Finger Pulp Research Articles

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.

A hitchhiking approach to reconstruct the finger pulp and the subsequent 1st toe hemi-pulp donor site defect

The free 1st toe hemi-pulp transfer for finger pulp reconstruction was acknowledged as the optimal one. However, the treatment of the 1st toe donor defect, owning to the impossibility of primary closure, was frequently oversimplified. This study presented a "hitchhiking" approach to resurface finger pulp and the subsequent 1st toe donor site defect in a one-stage procedure. From 2014 to 2019, finger pulp amputations (13 digits in 12 patients) were reconstructed with free 1st toe pulp flaps, and the donor site was resurfaced by the 2nd toe pedicled flap with the 2nd toe's primary closure. Therapeutic evaluation of repaired fingers and toes was based on cold intolerance, two-point discrimination (2PD), and gait disturbance. All finger and toe pulp flaps survived uneventfully. The average size of free 1st toe and pedicled 2nd toe flap was 3.1cm×2.0cm (3.5cm×1.4cm to 4.2cm×2.5cm) and 3.0cm×1.1cm (2.0cm×0.9cm to 3.8cm×1.5cm), respectively. The regained average static 2PD on the finger and 1st toe pulps was 6mm (ranged 5-10mm) and 4mm (ranged 2-6mm), respectively. All reconstructed 1st toe pulps were qualified for normal gait. One patient complained the mild cold intolerance, and hammer-toe deformities were involved in two cases. To fulfill donor site care and cost-effective rule, the toe-to-finger pulp reconstruction can't underestimate the morbidity on 1st toe donor site due to inappropriate intervention. Equally importantly, the hitchhiking pedicled 2nd toe flap should be recruited in the reconstructive scheme.

Oral Glucose Load and Human Cutaneous Microcirculation: An Insight into Flowmotion Assessed by Wavelet Transform.

Simple SummaryThere is increasing evidence to suggest that microcirculation becomes dysfunctional earlier than large blood vessels or the heart in several diseases. In diabetes mellitus, a disease characterized by chronic hyperglycemia, microvascular impairment is well-established; on the contrary, the effect of acute hyperglycemia in microcirculation remains unclarified. Our aim was to investigate the microvascular effect of an oral glucose load (OGL) using laser Doppler flowmetry (LDF) as a perfusion quantification technique, coupled with wavelet transform (WT) to perform a spectral decomposition of the LDF signal. On two distinct occasions (pre-load and post-load), sixteen healthy subjects drank either a standard glucose solution or water. Perfusion was assessed by LDF and WT while resting and during post-occlusive reactive hyperemia (PORH), evoked by a transient three-min occlusion of the brachial artery, in the forearm and the finger pulp. The OGL affected microcirculation in both sites compared to water, significantly blunting the PORH response in the forearm. The WT revealed significant differences in the cardiac and sympathetic components after OGL between the pre-load and post-load periods. These results suggest that an OGL induces a short-term subtle microvascular impairment, probably involving a modulation of the sympathetic nervous system.Microcirculation in vivo has been assessed using non-invasive technologies such as laser Doppler flowmetry (LDF). In contrast to chronic hyperglycemia, known to induce microvascular dysfunction, the effects of short-term elevations in blood glucose on microcirculation are controversial. We aimed to assess the impact of an oral glucose load (OGL) on the cutaneous microcirculation of healthy subjects, quantified by LDF and coupled with wavelet transform (WT) as an interpretation tool. On two separate occasions, sixteen subjects drank either a glucose solution (75 g in 250 mL water) or water (equal volume). LDF signals were obtained in two anatomical sites (forearm and finger pulp) before and after each load (pre-load and post-load, respectively), in resting conditions and during post-occlusive reactive hyperemia (PORH). The WT allowed decomposition of the LDF signals into their spectral components (cardiac, respiratory, myogenic, sympathetic, endothelial NO-dependent). The OGL blunted the PORH response in the forearm, which was not observed with the water load. Significant differences were found for the cardiac and sympathetic components in the glucose and water groups between the pre-load and post-load periods. These results suggest that an OGL induces a short-term subtle microvascular impairment, probably involving a modulation of the sympathetic nervous system.

Clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand

Objective: To investigate the clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand. Methods: The retrospective observational study method was used. From May 2014 to June 2019, 8 patients with thumb damage and soft tissue defect of hand were admitted to the 988th Hospital of Joint Logistic Support Force of PLA, including 6 males and 2 females, aged from 25 to 46 years. Among them, thumb damage in 3 cases were degree Ⅱ, 1 case was degree Ⅲ, and 4 cases were degree Ⅳ. All thumb damage were repaired with perforator flap combined with toe transplantation. The skin and soft tissue defects of hand were repaired by free anterolateral thigh perforator flap in 6 cases and free deep inferior epigastric perforator flap in 2 cases. The thumb damage of degree Ⅱ was repaired by the first toe transplantation combined with perforator flap, and thumb damage of degree Ⅲ or Ⅳ was repaired by the second toe transplantation combined with perforator flap. The survival and blood supply of reconstructed thumbs and flaps, and wound healing of donor sites were observed after surgery. All the patients were followed up for 10 to 18 months, the appearance of the reconstructed thumbs, sensory recovery, and foot walking function were observed. At the final follow-up, the functional reconstruction of the thumb was evaluated. Results: All the blood supply and survival of the reconstructed thumbs and flaps were good, and all the wounds of donor sites healed well. During the follow-up, the appearances of the reconstructed thumb and flap were good, the sensation of pain and touch of the finger pulp recovered well, and no significant impact on foot walking function was observed. At the final follow-up, the function of reconstructed thumb was evaluated as excellent in 4 cases, good in 3 cases, and fair in 1 case. Conclusions: The repair method of perforator flap combined with toe transplantation technique can complete the targeted repair of thumb damage with skin and soft tissue defect of hand in one stage, minimizing the foot donor site injury and shortening the course of disease and early rehabilitation, which is one of the ideal methods for the treatment of complex thumb damage.

Adipose tissue-derived stromal vascular fraction for treating hands of patients with systemic sclerosis: a multicentre randomized trial Autologous AD-SVF versus placebo in systemic sclerosis.

To assess the superiority of adipose tissue-derived stromal vascular fraction (AD-SVF) injection into the fingers vs placebo in reducing hand disability in systemic sclerosis (SSc) patients. We performed a double-blind, multicentre, phase II trial from October 2015 to January 2018 in France. SSc patients with a Cochin Hand Function Scale (CHFS) ≥20/90 were randomized 1:1 to receive injection of AD-SVF or placebo. AD-SVF was obtained using the automated processing Celution 800/CRS system. The placebo was lactated Ringer's solution. The primary efficacy end point was the change of the CHFS score from baseline to 3 months. Secondary efficacy endpoints included the CHFS score at 6 months, hand function, vasculopathy, hand pain, skin fibrosis, sensitivity of the finger pulps, Scleroderma Health Assessment Questionnaire, patients and physician satisfaction, and safety. Forty patients were randomized. The AD-SVF and placebo groups were comparable for age, sex ratio, disease duration, skin fibrosis of the hands and main cause of hand disability. After 3 months' follow-up, hand function significantly improved in both groups with no between-group difference of CHFS (mean change of -9.2 [12.2] in the AD-SVF group vs -7.6 [13.2] in the placebo group). At 6 months, hand function improved in both groups. This study showed an improvement of hand function in both groups over time, with no superiority of the AD-SVF. Considering the limits of this trial, studies on a larger population of patients with homogeneous phenotype and hand handicap should be encouraged to accurately assess the benefit of AD-SVF therapy. ClinicalTrials.gov, https://clinicaltrials.gov, NCT02558543. Registered on September 24, 2015.

Comments on “finger pulp reconstruction with thenar flap: Aesthetic and functional outcome”-----relevant questions demanding attention related to the study

Comments on “finger pulp reconstruction with thenar flap: Aesthetic and functional outcome”-----relevant questions demanding attention related to the study

Normative values of the vibration perception thresholds at finger pulps and metatarsal heads in healthy adults.

AimsTo establish normative values of vibration perception thresholds (VPTs), using multi-frequency vibrometry at finger pulps and at metatarsal heads of the foot in healthy adults. We also aimed to investigate factors that could potentially affect VPTs such as age, sex, height, weight, foot- or handedness and skin temperature.MethodsVPTs were examined in 924 healthy and randomly selected subjects in the southern Sweden (mean 46 years; 628 women and 296 men). Inclusion criterias were adult subjects (>18 years) in considerable health without diabetes mellitus or other nerve affecting disorders. VPTs were measured at the finger pulps of index and little finger, as well as the first and fifth metatarsal heads of the foot, through multi-frequency vibrometry using the VibroSense Meter® I device. Patient characteristics were recorded and skin temperature was measured before assessment of VPTs.ResultsWe present normative values of VPTs for a large population of both male and female subjects in various ages. VPTs detoriated as age increased (0.09–0.59 dB per year; p<0.001), i.e. progressing with normal aging. Increasing skin temperature affected VPTs in finger pulps, but not at metatarsal heads, with -0.2 to -1.6 dB, i.e. vibration perception improved with higher temperatures. Height was only found to affect the VPTs of metatarsal heads (250 Hz: 0.42 dB per cm). Sex, weight and handedness did not affect the VPTs.ConclusionWe investigated the normative values of VPTs and presented affecting factors as age, skin temperature and height. With these results, VPT testing through multi-frequency vibrometry is enabled to be used in a clinical practice as a diagnostic tool when investigating neuropathy and other neurological disorders.

