Finger Avulsion Research Articles

Anatomy, evolution, and clinical aspects of the superextended-intercompartmental-supraretinacular artery perforator flap (SISAP-flap): A proof of concept

BackgroundExtended soft tissue defects of the fingers—irrespective of their origin—are challenging to treat. In cases of missing amputates or crush injuries, the options are often limited to further amputation, ray resection, or free tissue transplantation. The SISAP-flap was developed to add an extra option to treat finger avulsion injuries or otherwise extended soft tissue finger defects. MethodsCadaveric SISAP-flaps were individually dissected, tested for arterial perfusion using red ink and radiopaque dye, and transposed into artificially created same-size defects. After introducing this flap in the clinic, which was partially successful in the first patient, we modified the flap to its definite design. ResultsAverage cadaver flap size ranges between 11 cm and 22 cm in length, allowing dorsal wrapping of the flap over the fingertip and way back to the palmar metacarpophalangeal-joint. The flap is based on the distal web space perforator, which is commonly used by a dorsal metacarpal artery flap and supercharged using an intercompartmental, supraretinacular artery. Donor sites were closed primarily with little tension. Application of the flap in the clinic resulted in satisfactory functional and esthetic outcomes. ConclusionThe SISAP-flap is a new option for the reconstruction of extended finger defects and should be added to the reconstructive surgeon’s armamentarium of pedicled flaps, providing relatively short operating times and promising clinical outcomes.

Ulnar Parametacarpal Flap for Small Finger Avulsion Injury.

In difficult cases of replantation following small finger avulsion injury, in which amputation occurs at the proximal interphalangeal joint, the ulnar parametacarpal island flap, rotated 180° (propeller flap), can be used as an alternative method for covering a skin defect of the proximal phalanx. This flap can prevent metacarpophalangeal joint dysfunction and additional finger shortening. We propose the use of an ulnar parametacarpal flap for this purpose and report the outcomes of two successful cases treated with this method and followed up for 12 months.

Avoiding Ring Avulsion Injuries With Silicone Rings: A Biomechanical Study

Finger avulsion injuries account for 5% of upper extremity injuries requiring evaluation in an emergency room. They are devastating injuries that require microvascular reconstruction or amputation. As public awareness rises, there is a growing market for silicone rings, with limited data on their ability to prevent ring avulsion injuries. Five cadaver forearms were attached to a custom fixture, allowing for ring avulsion simulations. Specifically designed silicone or metal rings of varying sizes (#4-#11) were assigned to one of five fingers on each forearm, based on fit. The contralateral corresponding finger was tested using a ring of the same size in the other material. A preload of 2 N was applied to each ring, and ultimate failure force was determined by applying an upward force at a loading rate of 500 mm/sec until failure. Additionally, a fifth cadaver forearm was used to determine the ultimate failure force of silicone rings in a clenched fist position. The average ultimate failure force for silicone rings of all sizes was 53.0 N, compared to 495.2 N for metal rings of all sizes. The average ultimate failure force of silicone rings in the clenched fist position was increased across rings of all sizes, with an average of 99.9 N. There were no degloving injuries in the silicone ring avulsion group. Biomechanically, silicone rings have a significantly lower failure force than metal rings and may help prevent ring avulsion injuries. The use of silicone rings should be encouraged in professions where ring avulsion injuries are more likely, such as heavy labor.

Complete ring finger avulsion: Review of 16 years of cases at a Hand Emergency Unit

Replanting complete ring avulsion injuries remains a challenge for hand surgeons. The prognosis depends on achieving satisfactory function. We present the results of our 16 years’ experience with managing this type of injury. Our cohort consisted of 83 cases of complete ring avulsion injuries in patients with an average age of 23.5 years, treated in a Hand Emergency Unit between 1998 and 2014. Seventy-two were replanted. A vein graft was used in 57 cases to bridge the arterial injury and direct anastomosis was performed in 15 cases. Forty-one cases were a microsurgical success. Twenty-four patients were reviewed with an average follow-up of 87 months. The mean of total active motion was 164°, with 64° range of motion in the proximal interphalangeal joint on average. The two-point discrimination for sensitivity averaged 6mm. Two cases of severe cold intolerance were noted. Using a graft for vascular repair increases the odds of microsurgical success. The functional outcome depends on the condition of the proximal interphalangeal joint. Cold intolerance and lack of sensitivity have little effect on the functional outcome and patient satisfaction. Replantation of complete digital avulsion injuries should be attempted. Amputation at the metacarpal base is better discussed later on, after the initial surgery.

