Dorsum Of Hand Research Articles

The application of heating film to hands reduces the decline in manual dexterity performance associated with cold exposure.

Exposure to cold temperatures decreases finger temperature (Tfing) and dexterity. Decreased manual function and dexterity can be serious safety risks, especially in tasks that require fine motor movements that must be performed outdoors. The aim of this study was to determine whether hand heating with a minimal power requirement (14.8W) results in a smaller reduction in Tfing and manual dexterity performance during mild cold exposure compared to a non-heated control condition. In a randomized crossover design, twenty-two healthy participants were exposed to a moderately cold environment (5 ºC) for 90min. One condition had no intervention (CON), while the other had the palmar and dorsal hands heated (HEAT) by using electric heating films. Tfing and cutaneous vascular conductance (CVC) were continuously monitored using laser Doppler flowmetry. Manual dexterity performance and cognitive function were assessed by the Grooved Pegboard Test (GPT) and Stroop Color-Word (SCW) test, respectively, during the baseline period and every 30min during the cold exposure. After the cold exposure, Tfing was higher in HEAT relative to CON (CON 9.8 vs. HEAT 13.7ºC, p < 0.0001). GPT placing time, as an index of dexterity performance, was also shorter in HEAT by 14.5% (CON 69.10 ± 13.08 vs. HEAT 59.06 ± 7.99s, p < 0.0001). There was no difference in CVC between the two conditions during the cold exposure (p > 0.05 for all). Cognitive function was similar between two conditions (p > 0.05 for all). The proposed hand heating method offers a practical means of heating fingers to maintain dexterity throughout prolonged cold exposure.

Managing RS3PE: Diagnostic approach, initial steroid response, and long-term management with DMARDs

Background. RS3PE, or Remitting Seronegative Symmetrical Synovitis with Pitting Edema, is a unique and relatively rare form of inflammatory arthritis that predominantly affects older adults. It is distinguished by its hallmark features: symmetrical swelling of the joints, significant pitting edema in the extremities, and a negative serological profile for common markers associated with rheumatoid arthritis, such as rheumatoid factor (RA factor) and anti-citrullinated protein antibodies (anti-CCP). This condition is often characterized by a remitting course, meaning that symptoms may improve or resolve over time, particularly with appropriate treatment. The condition usually affects older adults and can sometimes be associated with other underlying health issues, such as malignancies or infections. The “remitting” aspect of RS3PE refers to the fact that the symptoms often improve or resolve over time, particularly with appropriate treatment, which usually involves corticosteroids or other anti-inflammatory medications. Case report. This case study details the clinical presentation, diagnosis, and management of a 56-year-old female patient with known hypertension who presented with bilateral dorsal hand swelling, pain, and early morning stiffness over a 15-day period. The patient’s initial examination revealed bilateral pitting edema and active arthritis in the proximal interphalangeal joints, with significant warmth and tenderness. Laboratory tests showed elevated ESR and CRP, normocytic normochromic anemia, and negative rheumatoid factor and anti-CCP antibodies. Imaging studies, including X-ray, ultrasound, and mammogram, showed no erosive changes or malignancy, while a Pap smear and serum CA-125 levels were within normal limits. The clinical picture, combined with the exclusion of other conditions, supported the diagnosis of RS3PE. Treatment commenced with intravenous low-dose dexamethasone, which led to significant symptomatic improvement. This was followed by a transition to oral prednisolone, and the patient initially showed complete resolution of symptoms. However, recurrence of symptoms occurred upon discharge, prompting the introduction of steroid-sparing agents: methotrexate and hydroxychloroquine, alongside continued oral steroid treatment. Over a two-month follow-up period, the patient experienced no signs of relapse. This case fits the clinical and investigative criteria for RS3PE. The patient showed symptomatic improvement after treatment with low-dose steroids.

