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      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

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          Abstract

          We report a unique case of cold intolerance following identical fingertip amputations of two fingers on the same hand. The index finger was replanted and the middle finger was reconstructed with a free flow-through hypothenar perforator flap to anatomically restore the digital arterial arch circulation and successfully treat cold intolerance.

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          A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

          To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. Therapeutic, Level III.
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            Cold-stress tests involving finger skin temperature measurement for evaluation of vascular disorders in hand-arm vibration syndrome: review of the literature.

            Cold-stress tests are used for evaluating vascular disorders in the hand-arm vibration syndrome, and the value of such tests based on finger skin temperature measurement has been investigated. However, there is a wide difference in the test conditions among countries and researchers. Standardization of the cold-stress tests is currently under discussion within the International Organization for Standardization. We reviewed various aspects of the cold-stress tests involving finger skin temperature measurement, including water temperature, hand immersion time and other test conditions, and evaluated their diagnostic significance. Water temperature varied from 0 degrees C to 15 degrees C and hand immersion time varied from 0.5 min to 20 min. The cold-stress tests are associated with relatively severe suffering, thus, higher temperature of cold water and shorter time of immersion are desirable. To date, however, there has not been sufficient data indicating diagnostic value in a test method involving cold water at around 15 degrees C. Diagnostic value is also influenced by other test conditions, such as room temperature, season, use of ischemia during immersion. For standardization of the cold-stress test involving finger skin temperature measurement, these factors must be considered together with water temperature and immersion time.
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              Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction.

              Various fingertip reconstructions have been reported for situations where microsurgical finger replantation is impossible. One method is the digital artery perforator (DAP) flap. Herein we report 13 DAP flaps for fingertip and finger stump reconstruction following traumatic finger amputations, highlighting modifications to the originally described DAP flap.
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                Author and article information

                Journal
                Case Reports Plast Surg Hand Surg
                Case Reports Plast Surg Hand Surg
                Case Reports in Plastic Surgery & Hand Surgery
                Taylor & Francis
                2332-0885
                27 December 2021
                2022
                27 December 2021
                : 9
                : 1
                : 33-36
                Affiliations
                Department of Plastic and Reconstructive Surgery, Mie University , Tsu, Japan
                Author notes
                CONTACT Ryohei Ishiura ishiura-prs@ 123456med.mie-u.ac.jp Department of Plastic and Reconstructive Surgery, Mie University , 2-174 Edobashi, Tsu 514-8507, Japan
                Article
                2020656
                10.1080/23320885.2021.2020656
                8725866
                1966b79f-c8e8-4d15-bbfe-ad4604bdab4f
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 3, Tables: 0, Pages: 4, Words: 2174
                Categories
                Case Report
                Case Report

                digital amputation,digital replantation,hypothenar flap,digital arterial arch,cold intolerance

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