Semmes-Weinstein Test Research Articles

Reconstruction of Allen's type IV fingertip amputation via bilateral unequal-sized hallux osteo-onychocutaneous free flaps: A retrospective study with 5-year follow-up

PurposeThe reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique. MethodsA retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD. ResultsThe mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory. ConclusionBilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.

Comparison of Fibrin Glue With Conventional Suturing in Peripheral Nerve Repairs: A Study of Sensory and Motor Outcomes.

Nerve injuries have traditionally been repaired with sutures, and this method is considered the gold standard technique in the management of nerve injuries. However, fibrin glue has recently become a promising tool for repairing nerve injuries and has advantages including ease of usability, atraumatic application technique, and decreased co-optation time of the nerves. This study aims to clinically evaluate the efficacy of nerve repair with fibrin glue compared with the usual suture technique in terms of sensory and motor outcomes. A total of 80 patients were included in the study; 50 patients underwent primary nerve repair, and 30 patients underwent Oberlin's repair. These subsets were randomly divided into two groups in which the nerves were repaired with microsutures in one group and fibrin glue in the other group. In the comparison of fibrin glue with microsutures, there were no significant differences between the two groups in the 2-point discrimination (2PD) test, Semmes-Weinstein test, motor function, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. However, the co-optation times were significantly shorter with fibrin glue than with microsutures. Based on our findings, nerve repair with fibrin glue is as effective as microsutures in terms of sensory and motor recovery and has added advantages of ease of usability and shorter repair times. Therefore, fibrin glue may be an effective alternative to sutures in nerve repair.

The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory

IntroductionHow to reconstruct the damaged fingertip is a clinical problem. Our team propose the theory of equivalent design and use the mini toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique to reconstruct Allen’s type II fingertip injury. Thus, we perform the retrospective study to evaluate the effects of this technique on fingertip injury.Materials and methodsA retrospective analysis was performed on 56 patients admitted to our hospital from January 2015 to January 2020 who used equivalently designed miniature hallux toenail flaps for the plastic repair of fingertip damage. We recorded the size of the miniature hallux toenail flap, operation time, intraoperative blood loss, and complications and calculated the survival rate of the transplanted miniature hallux toenail flap. During routine follow-up after surgery, we recorded nail growth time and observed finger appearance. At the last time of follow-up, we recorded Semmes-Weinstein evaluating tactile sensation and Two-point discrimination testing (TPD). The efficacy was evaluated by Zook score evaluation.ResultsThe size of the mini hallux toenail flap was 0.71 cm × 1.22 cm to 0.88 cm × 1.71 cm. The operation time was (3.54 ± 0.58) hours, the intraoperative blood loss was (20.66 ± 4.87) ml, and the survival rate of mini hallux toenail flaps was 100%. The postoperative follow-up time was (30.82 ± 11.21) months, and the total nail growth time was (9.68 ± 2.11) months. The average tactile sensation evaluated by the Semmes-Weinstein test was (0.32 ± 0.14) g, and the average TPD was (7.33 ± 1.02) mm. According to Zook score, the curative effect of fifty-six cases were all excellent or good with 100% excellent and good rate, and all patients had beautiful appearances and good function of damaged fingertips.ConclusionsBased on the equivalent design theory, the mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique is an effective method to reconstruct Allen’s type II fingertip injury with a beautiful appearance and good function.Type of study/level of evidenceTherapeutic IV.

STUDY OF FINGERTIP RECONSTRUCTION USING CROSS FINGER FLAP AND FTG

Objectives: Fingertip injuries are frequent and there are many techniques used for reconstruction fingertip injuries. The authors reviewed the outcomes of fingertip reconstruction, including sensation and shape, using the combined technique of the cross-finger flap and full thickness skin graft and defined the optimal dimensions of fingertip defect that is applicable to this technique. Between 2019 and 2021, 40 cases, aged 3-60 years (mean, 28.1 years), who hadMethods: undergone fingertip reconstruction using a combination of the cross-finger flap and full thickness skin graft were reviewed. The presence of fingertip and nail deformity and the results of the Semmes-Weinstein (S-W) monofilament and static two-point discrimination tests were analyzed. Fingertip deformities were noted in 12 cases whereResults: the defect was more than 50% of the Tamai zone I or extended to zone II. Mild nail plate deformity was found in 12 cases with more than 40% of the nail bed defect. 8 out of these 12 cases presented with partial phalangeal tuft defects. 32 fingers were examined using the Semmes-Weinstein test, and their scores were between 2.83 and 4.31 in 20 fingers and 4.56 in 12 fingers. 24 were examined for static two-point discrimination, with 5 mm in 12, 6 mm in 4, and 10 mm in 2. The color and contour of all donor fingers were almost typical. The combination of the cross-finger flap andConclusions: full-thickness full thickness skin graft is applicable to around 50% of fingertip defect within the Tamai zone I, achieving a satisfactory shape and regaining more than protective sensation.