Deep learning techniques for hand vein biometrics: A comprehensive review

Biometric authentication has garnered significant attention as a secure and efficient method of identity verification. Among the various modalities, hand vein biometrics, including finger vein, palm vein, and dorsal hand vein recognition, offer unique advantages due to their high accuracy, low susceptibility to forgery, and non-intrusiveness. The vein patterns within the hand are highly complex and distinct for each individual, making them an ideal biometric identifier. Additionally, hand vein recognition is contactless, enhancing user convenience and hygiene compared to other modalities such as fingerprint or iris recognition. Furthermore, the veins are internally located, rendering them less susceptible to damage or alteration, thus enhancing the security and reliability of the biometric system. The combination of these factors makes hand vein biometrics a highly effective and secure method for identity verification.This review paper delves into the latest advancements in deep learning techniques applied to finger vein, palm vein, and dorsal hand vein recognition. It encompasses all essential fundamentals of hand vein biometrics, summarizes publicly available datasets, and discusses state-of-the-art metrics used for evaluating the three modes. Moreover, it provides a comprehensive overview of suggested approaches for finger, palm, dorsal, and multimodal vein techniques, offering insights into the best performance achieved, data augmentation techniques, and effective transfer learning methods, along with associated pretrained deep learning models. Additionally, the review addresses research challenges faced and outlines future directions and perspectives, encouraging researchers to enhance existing methods and propose innovative techniques.

Nearly complete hair re-pigmentation in an older patient treated with hydroxyurea for essential thrombocytosis

Introduction Employed in the treatment of malignancies and non-neoplastic conditions, hydroxyurea is associated with integumentary adverse effects, including skin discoloration, xerosis, pruritus, cutaneous atrophy, chronic leg ulcers, oral ulcerations, alopecia, and some nail abnormalities. Case Report A 77-year-old woman was diagnosed with essential thrombocytosis and started on low dose hydroxyurea. After 20 weeks of treatment, she experienced an unexpected change in hair color from gray to dark brown, without using hair dye or supplements. She later developed bilateral dorsal hand melanoderma, melanonychia, and onychodystrophy. Management and outcome It was decided to monitor the patient with no action taken as she was happy with this side effect of hydroxyurea. The platelet count has remained in excellent control. The dark brown hair color persisted over time. Discussion/Conclusion Hair hyperpigmentation likely occurred through melanocyte activation via hydroxyurea. Severe side effects may require dosage adjustments, while milder effects can be monitored closely. The newly observed hair color restoration in this case highlights potential dual (therapeutic and aesthetic) applications of this class of agents.

Coverage of Soft-Tissue Defects of the Palm of the Hand: Introduction of a New Flap Design.

The palm is of great importance for maintaining a functioning hand. The reconstructive demands of thickness, texture, color matching, pliability, and sensation for palmar defects represent a unique challenge for plastic surgeons. This study introduced a novel versatile design for the ulnar palmar artery perforator flap (UPAPF) to cover large palmar soft-tissue defects of the hand. The fifth metacarpophalangeal joint was identified as a landmark where the perforator was nearly 1 to 1.5 cm proximal. A template of the defect was outlined after adequate debridement. Meticulous dissection was executed under loupe magnification to trace the perforator until an adequate length of the pedicle was obtained for rotation. The harvested type B fasciocutaneous flap was rotated nearly 90° to be insetting on the palmar defect. Two patients were presented with a soft-tissue defect of the palm measuring 4.8 × 5.5 cm2 and 3.8 × 5 cm2, respectively. The flap was harvested and positioned at the defects. The flaps survived in the 2 cases with minimal donor site complications. The patients acquired protective sensations within the flap at the end of the follow-up period. The UPAPF provides a stable coverage for palmar soft-tissue defects with satisfactory aesthetic and functional results. It is a convenient addition to the armamentarium for reconstructing palmar soft-tissue defects of the hand.