Digital replantation in forward surgical units: a cases study.

Introduction: Noncombat-related hand injuries are common in current theatres of operations. Crushing is one of the most frequent mechanisms that may cause traumatic amputations of digits. In the military setting, management of these digital amputations is challenging regarding limitation in microsurgical means in medical treatment facilities and aeromedical evacuation delays out of the combat zone.Methods: Two cases of digital replantation performed in French forward surgical units are described. The first case was a complete distal amputation of the medius which was successfully replanted in the operating theatre of an aircraft carrier. No complication was observed after evacuation. Functional and aesthetic results were excellent. The second case was a ring finger avulsion revascularized in a role 2 facility in Central African Republic. Unfortunately, revascularization failed due to arterial thrombosis during evacuation.Results: Digital, hand or more proximal upper extremity replantation may be considered for isolated amputations due to work-related accidents within the combat zone. For a surgeon trained to microsurgery, a microsurgical set and magnification loupes enable to attempt such procedures in austere conditions.Discussion: The authors propose an algorithm of management in the field according to the type and level of amputation.

Arthroscopy-aided fixation for metacarpophalangeal joint collateral ligament injury accompanied by osteochondral avulsion injury: our results and surgical technique

Aim: Though metacarpophalangeal joint collateral ligament injuries are commonly observed, the presence of accompanying avulsed osteochondral fragment or aponeurosis injury in adult patients is a situation that may require definite surgical treatment. Our study investigated patients attending our clinic after acute hand trauma with radial or ulnar collateral ligament injury who underwent arthroscopy-aided surgical treatment and who regularly attended check-ups to examine the efficacy and results of arthroscopy-aided treatment for collateral ligament injury of the metacarpophalangeal joint. Material and Methods: The study assessed fracture healing, joint movement angles and complications of 11 patients who attended our hand surgery department from December 2015 to April 2018 who had ulnar or radial collateral ligament injury of the metacarpophalangeal joint with accompanying osteochondral avulsion fracture repaired with the aid of arthroscopy with at least 1 year of continuous attendance at check-ups. Results: Four patients had 1st proximal finger avulsion fracture accompanying ulnar collateral ligament injury, four patients had 2nd proximal finger avulsion fracture accompanying ulnar collateral ligament injury, 1 patient had 4th finger and 2 patients had 5th finger proximal phalanx fractures accompanying radial collateral ligament injury. The patients’ avulsion fractures and ligament injuries healed without problem, 2 patients had limited joint movement angles and 1 patient developed complex regional pain syndrome. Conclusion: It is considered that the results of arthroscopy-aided collateral ligament injury repair and avulsed fragment fixation are good and perfect healing.

Reconstruction d’un arrachement digital par lambeau-greffe de Colson

Surgical treatment of complete cutaneous ring finger avulsion is a challenge in hand surgery. When replantation of the avulsed fragment is not technically feasible, the surgeon must consider reconstruction of soft tissue. Many surgical techniques have been described. We report a case of complete avulsion of the cutaneous sheath and nail of the fourth finger with preservation of mobility and collateral nerves. The reconstruction of soft tissue was performed by a Colson flap-graft. This simple and reliable technique of reconstruction allowed to obtain a functional and sensitive finger with a satisfactory cosmetic result.

