Semmes-Weinstein Monofilament Test Research Articles

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations.

Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

The efficiency of mirror therapy in peripheral nerve injuries.

The purpose of this study was to investigate the effectiveness of mirror therapy on pain, sensory, and functional development in addition to conventional rehabilitation and occupational practices in patients with a peripheral nerve injury in the hand. Twenty-six patients with peripheral nerve injury in the hand were included in this randomized controlled study between November 2017 and May 2018. The patients were randomly assigned to the mirror group (n=14) and the control (n=12) group. Both groups received conventional therapy in our clinic for 45 min a day during weekdays for six consecutive weeks. The mirror group received an additional 10-15 min of visual mirror therapy. Visual Analog Scale (VAS), Duruöz Hand Index, Quick Disabilities of the Arm, Shoulder, and Hand, Jebsen hand function test, and Semmes-Weinstein monofilament test were used for the assessment of pain, hand function, and sensation of the patients at baseline and after treatment. The handgrip strength of the patients was measured with a dynamometer. A total of 20 patients (17 males, 3 females; mean age 31.9±16.5, range 16 to 65 years) completed the study, with 10 in each group. Statistically significant improvement was detected in hand skill functions, such as page-turning (p=0.004), backgammon packing (p=0.023), and heavy object lifting (p=0.029) in the mirror group. A statistically significant decrease was found in total scores of VAS after treatment in both groups (p<0.05). The results imply that mirror therapy integrated with conventional rehabilitation may aid additional benefits on hand functions in peripheral nerve injury. These results demonstrate that mirror therapy can be used in addition to the rehabilitation program of patients with peripheral nerve injury.

Reverse dorsolateral proximal phalangeal island flap: Long-term results

ObjectivesThis study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. MethodsWe examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes–Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. ResultsMild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. ConclusionIn moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. Level of evidenceIV, therapeutic study.

Neurovascular Heterodigital Island Flap for Digital Pulp Defect Reconstruction: 58 Case Series

Aim: Our study aims to report the neurovascular heterodigital island flap reconstruction for finger pulp defects. Patients and Methods: This study included 58 patients presenting to our clinic with pulp defects between 2014 and 2022. The average age of the patients was 26 years (20 - 56 years). Injuries were Allen type 2 for 18 patients, type 3 for 33 patients, and type 4 for 7 patients. Pulp defects were caused by crush injury (n:42) and sharps injury (n:16). Results: None of the flaps administered to the participating patients developed any total loss. Three patients developed partial loss in the distal flap. Six patients were found to have superficial tissue infection. Two patients were found to have hyperpigmentation and hyperesthesia. While one patient with Allen type 3 pulp defect was detected to have 10 degrees of flexion contracture in the distal interphalangeal (DIP) joint and 5 degrees of flexion contracture in the proximal interphalangeal joint, three patients were found to have 5 degrees of flexion contracture only in the DIP joint. The mean static two-point discrimination of the pulp-administered flap was 5.2 mm (3-8 mm) and on the contralateral side was 3 mm. The mean Semmes-Weinstein monofilament test was 3.18 g (2.96 – 4.7 g) in the pulp administered flap and 2.92 g in the contralateral side. Conclusions: Reconstruction of pulp defects with neurovascular heterodigital island flap is a reliable treatment option with satisfactory functional and sensory outcomes.

Causes of Iatrogenic Median Nerve Injury after Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) is a less invasive procedure but has a higher risk of complications. We analysed ECTR cases dividing them into three periods according to a single surgeon's experience when the ECTR was performed: the initial, midterm and late period. Cases of iatrogenically induced median nerve injuries that occurred after ECTR were then noted and evaluated. Methods: We reviewed 195 ECTRs done with the 2-portal technique and divided the patients into three groups according to periods of when ECTR was done. The indications for ECTR surgery were limited to severe CTS cases. These groups of patients were similar in terms of age, duration of disease, electrophysiological study results and severity of the disease. The patients were evaluated for median neuropathy pre- and postoperatively using Semmes-Weinstein monofilament test (SWT), Disabilities of the arm, shoulder and hand (DASH) Score, Coin-flip test (CFT), postoperative paraesthesias and complications, such as pillar pain, and so on. Electrophysiological evaluation was performed only preoperatively. Results: Postoperative median nerve recovery was overall good. Normal recovery was noted in 181 cases (93%). SWT, DASH and CFT were all significantly improved upon follow-up in all three groups. In terms of iatrogenic neuropathy, median nerve palsy worsened (including those transiently worsened) after ECTR in 11 cases (5.6%), even in the later period. The sensory disturbance was equally worsening from the radial to the ulnar side. Conclusions: The fact that there were neurologically worsened cases even in the later period, when the operator is higher skilled in the technique, suggests that the surgical technique itself may be the one posing higher risk than the level of surgical skill. The most likely causes of aggravated nerve palsy were a direct injury by cannula insertion at the proximal portal, or additional median nerve compression during cannula insertion into the carpal tunnel. Level of Evidence: Level IV (Therapeutic).

