Ring finger transfer in reconstruction of transmetacarpal amputations

Four cases are described in which the opposite ring finger was used for finger reconstruction in transmetacarpal hand amputations. Thumb reconstruction was required in three of these four cases. This was achieved by hallux transfer, tube pedicle combined with an innervated first foot web neurovascular free flap, and second toe transfer respectively. In the fourth case, where a thumb was not required, double finger reconstruction was performed by the use of a second toe combined with a ring finger. This case highlights the limitations of the second toe for finger reconstruction, particularly in achieving palmar-digital grip. The advantages of the ring finger are length and mobility, especially sophisticated intrinsic muscle movement, sensory capacity, strength, wider span, and esthetic excellence.     

The Y-V-I principle for salvaging distal digit replantation

The replantation and revascularization of a distal finger following a crush injury or avulsion are difficult because of the shortness of the vessels after debridement. The success rate of the anastomoses may decrease when they are under tension. To address this, many maneuvers have been described, such as shortening the amputated part or proximal finger stump for tensionless closing, interposing a vein graft between the vessel ends, and vessel transfer from a neighboring finger. Regardless of which of these techniques is chosen, it is an additional drawback for the already traumatized hand or amputation stump. Y-V-I pedicle lengthening is a method for providing extra pedicle length. This article presents a pediatric patient with a traumatic partial amputation at the fourth distal interphalangeal joint in whom the finger was salvaged by achieving anastomoses using the Y-V-I pedicle-lengthening principle.     

Injuries to children's hands caused by the engine belts of agricultural machines: classification and treatment

Injuries to children's hands with farm machinery, particularly tractors, are common in rural areas. We present 58 cases of hand injuries in children aged from 3 to 7 (mean 4.5), caused by the engine belts of agricultural vehicles, who were referred from the cities in Central Anatolia. The injury patterns among patients were similar. The injury generally starts from the middle phalanx of the third finger, crosses the proximal phalanx of the fourth finger and ends in the hypothenar region. The patients were categorised into five groups and treatment planned accordingly. The most commonly involved digit was the third finger and the thumb the least. Surgical treatment depended on the severity of the injury and included primary closure of the lacerations, tendon repair, fixation of fractures, grafting, and local flaps. Results of these injuries are generally poor, so prevention is more important.     

Late arteriovenous fistula after finger replantation

The occurrence of arteriovenous fistula (AV) after finger replantation is a very rare complication. Since the first replantation performed in the Czech Republic in 1979, there has been one such case. A four-finger replantation was done for an injury on the right dominant hand on a 29-year-old patient. After 6 months, an arteriovenous fistula developed on the fourth finger. The other fingers were not affected. Following examination by digital subtraction angiography, selective ligature of the common digital artery for the fourth interdigital space was performed. Catheterization and embolization methods were not used. After detailed analysis of the factors which may have caused this complication, the following preventative and therapeutic approach is proposed. It is necessary to avoid tissue damage caused by cold. The advisable rate should be at least 1:1 between venous drainage of the finger in the area of the basic phalanx and the arterial supplementation. It would be better, however, to have the ratio at 2:1 or more. In case of the AV fistula formation before radical intervention, selective ligation of an artery causing vascular dilatation is advantageous.     

Congenital absence of the fourth metacarpal bone (congenital dysplasia of the ring finger)

Review of the related literature shows no reports of congenital absence of the fourth metacarpal or congenital dysplasia of the ring finger. I describe the clinical features, hand pattern profiles, and dermatogyphics of three patients with displastic floating ring finger. The surgical treatment is outlined.     

Glomus tumor and neovascular syndrome of the arm: a clinical case

Glomus tumour represents a benign tumor which originates from myoepithelial cells of arteriovenous anastomosis that has a preference for subungual localization with painful and multiform symptomatology. A fifty-year-old female presented a vasospastic symptom with hyperalgesia and cold hypersensitivity in the fourth finger of the right hand. There was a little palpable tumefaction and after an echography, we decided for surgical revision. Differential diagnosis with Raynaud's phenomenon is very important but not simple. The diagnosis is often late. MRI and angio-MR with its typical symptomatology could give the accurate diagnosis. The therapy is only surgical. The excision must be very careful making sure to spare the nervous structures.     