Design of Personalized Wearable Haptic Interfaces to Account for Fingertip Size and shape.

The size and shape of fingertips vary significantly across humans, making it challenging to design wearable fingertip interfaces suitable for everyone. Although deemed important, this issue has often been neglected due to the difficulty of customizing devices for each different user. This article presents an innovative approach for automatically adapting the hardware design of a wearable haptic interface for a given user. We consider a three-DoF fingertip cutaneous device, composed of a static body and a mobile platform linked by three articulated legs. The mobile platform is capable of making and breaking contact with the finger pulp and re-angle to replicate contacts with arbitrarily-oriented surfaces. We analyze the performance of this device as a function of its main geometrical dimensions. Then, starting from the user's fingertip characteristics, we define a numerical procedure that best adapts the dimension of the device to: (i) maximize the range of renderable haptic stimuli; (ii) avoid unwanted contacts between the device and the skin; (iii) avoid singular configurations; and (iv) minimize the device encumbrance and weight. Together with the mechanical analysis and evaluation of the adapted design, we present a MATLAB script that calculates the device dimensions customized for a target fingertip as well as an online CAD utility for generating a ready-to-print STL file of the personalized design.

Calcinosis cutis in limited cutaneous systemic sclerosis.

Soft tissue calcification is seen in some rheumatological diseases, including systemic sclerosis. We herein present a clinical image of calcinosis cutis of finger pulps and its characteristic radiographic image in a patient with limited cutaneous systemic sclerosis.

Classification for Thumb Opposition in Children with Thumb Hypoplasia.

Background: The Kapandji scale has 10 levels and includes abduction, rotation and flexion movements. Assessing children with thumb hypoplasia, this scale is poorly understood and confusing. The objective of the study is to evaluate an opposition scale simpler and understandable for children. Methods: It is a validation study of a simplified scale to qualify the opposition of the thumb, in order to asses only the abduction - rotation but not the flexion of the metacarpo-phalangeal (MP) or interphalangeal (IF) joint. The proposed classification goes from 0 to 3 degrees, where 0: No opposition, 1: The thumb touches the middle phalanx of the 2nd finger, 2: the thumb touches the pulp of the 2nd finger and 3: the thumb touches the pulp of the 5th finger. 10 patients with thumb hypoplasia were analyzed by 9 hand surgeons and 9 orthopedic surgeons. Results: The intraclass correlation coefficient shows a very good inter-observer reliability with a kappa of 0.991 (p = 0.000). When correlated by groups, the finding were very good between the hand surgeons group k = 0.980 (p = 0.000) and the orthopedic surgeons group 0.974 (p = 0.000). At 6 weeks a new evaluation was made, the intra-observer reliability was excellent k = 0.995 (p = 0.000). Conclusions: The proposed scale for the evaluation of the abductionrotation of the thumb is validated and useful in the evaluation of the results of a thumb opposition transfer with a good inter-observer and intra-observer reliability between orthopedic and hand surgeons.

Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein

To investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound. Between June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm. All the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good. Modified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.

Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs.

No standardized execution or evidence demonstrates the area of the digit giving the most accurate capillary refill time (CRT). This study investigated the reliability and validity of CRT, and the relative merits of areas where the test could be performed. In all, 127 healthy volunteers were assessed for normal CRT at the fingernail, lateral paronychia, and proximal and distal pulps of the index finger. The predictive validity of the CRT for the diagnosis of compromised vascular perfusion was also investigated on 24 subjects, using an inflated tourniquet. Three raters assessed interobserver reliability. The mean fingernail, lateralparonychia, proximalpulp, and distalpulp CRTs were 1.93, 1.78, 1.70, and 1.57s, respectively. The tourniquet and non-tourniquet results demonstrated significant mean differences; however, the fingernail showed a subtle difference (1.22s) compared with the proximal pulp (4.46s). The CRT interobserver reliability was fair at the fingernail (intraclass correlation coefficient [ICC] = 0.51), but very poor in occluded limbs (ICC = 0.13). At the lateral paronychia and finger pulp, the interobserver reliability was reasonable (ICC = 0.75-0.81 [non-tourniquet] vs 0.62-0.68 [tourniquet]). In a receiver-operating characteristic curve analysis, the proximal pulp demonstrated better discrimination (area under the curve = 0.93, 95% CI 0.89-0.97, p < 0.0001); the best cutoff point was calculated to be 3s at the proximal pulp. CRT use at appropriate areas is reliable. The most dependable site is the finger pulp, and the proposed cutoff is 3s.