The Pedicled Sensate Osteocutaneous Groin Flap for Reconstruction of the Forearm and Hand

Background The groin flap is axial pedicled and versatile. Until now, this flap has been used with many modifications for the reconstruction of forearm and hand defects. However, this flap has not been used in forearm, hand, and thumb reconstruction as a pedicled sensate osteocutaneous flap. In this study, a pedicled sensate osteocutaneous groin flap was used for the reconstruction of composite tissue defects on the forearm, hand, and thumb. Patients and Methods A pedicled sensate osteocutaneous groin flap was used to reconstruction composite tissue defects on the forearm, hand, and thumb in 7 patients. The mean age of the patients was 42 years. The defects were located on the dorsal surface of the forearm and hand in 2 patients, the dorsal surface of the hand and finger in 2 patients, and the thumb in 3 patients. The dimensions of the flap skin paddle ranged from 7 × 11 cm to 8 × 23 cm, and the dimensions of the bone component ranged from 1 × 1.5 × 3.5 cm to 1 × 1.5 × 5 cm. The mean follow-up duration was 26 months. Results All the flaps survived. Flap debulking was performed using 3 flaps. Sensory recovery in the flaps was completed approximately 18 months after the first operation. When the results of static 2-point discrimination test and Semmes-Weinstein monofilament test were evaluated at 18 months postoperatively, it showed that protective sensation was obtained. Except for 1 patient, motion restriction did not develop in the wrist, elbow, or shoulder joints. An acceptable aesthetic result, minimal donor site deformity, and protective sensation were obtained in all patients. Conclusions The pedicled sensate osteocutaneous groin flap can be safely used in the reconstruction of forearm and hand composite tissue defects that do not have available vascular structures for free flaps in the recipient area and in thumb reconstruction where toe transfer and pollicization cannot be performed.

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

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

Subclinical finding in the perception of tactile sensation involvement after SARS-CoV2 infection: comparison with healthy controls using Semmes–Weinstein monofilament testing

Subclinical finding in the perception of tactile sensation involvement after SARS-CoV2 infection: comparison with healthy controls using Semmes–Weinstein monofilament testing

Effects of mirror therapy on pain, sensitivity and functionality in patients with unilateral carpal tunnel syndrome. Randomised control trial

Purpose To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS). Material and methods A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2). Results At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores. Conclusions Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects.

Digital skin defect management: Hand and wrist volar flap solutions

BackgroundSelecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management. MethodsPatients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes–Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results. ResultsThe median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively. ConclusionsTo minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12–15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20–25 mm defects on the fingers and thumb, respectively.

Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer: A Randomized Controlled Trial.

To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy. This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy. Participants were randomized to cryocompression on dominant versus non-dominant hand and foot (treatment), with no intervention on the opposite side (control). Compression socks and gloves and ice bags were applied 15 minutes before, during, and 15 minutes after infusion. Primary outcome measures included the PNQ (Patient Neurotoxicity Questionnaire) and the Semmes-Weinstein monofilament test; secondary outcomes included the FACT/GOG-NTX (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity) and patient acceptability and tolerability. Sixty patients completing the study were necessary to detect a 70% reduction in the odds of PNQ grade C or higher peripheral sensory neuropathy with 80% power. Ninety-one patients were enrolled from January 2021 to October 2022; 69 were eligible for final analysis. Of the 91 patients, 64.8% were White, 30.8% were Black, and 1.1% were Hispanic or Latina. With successive cycles, more patients had sensory PNQ grade C or higher neuropathy on the control side compared with the cryocompression side. Cryocompression decreased the odds of sensory neuropathy (PNQ grade C or higher) by 46% at final visit (odds ratio 0.54, 95% CI 0.31-0.94; P =.03). There was no difference in tactile sensitivity based on the monofilament test between sides at the final visit. At the final visit, average FACT/GOG-NTX-11 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 11 Item Version) scores were significantly lower on the cryocompression than the control side (estimate -0.97, 95% CI -1.89 to -0.06; P =.04), as were FACT/GOG-NTX-4 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 4 Item Version) scores (estimate -0.35, 95% CI -0.64 to -0.05; P =.02). More than 85% of patients assessed the intervention as acceptable and tolerable. Cryocompression therapy reduces subjective chemotherapy-induced peripheral sensory neuropathy in patients who are receiving paclitaxel or cisplatin for gynecologic cancer. ClinicalTrials.gov , NCT04563130.

