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Abstract
Purpose:
Digits injured by punch press machines show peculiar types with segmental loss of middle part of digits. Although the distal parts of finger survived, thr results is frequently unfavorable with respect to function and appearance after inappropriate reconstruction.
Methods:
From August 2008 to February 2013, five digits injured by punch press machines in four patients were managed. Pinch strength, two-point discrimination and active range of motion were measured to evaluate finger function.
Results:
Three digits with a preserved amputated segment underwent replantation. Partial necrosis occurred in one digit in which local flap was performed. Secondary tendon graft was performed in the other digits. Two digits without segment was reconstructed by arthrodesis after shortening the length. The patients were generally satisfied with function and appearance.
REFERENCES
1. Lee KC, Lee DC, Kim JS, Ki SH, Roh SY, Yang JW. Digital replantation in industrial punch injuries. J Korean Soc Microsurg. 2010; 19:12–20.
2. Cai J, Cao X, Pan J, Hu J. Replantation of a multiple digit and circular palm amputation: a case report. Microsurgery. 1993; 14:221–4.
3. Pei GX, Zhao DS, Xie CP, Wang ST. Replantation of multi-level hand severances. Injury. 1998; 29:357–61.
4. Ozcelik IB, Purisa H, Sezer I, Mersa B, Aydin A. The results of digital replantations at the level of the distal interphalangeal joint and the distal phalanx. Acta Orthop Traumatol Turc. 2006; 40:62–6.
5. Goldner RD, Stevanovic MV, Nunley JA, Urbaniak JR. Digital replantation at the level of the distal interphalangeal joint and the distal phalanx. J Hand Surg Am. 1989; 14:214–20.
6. Huang YC, Liu Y, Chen TH. Use of homodigital reverse island flaps for distal digital reconstruction. J Trauma. 2010; 68:429–33.
7. Zhang X, Shao X, Zhu M, Jiang R, Feng Y, Ren C. Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx. J Hand Surg Eur Vol. 2013; 38:378–85.
8. Saalabian AA, Unglaub F, Horch RE, Kneser U. Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: case report. Arch Orthop Trauma Surg. 2012; 132:137–40.
9. Wang L, Fu J, Li M, Han D, Yang L. Repair of hand defects by transfer of free tissue flaps from toes. Arch Orthop Trauma Surg. 2013; 133:141–6.
10. Walaszek I, Zyluk A. Long term follow-up after finger replantation. J Hand Surg Eur Vol. 2008; 33:59–64.
11. Shooter D. Use of two-point discrimination as a nerve repair assessment tool: preliminary report. ANZ J Surg. 2005; 75:866–8.
12. Lutz BS, Klauke T, Dietrich FE. Late results after microvascular reconstruction of severe crush and avulsion injuries of the upper extremity. J Reconstr Microsurg. 1997; 13:423–9.
13. Blomgren I, Blomqvist G, Ejeskar A, Fogdestam I, Volkman R, Edshage S. Hand function after replantation or revascularization of upper extremity injuries: a follow-up study of 21 cases operated on 1979-1985 in Goteborg. Scand J Plast Reconstr Surg Hand Surg. 1988; 22:93–101.
Fig. 1.
(A, B) A 25-year-old male patient shows segmental amputation on right index and middle finger by punch press machine.
Fig. 2.
(A) Preoperative radiologic finding. (B) Postoperative radiologic finding at 7 months after replantation.
Fig. 4.
(A)Active range of motion is 30° in both finger. (B) Sufficient pinch strength to use a pen.
Fig. 5.
(A, B) A 53-year-old male patient shows segmental amputation on right index finger by punch press machine.
Fig. 6.
(A) Preoperative radiologic finding. (B) Postoperative radiologic finding at 3 months after arthrodesis.
Table 1.
Patient list
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