Finger replantation: Surgical technique and indications

In this article, we discuss the surgical technique of finger replantation in detail, distinguishing particularities of technique in cases of thumb amputation, children fingertip replantation, ring finger avulsion, and very distal replantations. We emphasize the principles of bone shortening, the spare part concept, the special importance of nerve sutures and the use of vein graft in case of avulsion or crushing. However, even if finger replantation is now a routine procedure, a clear distinction should be made between revascularization and functional success. The indications for finger replantation are then detailed in the second part of this paper. The absolute indications for replantation are thumb, multiple fingers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Fingertip amputations distal to the insertion of the Flexor digitorum superficialis (FDS) are also a good indication. Other cases are more controversial because of the poor functional outcome, especially for the index finger, which is often functionally excluded.

Reverse flow free fillet flap to resurface ring finger avulsion injury

MicrosurgeryVolume 32, Issue 5 p. 418-419 Letter to the Editor Reverse flow free fillet flap to resurface ring finger avulsion injury Andreas Gravvanis M.D., Ph.D., FEBOPRAS, Corresponding Author Andreas Gravvanis M.D., Ph.D., FEBOPRAS gravvani@yahoo.com Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceDepartment of Plastic Surgery, Microsurgery and Burn Center, “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this authorDespoina Kakagia M.D., Ph.D., FEBOPRAS, Despoina Kakagia M.D., Ph.D., FEBOPRAS Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this authorDimosthenis Tsoutsos M.D., Ph.D., Dimosthenis Tsoutsos M.D., Ph.D. Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this author Andreas Gravvanis M.D., Ph.D., FEBOPRAS, Corresponding Author Andreas Gravvanis M.D., Ph.D., FEBOPRAS gravvani@yahoo.com Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceDepartment of Plastic Surgery, Microsurgery and Burn Center, “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this authorDespoina Kakagia M.D., Ph.D., FEBOPRAS, Despoina Kakagia M.D., Ph.D., FEBOPRAS Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this authorDimosthenis Tsoutsos M.D., Ph.D., Dimosthenis Tsoutsos M.D., Ph.D. Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527 Athens, GreeceSearch for more papers by this author First published: 18 June 2012 https://doi.org/10.1002/micr.21993Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume32, Issue5July 2012Pages 418-419 RelatedInformation

Replantation of Finger Avulsion Injuries: A Systematic Review of Survival and Functional Outcomes

Replantation of Finger Avulsion Injuries: A Systematic Review of Survival and Functional Outcomes

Removal of a titanium alloy ring

British Journal of Hospital MedicineVol. 72, No. 9 Case ReportRemoval of a titanium alloy ringS Bleibleh, J Childs, M BaqaiS BleiblehSearch for more papers by this author, J ChildsSearch for more papers by this author, M BaqaiSearch for more papers by this authorS Bleibleh; J Childs; M BaqaiPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2011.72.9.529AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Fejjal N, Belmir R, El Mazouz S et al. (2008) Finger avulsion injuries: A report of four cases. Indian J Orthop 42(2): 208–11 Crossref, Medline, Google ScholarKapickis M, Kutz JE (2007) Titanium alloy ring crush injury. Am J Emerg Med 25(9): 1084 Crossref, Medline, Google ScholarUrbaniak JR, Evans JP, Bright DS (1981) Microvascular management of ring avulsion injuries. J Hand Surg Am 6(1): 25–30 Crossref, Medline, Google ScholarWilliams D (2001) The golden anniversary of titanium biomaterials. Med Device Technol 12(7): 8–11 Google Scholar FiguresReferencesRelatedDetailsCited byRing Removal: A Comprehensive Review of TechniquesThe Journal of Emergency Medicine, Vol. 63, No. 2Evaluation of a two rubber band technique for finger ring removalThe Annals of The Royal College of Surgeons of England, Vol. 98, No. 5Review of techniques for the removal of trapped rings on fingers with a proposed new algorithmThe American Journal of Emergency Medicine, Vol. 31, No. 11 1 September 2011Volume 72Issue 9ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 September 2011 Information© MA Healthcare LimitedThe authors would like thank to Dr David Kendrick who was involved with this patient's management along with Barrow Fire Brigade and Furness General Hospital Works Department.PDF download