Can second to fourth finger ratio play a role in determining the risk of benign prostatic enlargement

Benign prostatic enlargement (BPE) is a disease that testosterone plays a role in its aetiology. Second to fourth finger ratio is a marker of prenatal androgenic exposure and may be a risk factor for several androgen-related diseases such as BPE. In this study, we investigated the relationship between the second to fourth finger ratio and BPE. A total of 63 patients with BPE were included for study group, and age-matched 63 healthy patients were included as a control group. Finger was measured by the distance from the proximal crease to the tip by using a digital caliper. The mean age of patients with BPE and non-BPE was 62 ± 8.9 and 61.5 ± 7.1 years respectively. There was statistically significant difference between groups in terms of prostate-specific antigen levels, prostate volumes and international prostate symptom scores. The mean finger ratios for right and left hand were 0.97 ± 0.03, 0.99 ± 0.03(p = .001) and 0.93 ± 0.15, 0.98 ± 0.03(p < .001) for BPE and non-BPE groups respectively. Men with a lower second to fourth finger ratio have higher risk of developing BPE than men without BPE. Therefore, the second to fourth finger ratio, which is indicative of prenatal androgen exposure, can be used as a marker of BPE risk.     

Melorheostosis of upper limb: A report of four rare cases

Melorheostosis is a rare chronic bone disease, etiology of which remains unclear. It mostly affects lower limbs and clinical features vary in each case. Radiographs show characteristic "candle wax pattern" of hyperostosis. Herein we report four cases of upper limb affection with their symptoms, radiographic findings and treatment. First case presented with gradually progressive swelling in forearm which was initially misdiagnosed as filariasis. Plain radiograph eventually demonstrated melorheostosis of ulna. Second patient had deformity of index finger and pain in hand which was diagnosed on radiograph of hand. Third case presented with progressive flexion deformity of ring and little finger. Fourth patient had ulnar involvement which was an incidental diagnosis. First three patients were managed with bisphosphonates following which there was significant improvement in pain and fourth case was kept on follow-up as he was asymptomatic.     

Massive lipoma of the palm

Although lipomas of the hand are frequently encountered, a massive tumor involving one-half of the palm and extending into the fourth finger has been reported only once before. The case history of a 45-year-old male who underwent surgical removal of such a massive palmar lipoma is presented. Lipomas of the hand are discussed and the literature summarized. Details of the surgical evaluation and management of a massive lipoma of the hand are presented to assist other surgeons in handling similar cases.     

Syndactyly correction of the hand in Apert syndrome.

Surgical correction of syndactyly of the Apert hand should begin by 6 months and be completed by 3 years of age. As much surgery as possible is carried out at each sitting. Digit separation should be in order of functional importance. The first web space is deepened with a four-flap Z-plasty or a dorsal skin flap from the web and index finger. Syndactyly release using a dorsal flap and zig-zag technique is used to create the second and fourth web spaces. The complex long-ring syndactyly often requires a pedicled groin flap for reconstruction and preservation of growth potential. A five-digit hand can be achieved with adequate grasp and stable, sensate, well-aligned digits. These children can attain some degree of independent finger motion and aesthetically acceptable hands with this approach.     

A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase

PURPOSE: To examine prospectively the incidence of digital infarction and phentolamine rescue in a large series of patients in whom local anesthesia with adrenaline was injected electively into the hand and fingers. There continues to be a commonly held belief that epinephrine injection is contraindicated in the finger despite a lack of valid evidence to support this concept in the literature. METHODS: From 2002 to 2004 there were 9 hand surgeons in 6 cities who prospectively recorded each consecutive case of elective hand and finger epinephrine injection. They recorded each instance of skin or tissue loss and the number of times phentolamine reversal of adrenaline vasoconstriction was required. RESULTS: There were 3,110 consecutive cases of elective injection of low-dose epinephrine (1:100,000 or less) in the hand and fingers and none produced any instance of digital tissue loss. Phentolamine was not required to reverse the vasoconstriction in any patients. CONCLUSIONS: The true incidence of finger infarction in elective low-dose epinephrine injection into the hand and finger is likely to be remote, particularly with the possible rescue with phentolamine.     