Assessment of sensorimotor and strength related function of breast cancer patients during systemic drug therapy: a prospective observational study

BackgroundChemotherapy is a well-known risk factor for sensorial and motor disturbances. Chemotherapy induced peripheral neuropathy (CIPN) which predominantly affects sensory nerves might cause a diminished fine motor function. This prospective observational study aimed to assess the sensorimotor functions of breast cancer patients before, during, and after chemotherapy.MethodsA total of 56 breast cancer patients were evaluated at three different times as follows: T1 (before chemotherapy), T2 (middle chemotherapy), and T3 (completion of chemotherapy). Motor function was assessed with handgrip strength (HGS), peripheral muscle strength (PMS), and the Minnesota Manual Dexterity Test (MMDT). Semmes Weinstein Monofilament Test (SWMT) was performed to assess the sensory function. Fatigue was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Module Cancer Related Fatigue (EORTC-QLQ-FA12), respectively.ResultsHGS and MMDT were found significant (χ2: 11.279, p = 0.004 and χ2: 9.893, p = 0.007, respectively) whereas PMS was not found significant (F (2,110) = 1.914, p = 0.152). Pairwise comparisons with Bonferroni adjustments revealed that HGS was found significant between T1 and T3, while significant results were obtained between T1 and T2 as well as T2 and T3 in MMDT (p = 0.01 and p = 0.042). There were significant results in some reference points of SWMT, though they were not found after pairwise comparisons with Bonferroni adjustment (p > 0.05). Fatigue was found significantly increased from T1 through T3 (Median: 19.44 vs 27.77, z: -2.347, p = 0.019, Wilcoxon test).ConclusionOur study showed that decreased handgrip strength and fine motor function, as well as increased fatigue, are evident during the chemotherapy. SWMT can be an optional assessment in the context of tracking changes in cutaneous sensation during chemotherapy due to its non-invasive, cheap, and easily repeatable features among cancer patients. To preserve functional capacity as well as independence in daily living, precautions and follow up assessments during the systemic therapy process should be integrated as early as possible to prevent future deteriorations in daily life for patients who undergo chemotherapy.Trial registrationNCT04799080.

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations

BackgroundAntegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. MethodsTwenty patients with a mean age of 37 (18–63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. ResultsAll flaps survived completely at the end of follow-up (mean, 36 months; range 11–64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2–8) and Semmes–Weinstein monofilament test score was 3.48 ± 0.6 (2.44–4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). ConclusionsSince AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. Level of evidenceIV.

The effect of different treatment protocols with diode laser on regeneration in axonetmesis ınjuries of the ınferior alveolar nerve: an animal study.

The inferior alveolar nerve can be damaged during dental procedures, leading to symptoms, such as tingling, numbness, and reduced quality of life. Recovery depends on factors such as medications, surgery, and photobiomodulation therapy. Photobiomodulation therapy has shown the potential to improve nerve function and reduce regeneration time; however, there is no standard treatment protocol yet. This study aimed to examine the effect of diode lasers on nerve regeneration in patients with axonetmesis injuries. In this experiment on animals, Wistar rats' damaged sensory systems were treated with lasers to restore them. Animals were randomly divided into six groups: a sham group, a control group, and four laser treatment groups(1st group: performed every day, 10 sessions; 2nd group: performed every 2 days, 10 sessions; 3rd group: performed every day, 20 sessions; and 4th group: performed every 2 days, 20 sessions). Sensory function was determined using the Semmes-Weinstein monofilament test, which was repeated after the surgical procedure. The results showed that the 20-session group had the best improvement, most closely resembling the group without sensory test damage. The histomorphometric results showed that the number of axons was significantly lower in the group that received 10 daily sessions and in the control group than in the undamaged nerve. Axon diameter was lower in all groups than in the sham group. In conclusion, the remarkable aspect of this study is that consecutive-day 20-session laser treatment showed better improvement than the over-the-day 20-session treatment protocol.