Replantation of Finger Avulsion Injuries: A Systematic Review of Survival and Functional Outcomes

Recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged the historical practice of performing revision amputation for all complete finger avulsion injuries. The aim of this study is to conduct a systematic review of the English literature of replantation of finger avulsion injuries to provide best evidence of survival rates and functional outcomes. A Medline literature search yielded 1,398 studies, using key words "traumatic amputation" or "replantation", with limitation to humans and finger injuries. Inclusion criteria required that studies meet the following requirements: (1) primary data are presented; (2) the study includes at least 5 cases with either complete or incomplete finger avulsion injuries at or distal to the metacarpophalangeal joint; (3) the study presents survival rates, total active arc of motion (TAM), or static 2-point discrimination (2PD) data; (4) data for incomplete and complete avulsions are reported separately; (5) patients are treated with microvascular revascularization or replantation. Survival rates, TAM, and 2PD data were recorded and a weighted mean of each was calculated. Thirty-two studies met the inclusion criteria. Of these 32 studies, all reported survival outcomes, 13 studies reported TAM (metacarpophalangeal, proximal interphalangeal, and distal interphalangeal), and 9 studies reported sensibility. The mean survival rate for complete finger and thumb avulsions having replantation was 66% (n = 442). The mean TAM of complete finger avulsions after successful replantation was 174° (n = 75), with a large number of patients in the included studies having arthrodesis of the distal interphalangeal joint. The mean 2PD in patients after replantation was 10 mm (n = 32). We found that functional outcomes of sensibility and range of motion after replantation of finger avulsion injuries are better than what is historically cited in the literature. The results of this systematic review challenge the practice of performing routine revision amputation of all complete finger avulsion injuries.

Digital Avulsion With Compromised Vascularization

Avulsion of a digit has not always been an indication for replantation because of extensive injuries. The advent of microsurgery changed this, permitting avulsed digit replantations with varying rates of success. The aim of this study was to analyze surgical management of finger avulsion injuries of an exclusively pediatric series. A retrospective study of children with finger avulsion injuries and compromised arterial circulation degloving or amputation, treated primarily in our institution between 1997 and 2007. Factors that could affect the outcome included demographic and clinical data, description of the lesion using Urbaniak's and Tamai's classification, technical data related to surgery, and results of revascularization were collected. Twenty-three children with 23 digital injuries were identified as digital avulsions with compromised vascularization. The mean age was 11 years and 8 months (range, 2 to 15 y). Four cases involved devascularization classified as Urbaniak 2 and the other 19 cases involved amputation or complete degloving, classified as Urbaniak 3. In 7 cases, replantation was not performed because of the extent of the lesions (all were classified as Urbaniak 3). The complete survival rate when revascularization or replantation was attempted was 25%. One case required a new procedure 6 days after the first surgery with a trans-P2 amputation. Injuries classified as Urbaniak 2 had an overall survival rate of 75% and injuries classified Urbaniak 3 had an overall survival rate of 5.3%. The global rate of survival after revascularization or replantation of avulsed fingers in children seemed to be poor. Urbaniak classification is an important prognostic factor with a good prognosis for lesions classified as Urbaniak 2 and a very poor prognosis for lesions classified as Urbaniak 3.