Lateral Nasal Artery Perforator Flap for Nasal Reconstruction: Clinical Applications and Risk Factors Associated With Nasal Deformities.

Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities. Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test. Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients. Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.

Influence of intermittent pneumatic compression on foot sensation and balance control in chemotherapy-induced peripheral neuropathy patients

BackgroundChemotherapy-induced peripheral neuropathy, a side effect of cancer treatment, presents several issues to patients, including reduced sensation and increased fall risk. Previously, massage therapy has been shown to improve chemotherapy-induced peripheral neuropathy symptoms, possibly through increased blood flow. A custom built intermittent pneumatic compression device, previously shown to increase lower leg blood flow, was tested as a plausible treatment modality. MethodsSeven cancer survivors suffering from chemotherapy-induced peripheral neuropathy were recruited. Foot sensation (Semmes-Weinstein test) as well as static (dual and tandem stance) and dynamic (timed-up-and-go) balance control tests were performed both pre and post a 5-min intermittent pneumatic compression intervention. Self-reported feedback was provided by participants following testing and 24-h later. FindingsFive participants reported positive changes in their feet immediately following intermittent pneumatic compression treatment while four of those participants reported positive changes up to 24 h after intervention. Foot sensation was unchanged regardless of location tested (P ≥ 0.23). Postural sway path length and sway area were unchanged following intervention during dual stance (P ≥ 0.14), but path length was significantly reduced (~19.9%) following intervention during tandem stance (P = 0.033). Timed-up-and-go duration was also significantly reduced (~7.0%, P = 0.012). InterpretationOverall, these findings demonstrate that intermittent pneumatic compression may be a plausible treatment modality for improving self-reported foot sensation as well as static and dynamic balance control. As a pilot study, this study provides sufficient context for further research exploring the efficacy of intermittent pneumatic compression as a treatment using a randomized control trial design.

Utility of "reposition-flap" in the reconstruction of the avulsed thumb.

Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to “sacrifice” another anatomical region for thumb reconstruction, the “reposition-flap” technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using “reposition-flap” with an O’Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

Comparative outcome analysis of osseointegrated reconstruction and replantation for digital amputations.

The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients.Level of evidence: IV.

Peripheral blood levels of CXCL10 are a useful marker for diabetic polyneuropathy in subjects with type 2 diabetes.

Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus associated with high morbidity and mortality. Major risk factors for DPN include metabolic changes, duration of diabetes, nerve ischaemia and derangements in regeneration and nerve repair programmes. Chemokines have been previously implicated in the pathogenesis of various neuropathies and neuropathic pain processes. The aim of this pilot study was to evaluate the association between the plasma levels of chemokines (CXCL9, CXCL10 and CXCL11) in the presence of DPN in a cohort of type 2 diabetes (T2D) patients. We studied 73 patients with T2D: 36 with DPN and 37 without DPN. DPN was established through the Semmes-Weinstein test (SW). Plasma levels of circulating chemokines CXCL9, CXCL10 and CXCL11 were determined using DuoSet ELISA kits (Abingdon, UK). We found that levels of CXCL10 were significantly higher in patients with DPN than amongst patients without DPN (57.6±38.3 vs 38.1±33.4pg/mL, respectively; P=.034). Serum levels of chemokine CXCL9 were also higher amongst patients with DPN but did not reach a statistical significance (188.1±72.7 and 150.4±83.6pg/mL, respectively, P=.06). Increased circulating levels of CXCL10 were associated with DPN in T2D patients, suggesting a role of this chemokine in the DPN. Determination of CXCL10 levels could be used as a marker for the early detection and implementation of therapeutic strategies in order to reverse and prevent the DPN.