Contact eczema induced by hybrid manicure. The role of acrylates as a causative factor.

IntroductionAcrylates are widespread plastic materials, known for their sensitizing properties. So far, allergy to acrylate monomers has been known as occupational eczema, mainly concerning dentists and manicurists. However, a surge of allergic contact dermatitis (ACD) cases related to acrylates among users of hybrid varnishes have recently been reported.AimThis article reviews the pathogenesis, clinical manifestations, and dermoscopic features of contact eczema induced by hybrid manicure.Material and methodsThe study was performed on a group of 8 women. Clinical and dermoscopic features were evaluated and correlated with the period of exposure to acrylates. In addition, all patients underwent mycological examination to exclude fungal co-infection.ResultsMycological examinations in all patients gave negative results, although 1 patient developed local secondary mixed supra-infection due to Pseudomonas aeruginosa and Candida spp. Distribution of clinical manifestations corresponded to the area of contact with the allergen and comprised both skin and nail changes. The severity of inflammation correlated positively with the exposure period. Subungual hyperkeratosis and onycholysis were the most common findings (8/8 patients), and eczematous finger pulp fissuring was a rarer sign (2/8 patients) but more specific clinically.ConclusionsThe surge of contact dermatitis related to acrylates seen in recent years requires dermatologists’ awareness. Nail changes induced by hybrid manicure can mimic onychomycosis or nail psoriasis. Therefore comprehensive patch testing should be performed in doubtful cases. Due to the lack of patch tests in our study, we can only suspect that we were dealing with allergic contact dermatitis. In case of confirmed allergy to acrylates, the patient should be aware of this and avoid them.

O19 A Complex Case of Systemic Lupus Erythematosus with Class IV Lupus Nephritis in a 15-year-old Egyptian Girl

O19 A Complex Case of Systemic Lupus Erythematosus with Class IV Lupus Nephritis in a 15-year-old Egyptian Girl

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.

The semi-occlusive dressing - development of the confidence of the patients in the treatment and the odour emission during the treatment period

This study aims to analyse how the confidence of patients with a fingertip injury treated with a semi-occlusive dressing develops during treatment. In addition, the development of odour emission was recorded. 17 patients with a fingertip injury were treated by use of a semi-occlusive dressing. On each appointment, before the dressing was changed, patients were interviewed about their confidence in the type of treatment and the amount of odour emission. Confidence in type of treatment and amount of odour emission were graded on a numeric analogue scale with 0 = no confidence and 10 = absolute confidence, and 0 = no odour emission and 10 = extreme odour emission, respectively. After the fingertip injury healed, pulp thickness was measured by ultrasound and compared with the uninjured finger of the opposite hand. Already at the beginning of treatment, patient confidence in the type of treatment was high (8.5 ± SD 1.1). Odour emission reached a maximum of 5.6 ± SD 2.5 at the third dressing change. As odour emission decreased, confidence in type of treatment peaked between the third and fourth dressing change. After healing of the fingertip injury, the pulp of the injured finger was measured to be 3.0 ± 0.6 mm on ultrasound; pulp thickness of the uninjured finger of the other hand was 3.4 ± 0.8 mm. The confidence that a fingertip injury will heal by use of a semi-occlusive dressing is very high from the beginning of treatment. As odour emission decreases, confidence in treatment increases further.

Effect of different slow release potassium fertilizer rates on growth and productivity of banana cv.Williams plants