Safety and efficacy of the Tao facemask for positive pressure ventilation in morbidly obese patients

Purpose: Positive-pressure mask ventilation is an essential skill for individuals providing basic and advanced airway interventions in a variety of clinical settings. The C-E grip technique is most commonly used with standard facemasks to provide an effective seal that allows for positive pressure ventilation. The Tao mask is a novel facemask that utilises an ergonomic grip by using downwards pressure of the palm of the hand accompanied by midline jaw lift. Specifically, the technique to create a seal involves downwards pressure of the palm centred on the mask accompanied by a jaw lift with four fingers centred under the mandible. A previous comparison between the Tao and standard masks revealed superior performance across a cross-section of average patients. The purpose of this study was to evaluate the safety and effectiveness of the Tao mask compared to the standard mask in a subset of patients with morbid obesity as defined by a body mass index (BMI) greater than or equal to 40 kg/m2. Methods: This prospective crossover trial included 156 patients aged ⩾18 years at the Medical University of South Carolina who were scheduled for elective surgery under general endotracheal anaesthesia with a BMI of ⩾40 kg/m2 at the time of surgery. After the induction of general anaesthesia, but prior to the administration of a neuromuscular blocking drug (NMBD), each patient was ventilated with both the standard and Tao masks, and effectiveness was measured using both the Han and Warters scales. The process was repeated after the administration of an NMBD. Results: Data were collected and analysed from 153 individuals. The mean BMI was 50.7 ± 9.3 kg/m2. The Tao mask ventilation scores were significantly lower (more effective) than the standard mask scores on both the Han and Warters Scales before pre-NMBD ( p = 0.0002 and p &lt; 0.001, respectively) and after post-NMBD ( p = 0.002 and p &lt; 0.001, respectively). On the Warters Scale, it was significantly easier to ventilate with the Tao Mask pre-NMBD ( p = 0.0001). On the Han Scale, the Tao mask was significantly easier than the standard mask post-NMBD ( p = 0.03). With regard to mask sequence, the mean Warters scores were lower for the Tao mask pre-NMBD only when the standard mask was used first ( p = 0.002). Similarly, the difference in the mean Warters scores post-NBMD was significant only when the standard mask was used first ( p = 0.02). Conclusion: The Tao mask demonstrated equivalent safety and superior effectiveness in ventilating morbidly obese surgical patients despite a trial design that favoured the standard mask owing to anaesthetist experience. The use of the Tao mask may be particularly beneficial in clinical situations involving inexperienced operators or in patients for whom mask ventilation is likely to be difficult. ClinicalTrials.gov registration number: NCT03473366

Development of a 3D-printed phantom for total skin electron therapy dose assessment.

Total skin electron therapy (TSET) is a complex radiotherapy technique, posing challenges in commissioning and quality assurance (QA), especially due to significant variability in patient body shapes. Previous studies have correlated dose with factors such as obesity index, height, and gender. However, current treatment planning systems cannot simulate TSET plans, necessitating heavy reliance on QA methods using standardized anthropomorphic phantoms and in-vivo dosimetry. Given the relatively few studies on rotational techniques, comprehensive data in commissioning could streamline the process. Developing a full-body phantom would enable a more thorough TSET commissioning process, including testing for position-specific dose distributions and comprehensive measurements across all body surfaces, unlike the typical torso-only phantoms. This was created using digital modeling software, fabricated using 3D-printing FDM technology, and filled with tissue-equivalent gelatine. The phantom was positioned at an SSD of 340cm and irradiated with a standard rotational TSET plan using the 6E HDTSE mode on a Varian TrueBeam linac at gantry angles of±18° from the horizontal. The dose was measured at over 50 points across the surface using Gafchromic EBT3 film. Dose distributions were generally consistent with existing literature values from in-vivo dosimetry, with several position-specific differences identified, including the hands and scalp compared to conventional positions. Hotspots were observed for the mid-dorsum of the foot and nose, with areas under 80% of the dose identified as the soles of the feet, perineum, vertex of the scalp, top of the shoulder, and palm of the hand. Additionally, analysis using an interpolated dose heatmap found that 90% of the pixel area received a dose within 10% of the prescribed dose, indicating good uniformity with the commissioned technique. With high agreement with the current literature, a 3D-printed phantom proves effective for measuring doses in areas typically unmeasurable in TSET commissioning.