Reconstruction of the weight-bearing heel with nonsensate reverse sural artery flaps

BackgroundThe reverse sural artery flap (RSAF) is widely used to reconstruct foot and ankle defects. Although it is commonly used in a nonsensate type, there has been controversy as to whether it provides sufficient stability and durability when applied to weight-bearing heels. The aim of this study was to evaluate patient outcomes after weight-bearing heel coverage using a nonsensate RSAF. MethodsTwenty-three patients who underwent reconstruction surgery of the weight-bearing heel with RSAF from 2004 to 2018 in a tertiary hospital were retrospectively reviewed. All surgeries were performed without a sensate procedure. The patients’ experience of pressure sore on the flap area and the ability to use normal footwear were investigated. Light touch, Semmes-Weinstein test (SWT), and two-point discrimination tests were assessed, along with postoperative wound complications. ResultsHeel damage etiologies included malignant tumors in 14 (61%), trauma-related in 7 (30%) and diabetic ulcers in 2 (9%) patients. Patient mean age was 58 years (range, 18–93 years) and the mean follow-up period was 57 months (range, 12–185 months). The mean size of the flap was 64.1 cm2 (range, 20–169 cm2). All flaps healed without major complications. All returned to daily living activities and 20 (86%) patients were able to use normal footwear. Of the 11 patients who had available measurement records, 8 (73%) showed a light touch sense. The mean SWT value was 4.31 (range, 3.61– 4.56). Two-point discrimination was not observed in any of the patients. Two patients had experienced superficial ulcers on the flap within a one-year postoperative period, which spontaneously healed and did not recur. No full-thickness ulcers were observed during the follow-up period. ConclusionsThe results of this study suggest that patients who underwent nonsensate RSAF for the reconstruction of the heel could expect to maintain the property for stable weight-bearing without pressure sore.

Comparative assessment of fingertip replantation in paediatric and adult patients within a single institution.

The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes-Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3months) as compared with adult patients (4.1months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable.Level of evidence: IV.

Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction.

BackgroundLittle is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation.MethodsThirteen consecutive patients with a median age of 55 years (range, 21–70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed.ResultsAll flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10–51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C).ConclusionsFiner sensation could be partially restored. However, thermal sensation remained poor.

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Purpose: Plantar wounds represent a frequent practice of the plastic and reconstructive surgeon. The uniqueness and high complexity of the microarchitecture and biomechanics of the plantar region explain the complex challenge of its reconstruction. With the advances in microsurgery, including the plantar subunit principle, both applied in the restoration of plantar defects through the use of sensorineural free flaps have allowed an optimal reconstruction.Methods: A descriptive, retrospective study was carried out in a period of time established between January 2016 and January 2019, obtaining a total of 18 patients with plantar defects, reconstructed using sensory free flaps. Tissue stability, recovery of protective sensitivity, early ambulation, and correct use of footwear were evaluated.Results: The most frequent etiology was secondary to oncological resections due to melanoma (n = 12, 66.7%), followed by gunshot wounds (n = 4, 22.2%). Subunit 3 was the most frequently involved in 38.9% (n = 7). In the 88.8% of the cases, was used an anterolateral thigh flap (n = 16) and the lateral antebrachial flap in 22.2% (n = 2). The free flap survival rate was 100%. An average of seven points was obtained at 6 months based on the Semmes-Weinstein test. The mean for the return to their daily activities was 2.5 months. The patients of 94.4% (n = 17) recovered ambulation and could footwear. Conclusion: The reconstruction of plantar defects must have a systematic approached, taking the subunit principle as a central point. The treatment of plantar defects with sensorineural free flaps represent an unprecedented option for optimal reconstruction.

Abdominoplasty with Scarpa Fascia Preservation: Randomized Controlled Trial with Assessment of Scar Quality and Cutaneous Sensibility.

Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. Therapeutic, II.

The relationship between neurosensory disturbance of the inferior alveolar nerve and the lingual split pattern after sagittal split osteotomy

The aim of this study was to evaluate the relationship between neurosensory disturbance (NSD) and the different types of bilateral sagittal split osteotomy (BSSO) lingual fracture created. The study group consisted of 45 patients with mandibular deformities (90 sides; 14 males and 31 females). Computed tomography (CT) scans were obtained preoperatively and 1 week postoperatively. All patients were divided into lingual fracture line groups on the basis of their postoperative scans. NSD was tested preoperatively and 1, 3, and 12 months postoperatively by using a sensory touch Semmes-Weinstein (SW) test and the 2-point discrimination (TPD) test. Patients were divided into 2 groups on the basis of their lingual fracture lines after mandibular BSSO; among the 45 patients, 39 sides (43.3%) had short-splits, and 51 sides (56.7%) had long-splits. The short-split group was less affected at all tested times, and the difference between the 2 groups was significant 1 month postoperatively on TPD test but not at other times on the both tests. The split type did not affect the NSD incidence at 3 and 12 months postoperatively.

