• Archives of Plastic Surgery
• /
• v.42 no.6
• /
• pp.753-760
• /
• 2015

Background A number of conditions can alter a person's fingernail configuration. The ratio between fingernail width and length (W/L) is an important aesthetic criterion, and some underlying diseases can alter the size of the fingernail. Fingernail curvature can be altered by systemic disorders or disorders of the fingernail itself. Although the shape and curvature of the fingernail can provide diagnostic clues for various diseases, few studies have precisely characterized normal fingernail configuration. Methods We measured the W/L ratio of the fingernail, transverse fingernail curvature, hand length, hand breadth, and distal interphalangeal joint width in 300 volunteers with healthy fingernails. We also investigated whether age, sex, height, and handedness influenced the fingernail W/L ratio and transverse fingernail curvature. Results In women, fingernail W/L ratios were similar across all five fingers, and were lower than those in men. The highest value of transverse fingernail curvature was found in the thumb, followed by the index, middle, ring, and little fingers. Handedness and aging influenced transverse fingernail curvature, but not the fingernail W/L ratio. Fingernails were flatter on the dominant hand than on the non-dominant hand. The radius of transverse fingernail curvature increased with age, indicating that fingernails tended to flatten with age. Conclusions Our quantitative data on fingernail configuration can be used as a reference range for diagnosing various diseases and deformities of the fingernail, and for performing reconstructive or aesthetic fingernail surgery.

• Archives of Plastic Surgery
• /
• v.36 no.1
• /
• pp.46-50
• /
• 2009

Purpose: Finger injury by green onion cutting machine is one of the common hand injuries in the kitchen. It has a unique feature: there are multiple parellel laceration 3 - 5 mm wide. There are two directions of injuries(vertical, oblique). It may involve bone, tendon, nerve, and vessel injuries. We discuss its management and the long - term progress. Methods: We have treated six patients from 2003 to 2007. We carried out low tension approximation with thin suture materials to avoid ischemia and performed the additional operation as nail bed repair, tenorrhaphy, open reduction, vessel anastomosis, and composite graft. We reviewed the record of initial injury and collected the follow - up record. Results: They were all middle aged - women who had worked in the kitchen. Right hand was dominent over left hand. The ratio of the directions was 3 : 3 (vertical : oblique). They were all competely healed although there were three atrophy, four hyperesthesia, and one nail deformity. Conclusion: Finger injury by green onion cutting machine is a unique pattern of laceration with various accompanied injuries. It may look like a severe form of injury, but in most cases have relatively favorable progress. We have to perform careful examination of accompanied injuries and carry out the proper management. First and foremost, the user especially in the middle aged women should be warned to be careful in handling this risky machine.

• Archives of Plastic Surgery
• /
• v.48 no.1
• /
• pp.98-106
• /
• 2021

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes. Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed. Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up. Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.396-399
• /
• 2010

Purpose: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. Methods: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. Results: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. Conclusion: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged (zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.

• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.491-491
• /
• 2019

• Journal of Trauma and Injury
• /
• v.34 no.4
• /
• pp.257-262
• /
• 2021

Purpose: Pediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period. Methods: We conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries. Results: Among the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups. Conclusions: Hand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.

• Archives of Reconstructive Microsurgery
• /
• v.9 no.2
• /
• pp.103-109
• /
• 2000

Purpose : We performed this study in order to analyze the clinical results of functioning gracilis musculocutaneous free flap transplantation for reconstructon of hand function in cases of Volkmann's ischemic contracture and massive soft tissue injury of forearm. Materials and methods : 18 cases were reviewed with 5 yeas of mean follow up period. We evaluated total active motion of the finger joints and wrist, pinch and grip strength. Results : The flap were survived in 17 cases and 1 case was failed due to infection. The sum of active motion of finger joints(TAM) was improved from 0 to $173.8^{\circ}$. The average grip and pinch strength was improved from 0 kg to $2.7{\pm}2.1kg$ and from 0 kg to $2.4{\pm}1.6kg$. Conclusion : The results in most cases were acceptable in relatively long term follow-up. It may be an option for reconstruction of hand function in cases of Volkmann's ischemic contracture and traumatic upper extremity injury.

• Archives of Reconstructive Microsurgery
• /
• v.9 no.1
• /
• pp.44-48
• /
• 2000

The advent of free bone flaps has made successful replacement of extensive areas of bone loss in the upper and lower extremities. The microvascular free bone flaps have faster healing without bony absorption or atrophy and can heal in the hostile environment of scarred bed or infection. Since the fibula free flap introduced by Taylor and colleague in 1975, it has been used extensively for skeletal reconstruction of extremities. In 1988, the folded vascularized fibula free flap was first described as a technique to reconstruct significant long bone defect of upper and lower extremities. During the same time, the fibular free flap has evolved to become most preferred choice of mandibular reconstruction. Up to present day, few reports have been made on the fibular free flap used for reconstruction of injured hand containing metacarpal bone and soft tissue defect. We present here our new and unique experiences with vascularized fibular osteocutaneous free flap as useful and satisfactory one for reconstruction of hand with composite defects.

• Archives of Craniofacial Surgery
• /
• v.16 no.1
• /
• pp.29-30
• /
• 2015

In cleft palate surgery, the environment is especially critical when suturing. Encum-bered, obstructive space in the environment can hinder a suture while using the Dingman mouth gag. We introduced a novel but simple draping technique. A simple hand towel is placed over the gag. A hole is cut out in the middle according to each patient's mouth. After making the hole, the hand towel is soaked in water and gently squeezed. Then the towel is properly placed over the Dingman mouth gag. Dripping water on the hand towel during the suture helps keep it in place. Using this draping technique, we cut 14 minutes of operation time compared to the average operation time of the past 2 years. There were several disadvantages in previous draping method. First, long suture material may easily get caught. Second, the operation field can easily be contaminated. Third, focusing on the operation becomes difficult due to the obstruction. This draping technique can compensate for the disadvantages of the previous Dingman mouth gag.

• The Journal of Korean Physical Therapy
• /
• v.36 no.1
• /
• pp.14-20
• /
• 2024

Purpose: This study was performed to identify and investigate the therapeutic effects of low-level laser (LLL) combined with a light-emitting diode (LED) on post-operative wound healing and functional recovery after hand orthopedic surgery. Methods: The study subjects were twenty patients who had passed the acute inflammatory phase after hand orthopedic surgery and were assigned equally to an experimental or a control group. Phototherapy was administered three times weekly for two weeks. Changes in wound length, edema, pain, and hand function were measured. Results: Significant differences in wound length, edema, pain, and hand function were observed between the experimental and control groups (p<0.05). However, no significant intergroup difference was observed (p>0.05). Nonetheless, a comparison of results showed changes in the experiment group over the two-week study period were significantly greater than in the control group (p<0.05). Conclusion: These findings show that combined LLL plus LED phototherapy positively influences post-operative hand rehabilitation.