Acute Forearm Compartment Syndrome Secondary to Digit Avulsion Injury

Patients with mutilating hand and finger injuries often present first to orthopaedic, plastic, or general surgeons covering emergency room call and sometimes present only by telephone consultation. The present report describes a patient who presented with a severe finger avulsion in whom the most urgent issue was an ipsilateral forearm compartment syndrome secondary to the avulsion. The patient was informed that data concerning the case would be submitted for publication, and he consented. A fifty-five-year-old man was using a high-speed rotary tool, which caught a nylon cord that became wrapped around the right, dominant index finger. He presented to the emergency room with an open dislocation of the proximal interphalangeal joint. The soft tissues were nearly circumferentially avulsed (Fig. 1). Distally, the finger was dusky and insensate. The remaining fingers had normal color and capillary refill. The patient was otherwise healthy and denied taking any regular medications, including Coumadin (warfarin) and anti-inflammatory medications. Fig. 1 Near circumferential degloving injury of the index finger. The patient complained of severe and worsening pain in the forearm and required 8 mg of intravenous hydromorphone in one hour. Physical examination revealed tense swelling and tenderness, which was greatest at the volar aspect of the middle part of the forearm and was worse with passive extension of the uninjured digits. He also complained of numbness in the median and ulnar nerve distributions, where he had corresponding decreased sensibility on examination. Radial and ulnar pulses were palpable at the wrist. Radiographs of the hand reflected dislocation of the proximal interphalangeal joint of the …

River Tree Rope Swing Injuries

To review injuries associated with falls from river tree rope swings (RTRS) and identify points of action for prevention. This study was a retrospective analysis of injury reports directly related to falls from RTRS. Case reports for 2002-06 were extracted from the National Electronic Injury Surveillance System (NEISS), US legal literature, and news reports. Direct observation of river tree rope swings was performed with kayak and camera to identify potential hazards. A laboratory study was performed on samples of rope used in RTRS to assess entanglement risk. NEISS detailed 73 injuries directly related to falls from RTRS in ages 5-25 years. Finger fractures were the most commonly reported injury. Based on NEISS data, an estimated 700 injuries may occur related to RTRS each year. RTRS share risk of severe injuries with traditional rope swings such as lower extremity fractures, concussions, and spinal cord injuries. Drowning, finger avulsion and genital lacerations appear more common with river tree rope swings. RTRS are dangerous and are associated with a variety of serious injuries from falls and entanglement. The most hazardous risk factors of RTRS are use by a non-swimmer, shallow water, extreme fall distance, and presence of a small diameter retrieval line. RTRS injuries occurring in remote locations are challenges to rural physicians and EMS providers. Prevention of recreational injuries, including injuries sustained from RTRS, remains a daunting task.

Finger avulsion injuries: A report of four cases

Injury that occurs to a finger wearing a ring though rare can have grave consequences. It is a preventable injury which has a peculiar mode of trauma that is usually occupational. Injury ranges from simple contusion to degloving of soft tissues to traumatic amputation. We hereby report our experience of four cases of finger avulsion injuries due to a ring and discuss their variable clinical presentation and individualized management.

Reconstruction d'une forme particulière d'arrachement digital par bague par greffe de peau totale et lambeau « cross finger »

An exceptional case of complete cutaneous ring finger avulsion is reported. The distal fragment was not replantable because of lack of vessels. The reconstruction restored a functional finger.

Finger Avulsion with Pulled-Out Flexor Tendon

A 17-year-old boy jumped over a fence and sustained an avulsion injury. The fifth finger was amputated, and the tendon of the flexor digitorum profundus muscle was completely pulled out. The finger was replanted microsurgically.

Trans-digit Salvage Replantation Using Part of an Amputated Digit for Reconstruction of Thumb Pulp

Hand trauma is a common problem in daily practice. Restoration of hand function is important, especially for the pulp defect. Pulp defect can be reconstructed by many methods. However, every method has some limitations and drawbacks, like donor site deformity and morbidity. It is common for hand trauma to have multiple fingers involvement. The option of the treatments depends on the extent of tissue damage. For the non-replantable amputated finger, the residual viable tissue of the amputated part can be used for other finger defect reconstruction. We reported a patient having left hand crush injury with small finger avulsion amputation at the level of metacarpophalangeal joint and thumb pulp defect. A fillet flap was harvested from the non-replantable small finger to reconstruct the pulp defect of thumb. At one-year of follow-up, good functional result and aesthetic appearance were archived.

Treatment of Finger Avulsion Injuries with Innervated Arterialized Venous Flaps

Treatment of Finger Avulsion Injuries with Innervated Arterialized Venous Flaps