Fingertip Replantation Using Artery-Only Anastomosis With a Pulp Tissue Reduction Method: A Combination of Pulp Tissue Reduction, Bone Fixation Without Gaps, and Pinprick Testing Twice a Day.

In fingertip replantation with arterial anastomosis alone, many external bleeding techniques have been described to satisfy venous outflow, and some patients require blood transfusions. We used a pulp tissue reduction method to avoid the need for external bleeding techniques and blood transfusions. We examined 18 fingers in cases of Ishikawa's subzone II, III, and IV amputation that were replanted with artery-only anastomosis and pulp tissue reduction from April 2003 to March 2018. The method consisted of pulp tissue reduction to the level of the fingerprint core, bone fixation without gaps to promote venous drainage through bone marrow, and pinprick testing twice a day. Prostaglandin E1 and/or urokinase were administered intravenously, but no other anticoagulants were used systemically or locally. Postoperatively, only the pinprick test was performed twice a day for 5 days. The patients ranged in age from 26 to 74 years (mean, 47 years). There were 13 men and 5 women. The total success rate was 89% (16/18). Of the 2 salvage failures, one was due to venous congestion and the other was due to arterial insufficiency. The survival rates of Ishikawa's subzone II, III, and IV amputation were 100% (4/4), 71% (5/7), and 100% (7/7), respectively. No blood transfusions were required in any of the cases. The Semmes-Weinstein test was performed for 14 of 18 fingers: the result was blue in 11 fingers and purple in 3 fingers. The pulp tissue reduction method resulted in a high success rate without the need for external bleeding or blood transfusions. Fingertip replantation with artery-only anastomosis, a pulp tissue reduction method, is effective for replant survival when subcutaneous venous repair is impossible because a reduced pulp volume may facilitate replant survival under conditions of irregular venous drainage, such as bone marrow drainage.

Clinical outcome and ultrasonographic evaluation of treatment using polyglycolic acid-collagen tube for chronic neuropathic pain after peripheral nerve injury

BackgroundA novel polyglycolic acid (PGA)-collagen tube has been available in Japan since March 2013, and the development of high-resolution ultrasonography has recently allowed detailed evaluation of nerves. The purpose of this study was to report the clinical outcomes and evaluations of in-vivo changes under high-resolution ultrasonography for treatment using PGA-collagen tube for painful chronic nerve injury. MethodsFour patients underwent surgical management of peripheral nerve neuroma, with nerve defects after neuroma resection reconstructed using PGA-collagen tube. Mean duration of follow-up was 30 months. Patients were surveyed to determine visual analog scale scores for pain before surgery and at final follow-up. At final follow-up, sensory function was evaluated using the Semmes–Weinstein test, static 2-point discrimination (2PD), and moving 2PD. Furthermore, we performed ultrasonography for all patients every 1 month after surgery. ResultsIn all cases, resting pain, radicular pain, and dysesthesia were improved immediately after the operation and remained improved until the last follow-up. At the time of final follow-up, the Semmes–Weinstein test was red in 2 cases and blue in 2 cases. Mean static 2PD was 15.5 ± 5.3 mm and mean moving 2PD was 11.5 ± 5.3 mm. Ultrasonography revealed that the PGA outer wall had disappeared by 3 months postoperatively, and a hypoechoic linear shadow bridged the proximal and distal stumps. Swelling of the junction between nerve and nerve conduits was revealed at 4 months after surgery and remained until last follow-up. ConclusionsAll patients were very satisfied with pain relief, but recovery of sensory function was insufficient. Ultrasonographic evaluation after using PGA-collagen tube for painful chronic peripheral nerve injury was useful for observing in-vivo changes. Type of study/level of evidenceTherapeutic IV.

Tamai Zone 1 Fingertip Amputation: Reconstruction Using a Digital Artery Flap Compared With Microsurgical Replantation

The surgical treatment of fingertip amputations is controversial. This study was designed to compare the clinical results of 2 surgical procedures for fingertip amputation: reconstruction with a digital artery flap and microsurgical replantation. Between 2003 and 2015, 37 patients with Tamai zone 1 fingertip amputation of the index or middle finger were treated by reconstruction with a digital artery flap (n= 23) or microsurgical replantation (n= 14). Data for these patients were evaluated retrospectively. Nerve suture was not conducted in microsurgical replantation because spontaneous sensory recovery is expected in zone 1 replantation. Primary outcomes included hand dexterity (Purdue Pegboard Test), and disability of the upper extremity (Disabilities of the Arm, Shoulder, and Hand score). Secondary outcomes included strength (key pinch), digital sensitivity (Semmes-Weinstein test), and finger mobility (% total active motion). The average follow-up period was 34 months. There was no significant difference in the primary outcomes between the 2 groups. The reconstruction group showed significantly better results for the secondary outcomes. This study suggests that the 2 procedures were comparable regarding postoperative activities of daily living and hand performance, but reconstruction using a digital artery flap gave better objective functional outcomes than microsurgical replantation. Therapeutic IV.