Bilateral tuberculous dactylitis of both hand and feet in a female toddler: a case report on a rare presentation of skeletal tuberculosis in children

BackgroundEven though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet.Case PresentationA one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery.ConclusionTubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study

PurposeIntradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients. DesignA prospective observational study. MethodsAfter institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure. FindingsThe patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001). ConclusionsWe found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

Differences in Somatosensory Function Related to Hand Dominance: Results of a Quantitative Sensory Testing Study in Healthy Volunteers.

Quantitative sensory testing commonly utilizes the unaffected, contralateral side as a control to detect somatosensory dysfunction. There is scant evidence that somatosensory function for the volar dominant and non-dominant hands is equivalent, therefore intra-patient comparisons are unwarranted. This study aimed to identify dominance-related differences in palmar hand somatosensation, thereby determining if the unaffected contralateral hand is a valid comparator in clinical populations. With ethical approval (IREC_13_1_10) and informed consent, 110 healthy adult volunteers' participated in this clinical measurement study. Somatosensory function was assessed with the German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) protocol. Half of the participants were tested on the dominant hand. Thirteen parameters of thermal and mechanical detection and pain threshold were evaluated at both the dorsal and volar hand (distal middle finger). Tests were performed in the same order and instructions were read from a standardized script. Results for dorsal hand tests were compared to DFNS normative data to confirm participants met study inclusion criteria. Between-group differences for age and sex were investigated with the independent samples t-test and Chi-square test of independence, respectively. Group differences for dominant and non-dominant hands for all 13 continuous QST parameters were investigated with the Mann-Whitney U-test. Data for 106 participants were included in statistical analysis. Fifty percent of participants were tested on the dominant hand [n=53]; there were no differences for age or sex between groups (dominant or non-dominant hand test group). The dominant volar hand was significantly more sensitive to vibration detection threshold than the non-dominant hand (P=0.001). There were no significant differences related to dominance for other DFNS QST measures. For quantitative sensory testing with the DFNS protocol in healthy cohorts, the contralateral, unaffected hand is a valid control, with the exception of vibration detection threshold.

50546 Secondary intention healing of surgical wounds in the dorsal hand: an under-utilized technique?

50546 Secondary intention healing of surgical wounds in the dorsal hand: an under-utilized technique?

Assessing Changes in Hand Tactile Sensitivity After Glabellar Botulinum Toxin Treatment.

We aimed to assess behavioral changes in tactile sensitivity in patients receiving cosmetic glabellar botulinum toxin-A injections. In this prospective cohort study, we conducted quantitative sensory testing on 20 patients receiving 15 to 35 units of glabellar botulinum toxin-A treatment between October 1, 2022 and March 8, 2023. We used modified Von Frey filaments to exert forces between 0.25 mN and 512 mN to the dorsal hand just prior to botulinum toxin-A injections. Filament tips were uniform, rounded, and 0.5 mm in diameter to prevent nociceptor activation. This process was repeated 4 to 6 weeks after injection to assess for any change in minimal mechanical detection thresholds. Minimal mechanical detection thresholds decreased (patients detected smaller amounts of force) overall, in patients with prior botulinum toxin-A treatment, and in patients without prior botulinum toxin-A treatment: 5.34 mN to 4.33 mN (p = 0.22), 6.43 mN to 5.97 mN (p = 0.31), and 4.44 mN to 3.00 mN (p = 0.53), respectively. Our results suggest that the plastic changes observed in previous studies do not necessarily result in clinically significant manifestations when utilizing small to moderate amounts of botulinum toxin-A for aesthetic correction of glabellar lines, thus highlighting the safety of botulinum toxin-A for this indication. Further research is required to gain a comprehensive understanding of whether hand-associated cortical activity is altered after aesthetic amounts of botulinum toxin are injected.

Violaceous nodules of the extensor joints - a clinicopathological challenge.

Antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a condition characterized by vessel inflammation and may have a variety of etiologies. Among these, cocaine and its common adulterant, levamisole, have been described to contribute to the development of AAV with distinct cutaneous manifestations. Classically, these manifestations involve purpuric or necrotic lesions involving the ears, nose, and extremities. However, we present a case of cocaine-induced AAV presenting with violaceous nodules on the dorsal hands in order to demonstrate that this condition may not always present with retiform purpura and skin necrosis.