The Fate of Sensation in Noninnervated Perforator Free Flaps in the Lower Extremity.

The recovery of sensation for noninnervated perforator flaps is not well understood. This prospective study aims to evaluate the quality, tendency, and related factors for recovery of sensation. A total of 187 patients over a 6-year period were evaluated at intervals of 3, 6, 12, and +24 months for demographic data and sensory tests [Semmes-Weinstein (SW) monofilament test, static two-point discrimination, temperature, and pain] on peripheral and central regions of the flap. Further detailed assessment using the SW monofilament test was made according to flap thickness, size, type, and recipient sites. Factors correlated to poor recovery were evaluated. Among the flaps tested, the 5.07 SW monofilament test revealed that the peripheral flap sensory recovery was achieved in 72% at +24 months with a significantly increasing linear trend ( P < 0.001). However, the central recovery was noted in only 26% to 28%. The two-point discrimination was achieved in 21% without a significant trend, whereas temperature and pain showed significant improvement, achieving 49% and 64% on the peripheral region and 22% and 31% for the central region, respectively. The flap thickness, size, type, and recipient sites did not exert significance. Only smoking was a significant factor, with 13 times higher odds of hindering sensory recovery. The SW monofilament test, temperature, and pain sensation on the periphery of the flap showed increasing trend of recovery over the +24 months. Among the various factors, only smoking attenuated recovery. Understanding the fate of sensory recovery in noninnervated perforator flaps will allow the surgeons to further customize the reconstruction based on the defect and maximize efficiency. Risk, III.

Sensory and Functional Recovery after Suprafascial Free Flap in Foot and Ankle Reconstruction

Abstract Background The goals of foot and ankle defect reconstruction include weight-bearing and shearing tolerance, good mobilization, regaining protective sensation, and good contour for footwear fitting. This study reports the outcomes of foot and ankle defect reconstruction with suprafascial free flaps relative to sensory and functional recovery. Methods Eleven suprafascial free flaps were performed, which were supra-Scarpa fascial flaps in seven cases. Sensory recovery was assessed by Semmes-Weinstein monofilament test (SWMT), and functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) questionnaire at preoperative and subsequent visits. Results Eleven cases (age range: 21–83 years, seven males, mean body mass index: 24.8 kg/m2) were operated and the mean defect size was 109.8 cm2. The anterolateral thigh, medial sural artery perforator, and superficial circumflex iliac artery perforator flaps were used. The mean flap thickness was 0.8 cm. Average flap harvesting time and operative time were 83.9 and 452.0 minutes. Half of cases achieved 10 g SWMT (two cases regained baseline sensation) by 6-months post-operation, and all cases regained either 10 g SWMT or baseline sensation within 12 months. Significant improvement in the activities of daily living (ADL) and sports subscales was observed at 3 months (p &lt; 0.05). Significant improvement in the global function rating scale for both ADL and sports was achieved by 6 months (p &lt; 0.05). None experienced the recurrent ulcer. Conclusion Suprafascial free flap is a good reconstruction strategy for managing complex foot and ankle defects that yields favorable outcomes including adequate protective sensation and significant functional improvement.

Age-Related Changes in Plantar Sensation and Ankle Proprioception in Adolescents to Older Adults.

Plantar sensation and ankle proprioception occur in a stage-like variance across the life span. However, changes in adolescents, young adults, middle-aged adults, and older adults remain unclear. The aim of this study was to investigate the differences of plantar sensation and ankle proprioception in adolescents to older adults. A total of 212 participants were recruited in the study and were divided into four groups, including adolescents (n = 46), young adults (n = 55), middle-aged adults (n = 47), and older adults (n = 54). Plantar tactile sensitivity/tactile acuity/vibration threshold and ankle movement threshold/joint position sense/force sense were assessed in all groups. The Kruskal-Wallis H test was used to analyze the differences in Semmes-Weinstein monofilaments between different age groups in different plantar positions. One-way analysis of variance was used to determine differences in foot vibration threshold, two-point discrimination, and ankle proprioception between different age groups. Significant differences were found in the Semmes-Weinstein monofilament test (p < .001), the two-point discrimination test (p < .05), and the vibration threshold test (p < .05) in the six tested plantar positions among adolescents, young adults, middle-aged adults, and older adults. For ankle proprioception, significant differences were found in movement thresholds in ankle plantar flexion (p = .01), ankle dorsiflexion (p < .001), ankle inversion (p < .001), and ankle eversion (p < .001), as well as relative absolute errors in the ankle force senses of ankle plantar flexion (p = .02) and ankle dorsiflexion (p = .02) across the four age groups. Plantar sensation and ankle proprioception were sensitive in adolescents and young adults than in middle-aged adults and older adults.