Sensibilité de l’hémipulpe radiale de l’index — étude des tests de Semmes-Weinstein versus Cochet-Bonnet chez 25 sujets sains

In the presence of a wound to the palm, several methods of evaluation of the cutaneous sensitivity were proposed to search for sensory deficits. Some authors have shown that the sensitivity and specificity of any other test do not reach 100%. Most authors consider that any hand wound in the vicinity of a nerve path must be surgically explored. The purpose of this work was to verify whether the Cochet-Bonnet corneal sensitivity test had a lower cutaneous pulp sensitivity threshold than the Semmes-Weinstein monofilament test. The series included 25 healthy adult subjects. The average age was 30 years old. All were right-handed except one left-handed. None had a history of a medical or surgical pathology of upper limbs. The protocol consisted of evaluating the tactile cutaneous sensitivity threshold of the radial collateral hemi-pulp of the index finger by an independent observer using two tests, the Semmes-Weinstein esthesiometer and the Cochet-Bonnet. The Semmes-Weinstein test consisted of determining the finest monofilament perceived from a kit of 20 calibrated monofilaments from 0.0045 to 447.0 g. The monofilaments were applied one after the other perpendicularly to the hemi-pulp so that the wire bends slightly for 1.5 seconds. The Cochet-Bonnet test consisted of determining the longest perceived monofilament from a 12-length calibrated pen from 0.006 to 0.618 g. The monofilament was applied perpendicularly to the hemi-pulp so that the thread bent slightly for 1.5 seconds. The sensitivity threshold of the radial hemi-pulp of the index was lower with the CB test than with the SW test. The average cutaneous sensitivity threshold of the hemi-pulps of our series was 0.0388 g, which corresponds to the threshold of 0.035 g before 35 years found in the literature. Our results show that in healthy subjects, the threshold of sensitivity of the radial hemi-pulp of the index is lower with the Cochet-Bonnet monofilament test than with the Semmes-Weinstein monofilament test. The material needed to carry out the Cochet-Bonnet monofilament test is cheaper (424 €) and less cumbersome (1 monofilament) than that required for the Semmes-Weinstein monofilament test, which costs more (901 €) and is bulkier (20 monofilaments). It remains to test the sensitivity and specificity of the CB test on wounds of the palm to check the absence of nerve damage.

Predictors of Hand Dexterity after Single-Digit Replantation.

Microsurgical replantation of the thumb and digits has become an increasingly familiar technique in clinical practice worldwide. However, successful digit replantation does not always provide better hand function than revision amputation. Little information is available regarding predictors of motor skill activities of replanted hands. Therefore, we retrospectively evaluated hand dexterity after single-digit replantation at a minimum follow-up of 1 year and analyzed the factors influencing dexterity. This retrospective cohort study included 23 patients treated for amputation injuries at our institution from 2014 to 2015. Patients with amputations from Tamai's zone 2 to 5 of the thumb (3 patients), index finger (11 patients), or middle finger (9 patients) who underwent digital replantation surgery and were followed up for more than 1 year were included. Follow-up evaluations were conducted at an average of 23 months postoperatively (range: 13-25 months). We hypothesized that possible factors influencing hand dexterity after single-digit replantation were patient age, injured finger, key pinch strength, Semmes-Weinstein test result, and percentage of total active motion. Relationships between the outcome variable, which was the result of the Purdue Pegboard Test of hand dexterity, and explanatory variables were analyzed using Spearman's correlation coefficient. A p-value of < 0.05 indicated statistical significance. No postoperative complications occurred. Univariate analysis indicated that decreased hand dexterity after single-digit replantation was significantly associated with older age (p = 0.001) and poor recovery of sensation, as shown by the Semmes-Weinstein test (p = 0.012). Patient age was a risk factor for low hand dexterity after replantation surgery. Recovery of finger sensitivity enhanced dexterity of motor skill activities following finger replantation surgery.