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Fingertip injury
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Small injuries of the fingertip, especially in children, can be treated conservatively. Shortening of the bone is rarely necessary. Injuries with a surface area of more than 1 cm2 and intact pulp can be closed with a skin graft. Skin grafts of full thickness are preferred to prevent contraction. Preferable donor sites are the amputated part itself, the hypothenar area, and for larger areas in order of preference the groin, medial upper arm and elbow crease.
Proparacaine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A right-handed 45-year-old female ophthalmologist began to suffer itching of the middle fingertip on her left hand. The problem progressed and caused thickening of the periungual skin and onycholysis of the distal nail plate. The fingertip became increasingly erythematous with painful fissuring, crusting and occasional bleeding. The affected finger was used to hold down the lower eyelid whilst applying drops to patients’ eyes. When the ophthalmologist began using her index finger for holding the eyelid down whilst applying eye drops, similar symptoms started to develop on this finger within 7 days. Patch testing showed a positive reaction to proparacaine eye drops 0.5% at days 2 and 4. She changed to using oxybuprocaine eye drops. After that, the skin significantly improved within 2 weeks, although over half a year later the finger remains sensitive and prone to breaking down and the skin at the nail bed remains swollen. There is persistent deformity of the nail (8). It must be mentioned that the topical anesthetic itself was not tested in the patient and no mention was made of any excipients present in the eye drops and whether these were patch tested.
Nail degloving syndrome
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Surgically, crushing injuries of the fingertip may be classified under tip-amputation, volar, dorsal, and circumferential injury.2 The fingertip that has been crushed in closing a door or between two heavy objects may produce nail degloving.3
Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Zhongqing Ji, Rongjun Nie, Shiyan Li, Chuancheng Liu, Bin Wei, Chunyong Zhu
The fingertip is a special anatomical structure. Its main function is to grasp and feel objects. Tactile recognition is a key function of the hand, especially the fingertip. Achieving the best sensory function is the aim of fingertip reconstruction [29,30]. Sensory function can be assessed clinically using the 2PD and SWM tests. Kim and colleagues examined 8 patients with static 2PD, 12 months post-surgery and obtained a mean 2PD result of 5.0 mm [31]. Dağhan Dağdelen and colleagues measured static 2PD at 7 months after repairing fingertip injury, with an average measurement value of 4.5 mm [32]. Comparison of our findings with past reports revealed that the sensory function of the recipient flap in this study was acceptable, although the mean static 2PD and SWM scores in the flap differed significantly from the contralateral side
Treatment of cold intolerance following finger pulp amputations: a case comparison between immediate finger replantation and delayed pulp and digital arterial arch reconstruction with flow-through free hypothenar flap
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Ryohei Ishiura, Makoto Shiraishi, Yoshimoto Okada, Kohei Mitsui, Chihena Hansini Banda, Kanako Danno, Mitsunaga Narushima
The reported incidence of cold intolerance following digital amputation with or without replantation remains high with more than 80% of patients developing symptoms [5–7]. A recent retrospective study of fingertip injuries by van den Berg et al. comparing results of reconstruction, bone-shortening, and conservative therapy revealed no difference in its occurrence rate across these treatment methods [7]. These results highlight the longstanding challenges in understanding the etiology, prevention and treatment of cold intolerance. Notably, these studies were limited by inherent bias in patient allocation to the various treatment methods based on the severity of the injury. This case report of two identical amputations in the same hand presents a unique comparison of long-term development and treatment of cold intolerance in replanted and flow-through flap reconstructed fingers.
Two patients with mixed connective tissue disease complicated by pulmonary arterial hypertension showing contrasting responses to pulmonary vasodilators
Published in Modern Rheumatology Case Reports, 2020
Katsuhide Kusaka, Kazuhisa Nakano, Shigeru Iwata, Satoshi Kubo, Tomoya Nishida, Yoshiya Tanaka
The findings of physical examination were as follows: body height, 150.0 cm; body weight, 39.7 kg; body temperature, 37.0 °C; blood pressure, 103/68 mmHg; pulse, 86 beats/min (regular); SpO2, 90% (room air); Ankyloglossia was detected. Raynaud’s phenomenon, fingertip ulcer, and finger swelling were observed. The second heart sound was intense. There was no abdominal tenderness. No edoema was observed in the lower extremities. There was neither swelling nor tenderness in the joints. The result of a 6-minute walk test was 310 m, and the lowest SpO2 was 75% (room air).