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J Hand Surg Am 2021 Jun 9. Epub 2021 Jun 9.

Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA. Electronic address:

Purpose: Targeted muscle reinnervation (TMR) transfers cut the nerve endings to the motor nerves of the nearby muscles to reduce neuroma pain and/or enhance prosthetic function. To guide surgeons, anatomic "roadmaps" describe nerve transfer options for TMR at various locations. This study aimed to landmark and measure motor entry points (MEPs) to the hand interossei muscles in the context of TMR for digital nerve neuroma management. Read More

J Hand Surg Eur Vol 2021 Jun 9:17531934211019572. Epub 2021 Jun 9.

Department of Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.

Following periarterial sympathectomy, patients with recurrent digital ischemia due to vasospastic or vaso-occlusive disease have few remaining treatment options. We performed a retrospective review from 1997 to 2019 to determine the safety and efficacy of revision periarterial sympathectomy. Eleven patients were identified who underwent revision periarterial sympathectomy, performed on average 84 months after their initial procedure. Read More

Plast Reconstr Surg Glob Open 2021 Jun 7;9(6):e3624. Epub 2021 Jun 7.

Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Replantation is an ideal method for treating fingertip amputation. However, in some cases, replantation is known to be a challenging issue. This report described a successful thumb tip reconstruction performed with bone and nail bed salvaged as spare parts, and a free posterior interosseous artery perforator (PIAP) flap. Read More

J Foot Ankle Surg 2021 May 1. Epub 2021 May 1.

Teaching Faculty, Medical Education Department, Grant Medical Center, Columbus, OH.

The period when medical students begin residency in teaching hospitals throughout the United States heralds a period known in the medical community as the "July Effect." Though several sentinel studies associated this timeframe with an increase in medical errors, residencies since demystified this phenomenon within their respective specialty. This study aims to evaluate the presence of the July Effect in a podiatric medicine and surgery residency program. Read More

Sensors (Basel) 2021 May 28;21(11). Epub 2021 May 28.

TWI-Hellas, 152 32 Halandri, Greece.

A decision support system (DSS) was developed that outputs suggestions for socket-rectification actions to the prosthetist, aiming at improving the fitness of transfemoral prosthetic socket design and reducing the time needed for the final socket design. For this purpose, the DSS employs a fuzzy-logic inference engine (IE) which combines a set of rectification rules with pressure measurements generated by sensors embedded in the socket, for deciding the rectification actions. The latter is then processed by an algorithm that receives, manipulates and modifies a 3D digital socket model as a triangle mesh formatted inside an STL file. Read More

Medicine (Baltimore) 2021 May;100(20):e25659

Department of Internal Medicine.

Abstract: Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Read More

Front Vet Sci 2021 30;8:645982. Epub 2021 Apr 30.

Department of Medical Veterinary Sciences, University of Bologna, Bologna, Italy.

In dogs, digit squamous cell carcinoma (SCC) is uncommon. Clinical signs are frequently underestimated, leading to a diagnostic delay. The purpose of this retrospective study was to report our experience regarding the clinical presentation, diagnostic work-up, treatment and outcome of 79 client-owned dogs with SCC of the digit. Read More

Cureus 2021 Apr 10;13(4):e14405. Epub 2021 Apr 10.

Orthopaedic Surgery, The Hughston Clinic, Columbus, USA.

Urbaniak class III ring avulsion injuries involve significant soft tissue and bone loss. Management typically focuses on immediate, temporary soft tissue coverage followed by a planned trip to the operating room for either amputation or replantation. While soft tissue coverage is of utmost importance, maintenance of digital length, functionality, and cost-effectiveness of viable treatment options should also be considered. Read More

Foot (Edinb) 2021 Jun 20;47:101803. Epub 2021 Apr 20.

Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore. Electronic address:

Introduction: Exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) commonly occurs after application of Topical Negative Pressure Wound Therapy (TNPWT) for a ray amputation wound. This is due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This results in toe gangrene requiring a ray amputation and ultimately a larger wound bed. Read More

JBJS Case Connect 2021 05 5;11(2). Epub 2021 May 5.

Department of Orthopedics, Prisma Health Midlands, Columbia, South Carolina.

Case: A 22-year-old roofer presented to the emergency department with partial amputation of the left middle finger. He was treated with revision amputation using a glove tourniquet. He followed up 14 days later demonstrating a retained tourniquet with severe ischemic changes. Read More

Pol Przegl Chir 2021 Mar;93(2):26-32

Department of Traumatology and Hand Surgery, Medical University in Wroclaw, Poland.

This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Read More

Hand Surg Rehabil 2021 Apr 30. Epub 2021 Apr 30.

Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48 Boulevard Sérurier, 75019 Paris, France.

Central ray amputation results severe esthetic blemish and functional and psychological sequelae. Three main reconstruction procedures have been reported in adults: digital translocation, intracarpal osteotomy, and metacarpal resection; none of these, however, have been studied in children. The aim of this study was to report medium-term results for treatment of central ray amputation by proximal metacarpal resection following failure of digit replantation in children (i. Read More

Medicina (Kaunas) 2021 Apr 14;57(4). Epub 2021 Apr 14.

Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.

About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. Read More

JAMA Netw Open 2021 Apr 1;4(4):e217934. Epub 2021 Apr 1.

Department of Dermatology, Mayo Clinic Arizona, Scottsdale.

Importance: Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP).

Objective: To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. Read More

Front Oncol 2021 1;11:644282. Epub 2021 Apr 1.

Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France.

Background: Pemetrexed and gemcitabine are both antimetabolites drugs approved in advanced non-small cell lung cancer (NSCLC). Their toxicity profile is well known. However, rare vascular side effects can occur such as vascular acrosyndromes and especially digital ischemia. Read More

Sci Rep 2021 Apr 16;11(1):8393. Epub 2021 Apr 16.

Department of Paediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.

Childhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). Read More

Prosthet Orthot Int 2021 Feb;45(1):94-99

1Prosthetics & Orthotics Service, Foot Care & Limb Design Centre, Tan Tock Seng Hospital, Singapore 2Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design, Singapore.

Background: Upper limb, in particular forequarter amputations, require highly customised devices that are often expensive and underutilised.

Objectives: The objective of this study was to design and develop a comfortable 3D-printed cosmetic forequarter prosthetic device, which was lightweight, cool to wear, had an elbow that could lock, matched the appearance of the contralateral arm and was completely free of metal for a specific user's needs.

Study Design: Device design. Read More

Indian J Plast Surg 2021 Jan 4;54(1):86-89. Epub 2021 Mar 4.

Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.

Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. Read More

Microsurgery 2021 Apr 3. Epub 2021 Apr 3.

Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Purpose: Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation.

Methods: Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Read More

Sensors (Basel) 2021 Mar 2;21(5). Epub 2021 Mar 2.

Department of Electrical and Electronic Engineering, The University of Manchester, Manchester M13 9PL, UK.

Diabetic foot ulcers (DFUs) are a life-changing complication of diabetes that can lead to amputation. There is increasing evidence that long-term management with wearables can reduce incidence and recurrence of this condition. Temperature asymmetry measurements can alert to DFU development, but measurements of dynamic information, such as rate of temperature change, are under investigated. Read More

J Am Coll Surg 2021 Jun 13;232(6):889-898. Epub 2021 Mar 13.

Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Electronic address:

Background: Malignant cutaneous adnexal tumors (MCATs) are rare and their natural history is poorly understood. Available literature indicates aggressive behavior with a significant risk of metastasis.

Study Design: Retrospective review of our institutional surgical oncology databases was performed for patients diagnosed with MCATs (2001-2020). Read More

J Vasc Access 2021 Mar 14:11297298211000897. Epub 2021 Mar 14.

Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Transradial access is a safe approach for visceral endovascular interventions, with lower complication rates compared to transfemoral access. This report describes an unusual case of ulnar artery thrombosis following splenic artery aneurysm embolization via left transradial approach, resulting in non-target digital ischemia and eventual amputation of the ring and little finger distal phalanges. Technical considerations to reduce the incidence of access complications are also reviewed, along with practice modifications undertaken at our institution following this case to improve outcomes. Read More

Circ Rep 2020 Aug 8;2(9):531-535. Epub 2020 Aug 8.

Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan.

Despite the growing knowledge regarding optimal treatments for critical limb ischemia (CLI), there are still a considerable number of patients who have to undergo major limb amputation. Intramuscular injection of autologous adipose-derived regenerative cells (ADRCs) in these patients has shown therapeutic potential in improving tissue ischemia, in both preclinical and initial pilot studies. Here, we present a clinical protocol for ADRCs use in a multicenter trial. Read More

Clin Rheumatol 2021 Mar 6. Epub 2021 Mar 6.

Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.

Objective: Systemic sclerosis (SSc) is a connective tissue disease characterized by microangiopathy. Peripheral arterial disease, increasingly studied during SSc, is responsible for digital ulcers, associated with a high risk of amputation. The aim of our study was to assess the frequency of lower limb arterial impairment in SSc patients by measuring ankle-brachial index (ABI), toe pressure (TP), and toe-brachial index (TBI). Read More

J Egypt Natl Canc Inst 2021 Mar 4;33(1). Epub 2021 Mar 4.

Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), Room no. 3095A, New Delhi, 110029, India.

Background: Acral vascular syndrome clinically presents as digital ischemia with Raynaud's phenomenon and erythromelalgia but can be rarely seen in the malignant condition. Patients may present pain, permanent digital blanching or cyanosis, and desquamation or ulceration of the fingers. Acral vascular syndrome is rarely associated with lymphoid neoplasm and is associated with smoking, autoimmune connective tissue diseases, and vasculitis. Read More

Spartan Med Res J 2020 Oct 30;5(2):14612. Epub 2020 Oct 30.

Beaumont Health System.

Squamous cell carcinoma is the most common tumor of the hand. This malignancy requires unique treatment considerations; the surgeon and patient must balance retention of maximal functional capacity of the hand and minimization of the risk of recurrence and metastasis. Digital-sparing and digital-sacrificing therapies should be considered. Read More

BMJ Case Rep 2021 Mar 2;14(3). Epub 2021 Mar 2.

Department of Surgery, University of PortHarcourt, PortHarcourt, Rivers State, Nigeria.

Amputations of the upper limb, in particular, have a major impact on patients' lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Read More

Clin Orthop Relat Res 2021 Feb 26. Epub 2021 Feb 26.

S. Hindiskere, Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India.

Background: Large, malignant bone tumors and revision limb salvage procedures often result in the resection of extensive lengths of the involved bone segment, leaving a residual segment of bone that may be too short to support a standard intramedullary stem for endoprosthetic reconstruction. Telescope allografting, in which an allograft is used to augment the remaining bone segment by telescoping it into the residual bone segment, was described for situations in which residual bone stock is insufficient after tumor resection or prosthetic revision. Apart from one study that first described the procedure [15], there are no other studies reporting the outcome of this telescopic concept for restoring bone stock. Read More

Plast Surg (Oakv) 2021 Feb 20;29(1):21-29. Epub 2020 Jul 20.

Toronto Western Hospital, Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada.

Background: Since 1965, the practice of digital replantation has seen great technical strides and become commonplace worldwide. However, some American authors have recently reported declining rates of replantation. We set out to characterize the patient population and describe treatment patterns from 2005 to 2016 at a large Canadian regional replantation center. Read More

Medicine (Baltimore) 2021 Feb;100(7):e24791

Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University.

Rationale: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons.

Patient Concerns: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. Read More