This study was carried out during the two successive seasons (2017 and 2018) on the first and second ratoon of healthy uniform banana cv. Williams (Musa spp.) Plants grown in sandy soil under drip irrigation system in a private orchard located at El-Tahadi region, Cairo Alexandria desert road, Behaira governorate, Egypt. The investigation aimed to study the effect of different slow release potassium fertilizer (SRKF) (50% K2O) rates (100%, 75% and 50%) were added as soil drench during mid March, mid June and mid September while, potassium sulphate dose used in control treatment was added at monthly intervals as soil application from mid March until mid October on vegetative growth, productivity, total yield income and net return/feddan of banana plants. The obtained results showed that, all treatments had a significant effect on enhancing the vegetative growth parameters, i.e. number of green leaves /plant, plant total assimilation area (m2/plant), leaf total chlorophyll content (CCI) and leaf macro element content (N, P and K) as (%) as well as leaf micro element content (Fe, Zn and Mn) as (ppm). Also, improving yield (ton/feddan), bunch weight (kg), number of hands/bunch, hand weight (kg), number of fingers/hand, finger weight (g), finger length (cm), finger circumference (cm), finger pulp weight (g), finger pulp/peel (ratio), TSS (%), TSS/TA (ratio), total sugars (%). In addition, the total yield income (1000 LE) and net return/feddan (1000 LE) in both seasons. Moreover, all treatments had no significant effect on plant pseudostem height (cm), pseudostem circumferences (cm) and leaf area (m2) of plant in both seasons and bunch length (cm) in the first season only. Treatment of: slow release potassium at 100% gave the highest values of physical and chemical properties of banana plants cv. Williams in both seasons compared to, control treatment (100% potassium sulphate) and slow release potassium at 50% gave the lowest values.

Neck cooling induces blood pressure increase and peripheral vasoconstriction in healthy persons

IntroductionNoninvasive temperature modulation by localized neck cooling might be desirable in the prehospital phase of acute hypoxic brain injuries. While combined head and neck cooling induces significant discomfort, peripheral vasoconstriction, and blood pressure increase, localized neck cooling more selectively targets blood vessels that supply the brain, spares thermal receptors of the face and skull, and might therefore cause less discomfort cardiovascular side effects compared to head- and neck cooling. The purpose of this study is to assess the effects of noninvasive selective neck cooling on cardiovascular parameters and cerebral blood flow velocity (CBFV).MethodsEleven healthy persons (6 women, mean age 42 ± 11 years) underwent 90 min of localized dorsal and frontal neck cooling (EMCOOLS Brain.Pad™) without sedation. Before and after cooling onset, and after every 10 min of cooling, we determined rectal, tympanic, and neck skin temperatures. Before and after cooling onset, after 60- and 90-min cooling, we monitored RR intervals (RRI), systolic, diastolic blood pressures (BPsys, BPdia), laser Doppler skin blood flow (SBF) at the index finger pulp, and CBFV at the proximal middle cerebral artery (MCA). We compared values before and during cooling by analysis of variance for repeated measurements with post hoc analysis (significance: p < 0.05).ResultsNeck skin temperature dropped significantly by 9.2 ± 4.5 °C (minimum after 40 min), while tympanic temperature decreased by only 0.8 ± 0.4 °C (minimum after 50 min), and rectal temperature by only 0.2 ± 0.3 °C (minimum after 60 min of cooling). Index finger SBF decreased (by 83.4 ± 126.0 PU), BPsys and BPdia increased (by 11.2 ± 13.1 mmHg and 8.0 ± 10.1 mmHg), and heart rate slowed significantly while MCA-CBFV remained unchanged during cooling.ConclusionsWhile localized neck cooling prominently lowered neck skin temperature, it had little effect on tympanic temperature but significantly increased BP which may have detrimental effects in patients with acute brain injuries.

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

PurposeFingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required. MethodsWe reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2–3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SPSS version 21). ResultsPartial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6–10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8–10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55). ConclusionThenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

Clinical observation on the distribution characteristics and rules of pressing sensitive acupoints in bronchial asthma patients

To compare the distribution characteristics of pressing sensitive acupoints on the body surface between bronchial asthma (BA) patients and healthy subjects, and to analyze the distribution rules of pressing sensitive acupoints in BA patients. Seventy BA patients and 70 healthy subjects were selected in this study. The pressing sensitive acupoints were checked with finger pulp and marked on human nerve segment graph. The numbers of pressing sensitive acupoints were counted and the positional relationship between distribution of pressing sensitive acupoints and the position of meridians and nerve segment was observed. (1) The incidence rates of pressing sensitive acupoints in BA patients group and healthy subjects group were 91.4% (64/70) and 15.7% (11/70) respectively, and the BA patients group was higher than the healthy subjects group (P<0.01). (2) The top 3 meridians with pressing sensitive acupoints occuring in BA patients were bladder meridian of foot-taiyang, lung meridian of hand-taiyin and large intestine meridian of hand-yangming, and the most frequent pressing sensitive acupoints were Feishu（BL 13）, Xinshu（BL 15）, Chize（LU 5） and Jueyinshu (BL 14). (3) The pressing sensitive acupoints in BA patients were distributed mainly on C4, C6 and T1-T6 nerve segment. Pressing sensitive acupoints have a close correlation with physical condition, and there is a close relation between pressing sensitive acupoints distribution and corresponding meridians and nerve segments in BA patients.