Comparison of Outcomes of Three Different Modalities for Treatment of Acute Fingertip Injuries

The fingertip has a crucial role in providing tactile and sensory functions to the brain. Anatomically, it refers to the region behind the extensor tendons and point of insertion of the flexor digitorum superficialis at the distal phalanx or interphalangeal joint in the case of the thumb. Objective: To compare the outcomes of three different modalities for managing acute fingertip injuries involving healing by secondary intention, primary closure, and local flap coverage. Methods: A randomized control trial was conducted, employing non-probability consecutive sampling. The inclusion criteria consisted of patients aged 20 to 40 years with fingertip injuries and tissue loss categorized as Allen II, III, or IV injuries. Cold intolerance was assessed using the Cold Intolerance Severity Symptom (CISS) questionnaire, which assigns a score ranging from 0 to 100. The sensibility of the injured and uninjured fingers was evaluated using the Semmes-Weinstein monofilament test (SWF). The chi-square test was used to examine relevant relationships. Results: Statistically significant associations were observed between smoking, comorbidities, and treatment modalities (p &lt; 0.001). Among smokers, 81% received Group A treatment, while only 38% of smoking patients were treated with Group B and 69% with Group C. In the Group A treatment, 54.8% of patients were left-handed, 57.1% had Allen III classification, 54.8% had transverse injuries, and only 8% experienced short-term complications (infection). Conclusions: Based on the study findings, no significant differences were identified among the three treatment modalities.

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve.

To illustrate the clinical outcomes of the reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defects. From December 2007 to December 2017, a total of 20 patients with finger pulp defects were treated with reverse digital proper artery island flap for innervated construction. Functional outcomes, aesthetic appearance, and complications were evaluated. Functional outcomes were assessed according to range of motion, sensory grade (S0-S4), static 2-point discrimination, Semmes-Weinstein monofilament test, and Cold Intolerance Severity Score. Aesthetic appearance was evaluated according to the Michigan Hand Outcomes Questionnaire. All flaps survived completely without any complications, and all patients were followed up for at least 12 months. The average static 2-point discrimination, Semmes-Weinstein monofilament, and Cold Intolerance Severity Score results of the injured fingers were 6.35 mm (range, 5-8 mm), 3.64 (range, 2.83-4.17), and 19 (range, 8-24), respectively. All patients achieved recovery in sensation from S3+ to S4. The active ranges of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected fingers were satisfactory. Based on the Michigan Hand Outcomes Questionnaire, 11 patients were strongly satisfied, and 9 were satisfied with the appearance of the injured finger. The reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve is an effective and reliable alternative for the reconstruction of finger pulp defect. In the recovery of sensation, this flap leads to satisfactory effects.

Development and Validation of a Wearable Device to Provide Rich Somatosensory Stimulation for Rehabilitation After Sensorimotor Impairment.

Training sensory discrimination of the skin has the potential to reduce chronic pain due to sensorimotor impairments and increase sensorimotor function. Currently, there is no such device that can systematically provide rich skin stimulation suitable for a training protocol for individuals with amputation or major sensory impairment. This study describes the development and validation of a non-invasive wearable device meant to repeatedly and safely deliver somatosensory stimulations. The development was guided by a structured design control process to ensure the verifiability and validity of the design outcomes. Two sub-systems were designed: 1) a tactile display for touch and vibration sensations, and 2) a set of bands for sliding, pressure, and strain sensations. The device was designed with a versatile structure that allows for its application on different body parts. We designed a device-paired interactive computer program to enable structured sensory training sessions. Validation was performed with 11 individuals with intact limbs whose upper arm tactile sensitivity was measured over 5 training sessions. Tactile discrimination and perception threshold were measured using the standard 2-point discrimination and Semmes-Weinstein monofilament tests, respectively. The results of the monofilament test showed a significant improvement (p = 0.011), but the improvement was not significant for the 2-point discrimination test(p = 0.141). These promising results confirm the potential of the proposed training to increase the sensory acuity in the upper arms of individuals with intact limbs. Further studies will be conducted to determine how to transfer the findings of this work to improve the pain and/or functional rehabilitation in individuals with sensorimotor impairments.