Anthropometric survey of dynamic hand dimensions: A pilot study

IntroductionEffective glove design requires understanding hand dimensions and movement. Designers must study hands in static and dynamic postures. They do this to identify key movement points. This study aimed to determine hand size during motion. The goal was to understand and specify how hand shape changes. Methods and materialsThirty dynamic hand dimensions of 100 Iranian males were measured in six postures using photography and three-dimensional modeling. The data were classified and compared based on hand positions. ResultsThe results showed significant differences in hand size during movements. Four hand.dimensions were found to have significant differences (p > 0.05) related to hand posture. Sizes either decreased or increased significantly. The dorsal hand length underwent a significant alteration. This was compared to the palmar hand length during movement. ConclusionThe results of this study help to design gloves with optimal fit, performance and comfort. The results show that the dorsal hand length should be increased, while the palmar hand length should be decreased in the design of the glove pattern. Gloves that are currently made based on static postures cannot provide a good fit. Attention should be paid to the measurement of the hand in dynamic positions.

Clinical application of perforator-based propeller flaps in repair of hand wound

To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.

Coincidence of acral peeling skin syndrome and Nagashima-type palmoplantar keratosis in a Japanese pedigree with acral skin peeling.

Acral peeling skin syndrome (APSS; MIM 609796) is a rare genodermatosis characterized by painless focal cutaneous exfoliation of the dorsal hands and feet, typically displaying autosomal recessive inheritance. While cases associated with a founder mutation in TGM5 are relatively common in European Caucasian populations, no APSS cases have been reported from Japan or other East Asian countries. In contrast, Nagashima-type palmoplantar keratosis (NPPK; MIM 615598), caused by variants in SERPINB7, is relatively common in East Asia due to founder mutations. We describe a 27-year-old Japanese woman with spontaneous focal cutaneous exfoliation of the dorsal hand following prolonged glove use, indicative of APSS. Histopathological examination revealed a cleft between the stratum corneum and stratum granulosum and within the horny layer of the epidermis, supporting this diagnosis. However, her mother and maternal uncle exhibited similar symptoms, and there was no reported consanguinity in the patient's parents or grandparents, prompting suspicion of an autosomal dominant genodermatosis. Whole-genome sequencing (WGS) revealed compound heterozygous variants in TGM5 (c.1037G>A and c.684 + 1G>A) as suspected causative variants in the patient, leading to an APSS diagnosis, the first reported in East Asia. On the other hand, her mother and maternal uncle were diagnosed with NPPK due to compound heterozygous pathogenic variants in SERPINB7 (c.796C>T and c.455-1G>A). This case highlights the complexity of diagnosing skin disorders when multiple genodermatoses with similar phenotypes exist within a pedigree. Comprehensive genetic analyses, such as whole-exome sequencing and WGS, are invaluable for identifying causative variants in such complex cases.

Bullous Drug Eruption.

A 63-year-old woman presented at our emergency department with a disseminated dermatosis that developed after undergoing a cardiac catheterization procedure. Her past medical history included an end-stage renal disease undergoing hemodialysis. Clinical examination revealed erosions and hemorrhagic crusts located on her lips and along the arteriovenous fistula. Additionally, we observed five hyperpigmented macules on her left hand's dorsum and palm and multiple hypopigmented macules in the genital area. Upon medical record review, we discovered the occurrence of prior bullous eruptions following contrast administration. A fixed drug eruption (FDE) due to radiocontrast was diagnosed based on clinical history, clinical examination, eruption timeframe, and positive drug provocation test. Intravenous contrast media reactions can be immediate or delayed, with delayed hypersensitivity reactions (DHR) occurring one hour to seven days post-administration. DHRs often present as maculopapular rashes. FDEs are rare. Skin tests are used to identify culprit agents. Ideally, intradermal tests, with delayed readings, and patch tests are combined for optimal sensitivity. Despite lacking standardized protocols, premedication with corticosteroids may mitigate reaction severity.