Anatomy of the radial branches of the palmar arch. Variations and surgical importance

In this study, the authors present the results of the investigation of arteries that replace digital collaterals of the radial side of the hand when the superficial palmar arch (SPA) does not develop completely. The replacement occurs with the first interosseous dorsal and the first interosseous palmar arteries. The former takes place through the middle developed branch that issues the radial collateral of the thumb and the ulnar collateral of the little finger whereas the latter takes place in three cases: a) presence of a branch entering into the retroadductor space and finishing like the previously mentioned; b) the origin of the trunk of the ulnar collateral of the thumb finger and the radial collateral of the index finger; c) due to the origin of both collaterals of the thumb finger. In cases when the SPA does not issue the fourth palmar collateral, this one is replaced by the second palmar interosseous artery, a branch of the deep palmar arch. These three arteries are combined to form three different basic kinds of arterial replacement that are described, adding a fourth group of exceptions that does not fit into any of the categories mentioned previously.     

Anomalous hands with cleft formation between the fourth and fifth digits

Three similar cases of cleft hand deformities between the fourth and fifth digits accompanied by hypoplasia of the small finger are reported. After analyses of clinical photographs, radiographs, angiograms, and dermatoglyphic prints of these abnormal hands, it is difficult to fit them into either the ulnar ray deficiency or cleft hand categories of the system of classification adopted by the International Federation of Societies for Surgery of the Hand.     

Multiple closed avulsions of flexor tendons of the hand caused by a firecracker blast

Closed avulsion, in the absence of pathology, of both flexor digitorum profundus and superficialis tendons from the same finger is uncommon. We report a multiple closed avulsion of long fingers flexor tendons, associated with pulleys rupture in the left hand of a healthy, 16-year-old boy. The lesion was caused by a firecracker blast which the patient had tried to hide. No injuries were found in the volar or dorsal areas of the hand. All affected flexor tendons were reinserted; in addition, second and third digits fourth annular pulleys were resutured to prevent posterior bowstringing. At present, the patient has completely recovered his range of motion and has obtained his driver license.     

组织瓣联合移植急诊修复手部严重组织缺损

目的：介绍采用组织瓣联合移植急诊修复手部组织严重缺损的方法。方法：修复20例手部严重外伤的组织搭配;（1）股前外侧皮瓣和带足趾（单侧或双侧）;Mu甲瓣的足痛皮瓣组合移植,修复全手皮肤撕脱伤5例。（2）双侧第二足趾及Mu甲瓣游离移植再造拇指,示,中指或示,中环指9例。（3）股前外侧皮瓣组合其它皮瓣修复手部及手指皮肤缺损6例。结果：20例43块移植组织瓣全部成活,再造手指及手功能恢复良好。结论：组织瓣联合移植急诊修复再赞赏手,是治疗手部组织严重缺损的理想方法。     

The clinical impact of the presence or absence of the fifth finger flexor digitorum superficialis on grip strength.

Previous studies have determined abnormalities in the fifth small finger flexor digitorum superficialis (FDS) tendons as interconnected (common) to the fourth finger (FDS) or absent. This study examined the effect of FDS-absent and FDS-common presentations of the fifth finger on grip strength in a mixed-gender group of rehabilitation science students and faculty members from the Medical University of South Carolina. This study evaluated 171 subjects. After controlling for gender, age, and hand dominance, the grip strength of subjects in the FDS-absent group was 6.9 lb weaker than the FDS-common group and 8.14 lb weaker than the FDS-independent group. The common group was 1.2 lb weaker than the normal group. Absence of the FDS occurred in 18.6% of female subjects and 15.3% of male subjects. Our findings suggest that hand therapists should expect lower results when measuring grip strength of FDS-absent or FDS-common individuals.     

