. The pin is first pushed into the distal site, and then into the proximal site, after drilling with a K-wire of the same diameter as the pin. All amputations were crush type, and levels of amputations were Tamai zone I in three cases, zone II in two and zone III in five. Eight of the 10 digits survived. The two digits that did not survive showed venous insufficiency. Bone union of the eight digits was successfully obtained after 9–19 weeks (median 12 weeks). No adverse events occurred such as distortion of the pin, infection or foreign body reaction. The HPLLA threaded pin may be an adequate device to fix fractures in digital replantation.

The Preferred Management of a Single-Digit Distal Phalanx Amputation.

Replantation of a single digit at the distal phalanx level is not routinely performed since it is technically challenging with questionable cost-effectiveness. The purpose of this study was to analyze international microsurgeons' clinical decisions when faced with this common scenario. A survey of a right-middle finger distal phalanx transverse complete amputation case was conducted via online and paper questionnaires. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, specialties, microsurgery fellowship training, and clinical experiences. Among 383 microsurgeons, 170 (44.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, 8 (2.1%) chose composite graft, and 6 (1.6%) favored other choices as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, Middle East/South Asia, and Central/South America regions tend to perform replantation (70.7, 68.8, and 67.4%, respectively) whereas surgeons from North America and Europe showed a lower preference toward replantation (20.5 and 26.8%, respectively p < 0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% (p = 0.004). Clinical experience and the surgeons' specialties did not show statistical significance in clinical decision making. From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Multiple factors are taken into consideration in selecting the most suitable reconstructive method for each case scenario. In addition to the technical challenges of the proposed surgery, the cost of the procedure and the type of facility needed are important variables in the decision making process.

Onicodistrofia lupóide simétrica canina como manifestação da psora latente: relato de caso

Symmetrical Lupoid Onycodystrophy (SLO) is a unusual immuno-mediated pathology with idiopathic etiology that can affect canine species. Differential diagnosis includes fungal, bacterial and autoimmune dermatitis and neoplasia. Histopathology is the main diagnostic technique, although it demands on the distal phalanx amputation. There are no predispositions regarding to dog’s breeds and the age of ill dogs can be from 3 to 8 years old. Clinical management can take up to six months to show some effect and has a uncertain prognosis. Homeopathy aims to patient well-being and miasm dynamics must be comprehended in order to set a correct prognosis evaluation. This article reports a canine clinical case with physycal and behavioural disturbances which, treated by its Simillimum (high-diluted medicine chosen by the similia principle), expressed the SLO as a latent psora manifestation and reached a cure status later. Homeopathy figure out as a great option to treat this illness condition.

Adult Mouse Digit Amputation and Regeneration: A Simple Model to Investigate Mammalian Blastema Formation and Intramembranous Ossification.

Here, we present a protocol of adult mouse distal terminal phalanx (P3) amputation, a procedurally simple and reproducible mammalian model of epimorphic regeneration, which involves blastema formation and intramembranous ossification analyzed by fluorescence immunohistochemistry and sequential in-vivo microcomputed tomography (μCT). Mammalian regeneration is restricted to amputations transecting the distal region of the terminal phalanx (P3); digits amputated at more proximal levels fail to regenerate and undergo fibrotic healing and scar formation. The regeneration response is mediated by the formation of a proliferative blastema, followed by bone regeneration via intramembranous ossification to restore the amputated skeletal length. P3 amputation is a preclinical model to investigate epimorphic regeneration in mammals, and is a powerful tool for the design of therapeutic strategies to replace fibrotic healing with a successful regenerative response. Our protocol uses fluorescence immunohistochemistry to 1) identify early-and-late blastema cell populations, 2) study revascularization in the context of regeneration, and 3) investigate intramembranous ossification without the need for complex bone stabilization devices. We also demonstrate the use of sequential in vivo μCT to create high resolution images to examine morphological changes after amputation, as well as quantify volume and length changes in the same digit over the course of regeneration. We believe this protocol offers tremendous utility to investigate both epimorphic and tissue regenerative responses in mammals.

Preferred Choices for Single-Digit Distal Phalanx Amputation: Decisions of 383 International Microsurgeons (Preprint)

Preferred Choices for Single-Digit Distal Phalanx Amputation: Decisions of 383 International Microsurgeons (Preprint)

Squamous cell carcinoma of the nail unit.

Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone invasion. The etiology remains unknown, although a strong association with different conditions, such as high-risk human papillomavirus (HPVs), trauma, or radiation exposure has been demonstrated. Nail SCC is called “the great mimicker nail tumor” because different clinical presentations may coexist, resembling benign or malignant nail lesions. For this reason, there is often a significant delay between the onset of nail SCC and the diagnosis. Clinical manifestation includes onycholysis and erythema, while in the advanced stages nail ulceration can be observed. The association with pain, swelling, and inflammation usually indicates an invasive SCC with involvement of the underlying bone. Metastasis is rare but possible with involvement of lymph nodes. A multidisciplinary approach to assessment, management, and follow-up is advised. Using careful examination and modern diagnostic methods, including onychoscopy, biopsy, and histopathology, will help identify SCC and prevent the invasive progression. X-ray is important to investigate the bone invasion to determine the best surgical approach that will have satisfying cosmetic and functional outcomes. Nevertheless, local excision with sufficient surgical margins, best if using Mohs surgery, is usually sufficient and superior to amputation of the distal phalanx. This review aims to highlight the correct approach in suspected SCC of the nail unit.

Abstract: Distal Phalanx Replantation Using Delayed Venous Repair

INTRODUCTION: Vein anastomosis is the most important factor determining the success in the replantation of distal phalanx amputations. The purpose of the study was to show that the delayed venous method provides a higher success rate in distal phalanx replantations and does not require use of specialized techniques. METHODS: The delayed venous method for vein anastomosis was used for the last 2 years. This surgical procedure includes initial arterial anastomosis, delayed expansion of the vein, and subsequent vein anastomosis. We have chosen to delay for at least one hour the veins repair, in order to allow the veins to expand to a more reasonable diameter for repair. RESULTS: The delayed method was used in 7 cases. Expansion of veins up to 1 mm or more resulted in a high success rate (71%). In contrast, the success rate for distal phalanx replantation is extremely low in other techniques, because of the difficulty of vein finding and anastomosis. CONCLUSION: It is very difficult to find the collapsed veins and to perform vein anastomosis immediately after arterial repair. The delayed venous method allows easier anastomosis of the subdermal veins of the distal phalanx. Therefore, it is a useful operative technique for treatment of amputated distal phalanx amputation.

Marjolin’s squamous cell carcinoma of the hallux following recurrent ingrown toenail infections

Marjolin’s squamous cell carcinoma (SCC) affecting the toe is rare. Due to resemblance with benign conditions it can often result in misdiagnosis. We report a case of Marjolin’s SCC affecting...

Five cases of acrometastasis to the hand from a carcinoma and review of the literature

Metastases in the hand bones are a rare form of cancer presentation. Their appearance as a sign of carcinoma is even rarer and is associated with a poor prognosis. While amputation is recommended in cases of isolated metastases in patients with at least a few months of survival, radiation therapy may be useful for treating pain and partially restoring function. We conducted a retrospective review of 5 consecutive patients (2 male, 3 female; mean age of 46 years) presenting with metastases in the hand bones who had lung (n=2), skin, uterus and kidney cancers. Conservative treatment was performed in three cases, transmetacarpal amputation in one case and distal phalanx amputation in one case. All patients died within a few months of the diagnosis (mean: 5.2months). Because acrometastases generally are related to widespread disease, the prognosis of patients with acrometastases is poor. These cases illustrate the rapid progression of the disease when acrometastases in the hand are present.

Expression of nAG and Prod-1 in Terminal Phalanx Amputation Stumps of Adult Mice: An Experimental Model of Bone Regeneration in Higher Vertebrates.

nAG and Prod-1 are proteins responsible for the regeneration of completely amputated limbs in salamanders (which are lower vertebrates). The purpose of this study was to introduce an experimental distal phalanx amputation model in mice (which are higher vertebrates) in which nAG and Prod-1 are expressed in the amputation stumps. Sixteen mice with amputation of the distal two-thirds of the distal phalanx were used. One hind limb was used and the central three digits were amputated. Injection of nAG and Prod-1 plasmids was performed in the footpad twice weekly in experimental mice (n = 8), and injection of solution only (without the plasmids) was performed twice weekly in control mice (n = 8). nAG and Prod-1 were expressed in experimental stumps only. This expression results in quicker and more mature bone regeneration in experimental animals, and this was shown using histology and immune stains to osteocalcin (an osteoblast marker). Finally, quantitative mRNA showed a 21-fold increase of osteocalcin in experimental stumps compared with control stumps, and this was statistically significant. Injection of nAG and Prod-1 into the footpad will result in their expression in the distal amputation stumps, and this will enhance bone regeneration in the model described.