Limb Salvage Using Microsurgical Free Tissue Transfer in Severe Frostbite.

Frostbite is often managed conservatively; however, in severe cases, microsurgical free tissue transfer is required for soft tissue coverage and limb salvage. Given its rarity, the techniques and outcomes of these cases are not well described. The purpose of this report is to present the largest case series, to date, of frostbite injuries requiring microsurgical reconstruction for limb salvage. A single-center retrospective review was conducted of all patients who underwent free tissue transfer by a single surgeon from 2008 to 2022. Patients of all ages were included if they suffered a frostbite injury requiring free tissue transfer. Demographics, operative details, and surgical outcomes were recorded. Eight patients with frostbite injuries were included in the report. Patients had frostbite injuries either to the lower extremities (n = 4) or to both upper and lower extremities (n = 4). Sixteen free flaps were done in total including four paired chimeric and eight single free flaps. Flap recipient sites included knees (n = 5), foot/ankle (n = 3), dorsal hands (n = 2), and thumbs (n = 2). All 16 flaps survived. Five patients had complications: four with major complications requiring operative management and two with minor complications requiring conservative management. Mean follow-up time was 505.7 days (range 115-1564). All lower extremity reconstructions were able to weight-bear at an average of 125.2 days post-injury (range 87-164). This case series demonstrates that free tissue transfer is a robust option for soft tissue coverage and functional limb salvage in patients with severe frostbite injuries to both upper and lower extremities.

Effectiveness of Tea Leaf (Camellia sinensis) Liquid Smoke as an Antiseptic

Microbes are often the cause of infectious diseases; one method of prevention is to use antiseptics. Excessive use of antisep- tics can cause mild to severe side effects, so an alternative antiseptic is needed. Liquid smoke is an alternative raw material to produce antiseptics because its main component can be used as an inhibitor of microbial growth. This study aims to determine the effectiveness of tea-leaf liquid smoke as an antiseptic against microbial growth in vivo and in vitro. The method for producing liquid smoke via pyrolysis involves distilling grade 3 liquid smoke to generate grade 1 and grade 2 liquid smoke. The in vitro test uses a microbial growth inhibition test with grade 1 and 2 liquid smoke concentrations of 35%, 50%, and 75%. The microbes used were Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, Candida albicans ATCC 10231, and Aspergillus flavus ATCC 9643. The in vivo test uses the swab test method on the palm of the hand. The results of the invitro test showed that the largest inhibition zone of tea leaf liquid smoke was obtained using grade 2 liquid smoke with a concentration of 75%.The results of the in vivo test showed that the effectiveness of tea leaf liquid smoke was 80% against bacteria and 85% against fungi. Based onthe results of the study, it can be concluded that tea leaf liquid smoke (Camellia sinensis) has potential as an antiseptic.

Genetic analysis of a child with Dyschromatosis symmetrica hereditaria

To investigate the clinical and genetic features of a child with Dyschromatosis symmetrica hereditaria (DSH) and variant of the ADAR1 gene. A child who was admitted to the Department of Dermatology of the First Affiliated Hospital of Zhengzhou University in June 2020 due to irregular pigmented maculopapular rash on the dorsum of hands was selected as the study subject. Whole exome sequencing (WES) was carried out for the child and his similarly affected father, and Sanger sequencing was used to verify the candidate variant. SWISS-MODEL was used to predict the secondary and tertiary structures of the wild-type and mutant ADAR1 proteins. The child, a 13-year-old boy, had symmetrical hyperpigmented and depigmented spots on the back of his hands and was clinically diagnosed with DSH. WES and Sanger sequencing results showed that he and his father had both harbored a heterozygous c.2858dup (p.T954Dfs*20) truncating variant in exon 10 of the ADAR1 gene. Based on the guidelines from the American College of Medical Genetics and Genomics, the variant was predicted as pathogenic (PVS1+PM2_Supporting+PM1+PP3). The c.2858dup (p.T954Dfs*20) variant of the ADAR1 gene probably underlay the DSH in this pedigree.