Leiomyoma of the hand: a case report

We report a case of leiomyoma of the finger in the right hand of a 12-year-old boy: a rare site for localization and unusual for age. This is a benign tumor originating from non-striated muscle that is very uncommon in the hand. The uterus is considered the most common location for leiomyoma and when it occurs in the extremities, it is more common in the leg, ankle and foot. It usually occurs in the third and fourth decades of life and it is rarely diagnosed before surgery as the diagnosis can only be confirmed histologically.     

Prevalence of the palmaris longus muscle and its relationship with grip and pinch strength: a study in a Turkish pediatric population

Clinical studies generally reveal a trend of variation in the reported prevalence of the palmaris longus (PL) muscle absence. The aim of this study was to find an answer to the question of whether the congenital absence of tendon would affect hand functions or not. A total of 585 subjects, comprised of 305 males and 280 females, were included in our study. Mean age was 8.9?±?1.4 standard deviation within a range of 6–11. For both sexes, the groups were divided further into three subgroups including 6–7, 8–9, and 10–11 years of age ranges. The grip strength of each hand and pinch strength of all fingers of each subject were measured separately. The absence of PL tendon in the right hand was 35.4 % in females, 25.9 % in males, and 30.4 % in overall average. The distribution of absence of the palmaris longus muscle between both genders was statistically significant. The p value for the right hand was 0.013. The absence of PL tendon in the left hand was 37.5 % in females, 27.9 % in males, and an overall average of 32.5 %. The p value for the left hand was 0.017. In terms of grip strength, a comparison between females and males did not reveal a significant difference. The pinch strength of the second fingers of both hands did not show any difference in both sexes. Pinch strength of the third finger of the right hand was different only in girls of subgroup 6–7 ages (p?=?0.024). In girls, the pinch strength of the fourth finger of the right hand of subgroups 6–7 and 10–11 ages showed difference (p?=?0.009 and p?=?0.026, respectively). In boys, the fourth finger in subgroup of 8–9 ages showed significant difference in both hands (p?=?0.011). The fifth fingers of both hands were found different in males for only subgroup of 8–9 ages (p?=?0.001). Pinch strength of the fifth finger of the right hand was different in females for only subgroups of 6–7 and 10–11 ages (p?=?0.023 and p?=?0.047, respectively). While grip strength of the hand was not affected in the case of absence of the palmaris longus, in both sexes, pinch strength of the fourth and fifth fingers of both hands decreased.     

Lumbrical tears in rock climbers

Performance rock climbing places high demands on the hand and may lead to specific injuries. In a "one-finger-pocket" hold, the interphalangeal joints remain in 20-40 degrees flexion. To increase the maximum force of the holding finger by the quadriga effect, the interphalangeal joints of the adjacent fingers become almost maximally flexed. Holding a "one-finger-pocket" with the ring or small finger leads to a shift of the deep flexor tendons which increases the distance between the two adjacent origins of either the third or the fourth lumbrical. This may cause disruption and tear of that muscle. An organized haematoma in the third lumbrical was visible by ultrasonography in one of the three cases described.     

A rare vasoproliferative lesion: angiolymphoid hyperplasia with eosinophilia of the hand.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vasoproliferative lesion of uncertain aetiology, involving the skin and subcutaneous tissue. The predilection of the tumour-like lesion is for the head and neck region. Radical surgical excision is still regarded as the most effective treatment. We present the case of a 33-year-old female with ALHE of the right hand. Preoperative MRI and angiography demonstrated involvement of the fourth and fifth rays, with complete occlusion of the ulnar artery, and a small lesion at the level of the metacarpophalangeal joint of the index finger. Complete tumour excision could not be achieved without resection of the fourth and fifth rays. One year postoperatively, there were no clinical signs of recurrence. The patient refused any further invasive diagnostic and follow-up examinations. Angiolymphoid hyperplasia of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion.