This study examined outcomes of 100 fingertip injuries treated at Bellevue Hospital between January and May 2011. 64% healed without surgery, 18% required surgery, and 18% were lost to follow up. Those requiring surgery tended to have larger defects, volar oblique injuries, exposed bone, and distal phalanx fractures. While treatment algorithms exist, the study found that many fingertip injuries can be treated nonoperatively to achieve good function and sensation and allow for earlier return to work.
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
The aspire of the journal is to present a platform for scientists and academicians all over the world to encourage, distribute, and discuss various new issues and developments in different areas of Pediatrics and to promote responsible and balanced debate on controversial issues that influence child health, including non-clinical areas such as ethics, law, surroundings and economics.
Austin Pediatrics accepts innovative research articles, review articles, case reports and rapid communication on all the aspects of Pediatrics.
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
Assessment of correlation of periodontitis in teeth adjacent to implant and p...Dr. Anuj S Parihar
Aims: The present study was conducted to determine correlation between peri‑implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri‑implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one‑way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52
in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
The Correlation between the Right Little Finger, Eye - Ear Distance and Verti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
The aspire of the journal is to present a platform for scientists and academicians all over the world to encourage, distribute, and discuss various new issues and developments in different areas of Pediatrics and to promote responsible and balanced debate on controversial issues that influence child health, including non-clinical areas such as ethics, law, surroundings and economics.
Austin Pediatrics accepts innovative research articles, review articles, case reports and rapid communication on all the aspects of Pediatrics.
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
Assessment of correlation of periodontitis in teeth adjacent to implant and p...Dr. Anuj S Parihar
Aims: The present study was conducted to determine correlation between peri‑implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri‑implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one‑way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52
in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
The Correlation between the Right Little Finger, Eye - Ear Distance and Verti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Objectives: To describe the pattern of clavicle fractures and to evaluate the results of surgical treatment for clavicle fractures. Patients and methods: This retrospective study included 38 cases of clavicle fractures who were treated by open reduction internal fi xation at Hanoi Medical University Hospital between January 2008 and June 2013.
Results: The ratio of male to female was 1.5/1. Average age was 42.0 years. Simple fractures (no intermediate fragments) are most common with 65.8% of patients. Middle third fractures accounted for
92.1% of patients. Bone union rate was 100%. The surgical results were excellent in 94.7% and good in 5.3% of cases according to Constant Score.
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons.
Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.
Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system.
Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P< 0.001).
Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000518.php
For more Open access journals in Crimson Publishers
Please click on link: https://crimsonpublishers.com/
For more Articles on Open Access Peer Reviewed High Impact Factor journals
Please click on link: https://crimsonpublishers.com/smoaj/index.php
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
Crimson Publishers-Acute Occupational Hand Injuries With Their Social and Eco...crimsonpublishersOOIJ
Acute Occupational Hand Injuries with Their Social and Economic Aspects: A Hospital Based Cross Sectional Study by SM Rabiul Islam in Orthoplastic Surgery & Orthopedic Care International Journal
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
The Use of Three Different Suturing Techniques for Wound Closure of Mucoperio...Ziad Hazim Delemi
The Use of Three Different Suturing Techniques for Wound Closure of Mucoperiosteal Flaps After Surgical Removal of Impacted Lower Wisdom Teeth (Comparative Study)
Similar to Treatment and outcomes_of_fingertip_injuries_at_a.17 (20)
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Plastic and Reconstructive Surgery • January 2013
tal. We hypothesized that this was likely because
the majority of fingertip injuries can be treated
conservatively without operative intervention.
Based on this observation, we sought to prospec-tively
follow patients with fingertip injuries to as-sess
outcomes, including return to work, return of
protective sensation, and aesthetic result based on
type of injury and structures injured. In addition,
we hoped to obtain epidemiologic data on the
mechanism and severity of these injuries.
Bellevue Hospital, which is the oldest public
hospital in the United States, is a large metropol-itan
hospital that services many indigent patients
in New York City. Given the inherent socioeco-nomic
limitations and cultural values of this pa-tient
population, poor patient compliance, irreg-ular
follow-up, and delayed presentation are
common obstacles in our experience. As a result,
this study design proves ideal for assessing the
outcomes of conservative management for these
injuries. In addition, the high-volume emergency
room provides many patients sustaining fingertip
injuries. Therefore, we hypothesize that, despite
currently accepted algorithms, a large portion of
fingertip injuries can be treated with nonoperative
management and achieve optimal sensation, fine
motor control, and aesthetic results.
PATIENTS AND METHODS
After obtaining institutional review board ap-proval
(no. 09-0718) from the New York University
School of Medicine and Bellevue Hospital, a pro-spectively
collected chart review of all fingertip
injuries presenting to Bellevue Hospital between
January of 2011 and May of 2011 was conducted.
Patients were enrolled in an electronically col-lected
database on initial presentation to the
emergency room, and their follow-up care was
tracked through the electronic medical record.
Injuries were classified based on the patient’s age,
mechanism of injury, handedness, occupation, ge-ometry
of injury, size of defect, fracture, exposure
of bone, nail bed injury, emergency room proce-dure
performed, need for splinting or surgical
intervention, and overall outcome. Geometry of
injury was described using a schematic adapted
from the Fassler angles and levels of amputation
of the fingertip5 (Fig. 1). Patients who were lost to
follow-up were contacted by telephone and ques-tioned
about their outcomes. Statistical analysis
was performed using the t test and analysis of
variance using Minitab 16 (Minitab, Inc., State
College, Pa.).
RESULTS
During the 5-month period between January
and May of 2011, 100 fingertip injuries in 83 pa-tients
were prospectively registered by means of
the electronic medical record system at Bellevue
Hospital. There were 57 male patients (67.8 per-cent)
and 26 female patients (32.2 percent). Pa-tients
were students (27 percent), maintenance
workers (18 percent), employed in the food in-dustry
(cooks/butchers) (14 percent), teachers or
in the art industry (11 percent), clerical workers
(10 percent), construction workers (9 percent),
unemployed (8 percent), and health care workers
(3 percent). The majority of patients were right
hand dominant (75 percent).
Injuries were distributed between the domi-nant
and nondominant hands, 52 percent right
hand and 48 percent left hand. The most common
mechanism of injury was crush (45 percent), fol-lowed
by laceration (32 percent) and avulsion (23
percent). There was one digit injured in 86.7 per-cent,
two digits injured in 7.2 percent, three digits
Fig. 1. Fassler wound geometry. (Printed in Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue
injuries of the fingertip: Methods of evaluation and treatment. An algorithmic ap-proach.
Plast Reconstr Surg. 2008;122:105e–117e. Reprinted with permission from
Fassler PR. Fingertip injuries: Evaluation and treatment. J Am Acad Orthop Surg.1996;
4:84 –92.) Copyright 1996 American Academy of Orthopaedic Surgeons.
108
3. Volume 131, Number 1 • Treatment of Fingertip Injuries
injured in 4.8 percent, and four digits in 1.2 per-cent.
There were 22 injured index fingers, 27 in-jured
long fingers, 23 injured ring fingers, 10 in-jured
small fingers, and 18 injured thumbs. Injury
patterns were type A in 34 digits, type B in 15 digits,
type C in 40 digits, and type D in 11 digits. The
average size of soft-tissue defect was 1.87 cm2.
Fifty digits required a nail bed repair in the
emergency room and 13 digits were treated with
a composite graft in the emergency room. Twelve
(92.3 percent) of these composite grafts healed
without requiring any further procedures, and
one was lost to follow-up. Sixty-eight digits healed
without surgery, 16 digits ultimately required sur-gical
intervention, and 13 digits required soft-tis-sue
surgery. Sixteen patients (16 digits) were lost
to follow-up after their initial presentation to the
emergency room. The average time from injury to
the operating room was 12.2 days. The surgical
procedures for soft-tissue management included
nail plate removal (n3), full-thickness skin graft
(n 3), cross-finger flap (n 2), completion
amputation (n 2), Atasoy flap (n 1), thenar
flap (n1), and first dorsal metacarpal artery flap
(n 1). Additional surgical procedures per-formed
included bony fixation (n 2) and ten-don
reconstruction (n 1).
Sensation was intact to two-point discrimina-tion
(7 mm) in 65 digits, impaired in eight, and
lost to follow-up or absent from notes in 27. Of
those eight digits with decreased two-point dis-crimination,
four (50 percent) were managed with
local wound care, three (37.5 percent) were
treated with nail plate removal, and one (12.5
percent) was treated with a cross-finger flap. Pa-tients
without documented examinations or who
were lost to follow-up were treated as follows: local
wound care, 24 patients (88.8 percent); cross-fin-ger
flap, one patient (3.7 percent); debridement,
one patient (3.7 percent); and full-thickness skin
graft, one patient (3.7 percent). Two patients with-out
documented examination treated with local
wound care were children younger than 3 years.
The average time until return to work was 3.26
weeks for all patients. Patients requiring surgical
intervention had a longer average return to work
time when compared with those not requiring
surgical intervention (4.33 weeks versus 2.98
weeks, respectively; p 0.0096). All patients not
lost to follow-up returned to work.
The 16 patients requiring surgical interven-tion
had a median age of 31 years. Nine were
manual laborers and six were nonmanual labor-ers.
Eight sustained a laceration, seven suffered an
avulsion injury, and one suffered a crush injury.
The majority of these injuries were volar oblique
with exposed bone (n 8), followed by transverse
(n 7) and then dorsal oblique (n 1). Thirteen
had fractures and 13 also had exposed bone. Four
injured their dominant hands and two injured
their nondominant hands.
When comparing patients requiring operative
intervention versus those healing with conserva-tive
measures in a univariate analysis, patients re-quiring
surgery were more likely to have suffered
a volar oblique injury [50 percent (n 8) versus
8.8 percent (n 6); p 0.001]. They were also
more likely to have exposed bone [81.3 percent
(n13) versus 35.3 percent (n24); p0.0009]
and an associated distal phalanx fracture [81.3
percent (n 13) versus 47.1 percent (n 32);
p 0.013]. Manual laborers were no more likely
to require surgical intervention [nine (56.3 per-cent)
versus 25 (36.7 percent; p 0.14] when
compared with nonsurgical intervention. Finally,
patients requiring operative intervention were
more likely to have a larger soft-tissue defect (3.28
cm2 versus 1.75 cm2; p 0.005) (Table 1). In the
multivariate analysis, mechanism, occupation, and
exposed bone were not found to be independent
predictors of need for surgical intervention.
DISCUSSION
Fingertip amputation is one of the most com-mon
injuries presenting to the emergency room.
The basic tenets of finger reconstruction are to
provide durable coverage, preserve sensation and
length, minimize discomfort, and expedite return
Table 1. Characteristics of Those Who Healed
without Surgery versus with Surgery
Healed with
Surgery (%)
Healed without
Surgery (%) p
No. of patients 16 68
Mean age, yr 31 10.8 32 18.2 0.86
Manual labor 9 (56.3) 25 (36.7) 0.14
Sex
Male 11 (68.8) 50 (73.5) 0.704
Female 5 (31.2) 18 (26.4) 0.698
Crush mechanism 1 (6.25) 15 (22.1) 0.146
Laceration
mechanism 8 (50) 22 (32.3) 0.183
Avulsion
mechanism 7 (43.7) 31 (45.5) 0.896
Orientation
A 0 (0) 29 (42.6) 0.0013
B 8 (50) 6 (8.8) 0.001
C 7 (43.7) 25 (36.7) 0.652
D 1 (6.25) 8 (11.7) 0.525
Exposed bone 13 (81.3) 24 (35.3) 0.0009
Fracture 13 (81.3) 32 (47.1) 0.013
Average soft-tissue
defect, cm2 3.28 1.75 0.001
109
4. Plastic and Reconstructive Surgery • January 2013
to work and normal activities.4 There are multiple
described techniques to treat fingertip amputa-tion.
To help navigate these options, treatment
algorithms have been developed.4 We follow a
standard algorithm in our center in an effort to treat
these patients in an expeditious manner. However,
secondary to our patient population, there is often
delay in presentation to the operating room despite
scheduled operative dates. On presentation, often
these wounds are healed and therefore no proce-dure
is performed. To better describe this, we per-formed
a prospectively enrolled retrospective review
of this patient population.
As previously mentioned, reconstructive strat-egies
will vary depending on the mechanism of
injury and severity of the injured digit(s). Other
factors include the patient’s preference, hand
dominance, occupation, age, sex, and reliability to
follow up. Standard procedures for fingertip re-construction
include revision amputation6 and
split-thickness7 or full-thickness skin grafts.8,9 Also,
various local flaps have been used, including the
V-Y volar advancement flap,10 the homodigital
neurovascular island flap,11 the first dorsal meta-carpal
artery flap,12 the Littler flap,13 the Moberg-
O’Brien flap,14 the Atasoy flap,15 the Hueston
flap,15 the Cutler flap,16 the modified volar ad-vancement
flap,17 the thenar flap,18,19 and the
cross-finger flap.20 In addition, free flaps have also
been shown to be effective when reconstructing
extensive fingertip defects secondary to trauma,
more specifically, the medial plantar venous flap,21
the glabrous flap,22 the free dorsoulnar artery per-forator
flap,23 the superficial palmar branch of the
radial artery flap,24 and various toe pulp flaps.
Of the 83 patients our group reviewed, 29
required nail bed repair on initial presentation to
the emergency room. Acute management of nail
bed injuries is well described.25–28 Nail bed repair
is often the first step in minimizing fingertip de-formities
and cosmetic and functional problems.28
The basic principles include sufficient cleaning,
minimal de´bridement of the nail bed (sterile and
germinal matrix), proper alignment of the injured
structures, preservation of marginal skin folds,
and an appropriate wound dressing.28 If the repair
is done properly, a new nail can grow that is in-distinguishable
from the patient’s original nail. If
the germinal matrix is not properly reapproxi-mated
or a wide scar is present, a permanent split
nail will result.28 Still, preservation of the nail bed
is not always attainable. Three of our patients ul-timately
underwent surgery for nail bed ablation.
Revision amputation is one of the mostcommon
operations of the hand.6 Regardless of wound ori-entation,
fingertip amputation injuries proximal to
the lunula often require revision amputation.4 The
reported advantage of revision amputation com-pared
with other reconstructive efforts is that it of-fers
the patient a relatively quick return to the
work force. The most common reported reason
for refusal of replantation is the inability to im-mediately
return to work.29 Only two digits in this
series were treated with revision amputation.[30]
Thirteen of the 100 digits in this review were
treated with a composite graft at the time of the
initial presentation. Composite grafts are typically
performed following a nonreplantable traumatic
distal fingertip amputation.11 This technique in-volves
excision of any bony segment and defatting
the pulp of the amputated digit, reapproximating
the prepared amputated segment to the remain-ing
digit, and using a bolster dressing. Some have
reported high success rates in terms of functional
and aesthetic outcomes with similar techniques.31
Specifically, Uysal et al. reported good retained
sensibility, acceptable aesthetic outcomes, and full
satisfaction from their patient population, who
were reported to have graft viability rates of almost
87 percent.32 Of the 13 digits treated with a com-posite
graft, 84.6 percent survived and 92 percent
of these had return of protective sensation.
Only 17 of the 100 digits reviewed ultimately
received surgical reconstruction. These interven-tions
included bone fixations, cross-finger flaps,
full-thickness skin grafts, local flaps, a thenar
flap, a dorsal metacarpal artery flap, and nail
bed ablation.
Furthermore, Lemmon et al. suggest that fin-gertip
amputation defect size less than or equal to
1.5 cm2 without exposed bone should be allowed
to heal by secondary intention. Our group found
an average size of soft-tissue defect to be 1.87 cm2
and, as one would expect, a significantly larger
average soft-tissue defect in fingertips that ulti-mately
required reconstruction compared with
those that did not require reconstruction. Of the
100 digits reviewed, 68 healed without surgery,
compared with just 13 requiring soft-tissue sur-gery.
The average defect size allowed to heal by
secondary intention was 1.75 cm2, compared with
the average defect size requiring surgery, which
was 3.28 cm2 (p 0.029) (Table 1). Interestingly,
of the six patients who ultimately reported hyper-sensitivity
on follow-up, five were treated with con-servative
wound management alone, which may
suggest inadequate soft-tissue volume in the af-fected
digit. There can be several explanations
that account for our relatively large average defect
size in patients who ultimately did not undergo
110
5. Volume 131, Number 1 • Treatment of Fingertip Injuries
reconstruction. First, 73 percent of our patients
were adults, with the majority employed as manual
laborers (27 percent) or in the food industry (13
percent) or other service industries (10 percent).
Presumably, these patients are compensated on an
hourly basis, with minimal or no paid sick leave.
Only 9.0 percent of our patient population was
employed as teachers, in the art industry, or cler-ical
workers. Our patient population often missed
operative appointments and presented later in the
healing process. This tendency also biased the
average size defect of our conservatively managed
patients despite our initial intention to treat in
these cases. Our treatment algorithm was not
based on a defect size cutoff but rather took into
account the type of injury, the necessity for our
patients to return to work, and our patient pop-ulation’s
generally poor reliability to return for
proper follow-up. Furthermore, 16 digits were lost
to follow-up.
There was a significant difference in average
return to work time when comparing the surgical
treatment arm to the nonsurgically treated pa-tients,
4.33 weeks compared with 2.98 weeks, re-spectively.
This may be influenced by our average
time from injury to the operation of 12.2 days. This
number may be elevated when compared with the
community because of the lack of appropriate fol-low-
up after initial injury in our patient popula-tion.
Accounting for these days, the average return
to work time would be similar in the nonoperative
group (2.98 weeks) and the operative group (2.68
weeks), arguing against surgical intervention pro-viding
quicker return to work for patients.
After evaluating the management of traumatic
injuries by prospectively assessing all fingertip in-juries
presenting to a large metropolitan public
hospital, it is clear that a large number of these
injuries can be treated by conservative manage-ment.
Despite this fact, suboptimal outcomes are
still being attained because of socioeconomic lim-itations,
poor patient compliance, poor follow-up
rates, and other factors. Although it is difficult to
mitigate the aforementioned factors, improve-ments
in patient education may help to improve
the patient’s understanding of the long-term se-quelae
of hand injuries. Also, patients should be
encouraged to speak with social workers to try to
gain workers’ compensation and other monetary
compensation to allow these patients to make de-cisions
based on their health and not on their job
status. Furthermore, increased surgical staffing
and operating room availability may decrease the
lag between the time of injury and the scheduled
operating room date to improve on intention-to-treat
outcomes in the face of a difficult-to-manage,
low-income, urban patient population.
Nicholas T. Haddock, M.D.
Department of Plastic Surgery
University of Texas Southwestern
1801 Inwood Road
Dallas, Texas 75390
haddockmd@gmail.com
REFERENCES
1. Chau N, Gauchard GC, Siegfried C, et al. Relationships of
job, age, and life conditions with the causes and severity of
occupational injuries in construction workers. Int Arch Occup
Environ Health 2004;77:60–66.
2. Sorock GS, Lombardi DA, Hauser RB, Eisen EA, Herrick RF,
Mittleman MA. Acute traumatic occupational hand injuries:
Type, location, and severity. J Occup Environ Med. 2002;44:
345–351.
3. Gavrilova N, Harijan A, Schiro S, Hultman CS, Lee C. Pat-terns
of finger amputation and replantation in the setting of
a rapidly growing immigrant population. Ann Plast Surg.
2010;64:534–536.
4. Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the
fingertip: Methods of evaluation and treatment. An algorith-mic
approach. Plast Reconstr Surg. 2008;122:105e–117e.
5. Fassler P. Fingertip injuries: Evaluation and treatment. J Am
Acad Orthop Surg. 1996;4:84–92.
6. Blair JW, Moskal MJ. Revision amputation achieving maxi-mum
function and minimizing problems. Hand Clin. 2001;
17:457–471, ix.
7. Moon SH, Lee SY, Jung SN, et al. Use of split thickness
plantar skin grafts in the treatment of hyperpigmented skin-grafted
fingers and palms in previously burned patients.
Burns 2011;37:714–720.
8. Wendt JR. Coverage of full-thickness volar hand skin defects
with lateral great toe skin grafts. Plast Reconstr Surg. 2001;
108:2069–2071.
9. Schenck RR, Cheema TA. Hypothenar skin grafts for finger-tip
reconstruction. J Hand Surg Am. 1984;9:750–753.
10. Mehling I, Hessmann MH, Hofmann A, Rommens PM. V-Y
flap for restoration of the fingertip (in German). Oper Orthop
Traumatol. 2008;20:103–110.
11. Chen SY, Wang CH, Fu JP, Chang SC, Chen SG. Composite
grafting for traumatic fingertip amputation in adults: Tech-nique
reinforcement and experience in 31 digits. J Trauma
2011;70:148–153.
12. Chen C, Zhang X, Shao X, Gao S, Wang B, Liu D. Treatment
of thumb tip degloving injury using the modified first dorsal
metacarpal artery flap. J Hand Surg Am. 2010;35:1663–1670.
13. Xarchas KC, Tilkeridis KE, Pelekas SI, Kazakos KJ, Kakagia
DD, Verettas DA. Littler’s flap revisited: An anatomic study,
literature review, and clinical experience in the reconstruc-tion
of large thumb-pulp defects. Med Sci Monit. 2008;14:
CR568–CR573.
14. Kapandji T, Bleton R, Alnot JY, Oberlin C. Digital flap au-tografts
for pulp coverage in distal amputations of the fin-gers:
68 flaps (in French). Ann Chir Main Memb Super. 1991;
10:406–416.
15. Vasseur C, Legre R, Leps P, et al. Qualitative retrospective
study comparing 43 advanced-rotated flaps to 19 island type
Venkataswami-Subramanian flaps (in French). Chir Main
2000;19:44–55.
16. Roberts AH. Kutler repair for amputated fingertip. Ann R
Coll Surg Engl. 1980;62:75–76.
111
6. Plastic and Reconstructive Surgery • January 2013
17. Souquet R. The asymmetric arterial advancement flap in
distal pulp loss (modified Hueston’s flap) (in French). Ann
Chir Main 1985;4:233–238.
18. Hugon S, Castus P, Schoofs M. Index reconstruction by
means of a fasciocutaneous thenar flap. Plast Reconstr Surg.
2010;126:43e–44e.
19. Melone CP Jr, Beasley RW, Carstens JH Jr. The thenar flap:
An analysis of its use in 150 cases. J Hand Surg Am. 1982;7:
291–297.
20. Mishra S, Manisundaram S. A reverse flow cross finger pedi-cle
skin flap from hemidorsum of finger. J Plast Reconstr
Aesthet Surg. 2010;63:686–692.
21. Yokoyama T, Tosa Y, Hashikawa M, Kadota S, Hosaka Y.
Medial plantar venous flap technique for volar oblique am-putation
with no defects in the nail matrix and nail bed.
J Plast Reconstr Aesthet Surg. 2010;63:1870–1874.
22. Orbay JL, Rosen JG, Khouri RK, Indriago I. The glabrous
palmar flap: The new free or reversed pedicled palmar fas-ciocutaneous
flap for volar hand reconstruction. Tech Hand
Up Extrem Surg. 2009;13:145–150.
23. Simsek T, Engin MS, Aslan O, Neimetzade T, Eroglu L.
Finger pulp reconstruction with free dorsoulnar artery per-forator
(DUAP) flap. J Reconstr Microsurg. 2011;27:543–549.
24. Lee TP, Liao CY, Wu IC, Yu CC, Chen SG. Free flap from the
superficial palmar branch of the radial artery (SPBRA flap)
for finger reconstruction. J Trauma 2009;66:1173–1179.
25. Van Beek AL, Kassan MA, Adson MH, Dale V. Management
of acute fingernail injuries. Hand Clin. 1990;6:23–35; discus-sion
37–38.
26. Shepard GH. Management of acute nail bed avulsions. Hand
Clin. 1990;6:39–56; discussion 57–58.
27. Shepard GH. Nail grafts for reconstruction. Hand Clin. 1990;
6:79–102; discussion 103.
28. Brown RE. Acute nail bed injuries. Hand Clin. 2002;18:561–575.
29. Ozer K, Kramer W, Gillani S, Williams A, Smith W. Replan-tation
versus revision of amputated fingers in patients air-transported
to a level 1 trauma center. J Hand Surg Am.
2010;35:936–940.
30. Heistein JB, Cook PA. Factors affecting composite graft sur-vival
in digital tip amputations. Ann Plast Surg. 2003;50:299–
303.
31. Chai Y, Kang Q, Yang Q, Zeng B. Replantation of amputated
finger composite tissues with microvascular anastomosis.
Microsurgery 2008;28:314–320.
32. Uysal A, Kankaya Y, Ulusoy MG, et al. An alternative tech-nique
for microsurgically unreplantable fingertip amputa-tions.
Ann Plast Surg. 2006;57:545–551.
Evidence-Based Medicine: Questions and Answers
Q: I’ll do my best to indicate the correct clinical question and Level of
Evidence (LOE) on my manuscript. How does the LOE grading process
work with PRS?
A: The authors’ own grading is the first step in the process toward
determining the “real” LOE of an article.
Once submitted, manuscripts are peer reviewed as part of the normal
review process. PRS is training its reviewer panels on how to determine
LOE clinical questions and grading. As part of the review process, we
will ask our reviewers to indicate their assessment of the LOE for the
papers they review. After manuscripts have been reviewed, revised, and
accepted for publication, they will be sent to independent evidence-based
medicine and LOE experts, who will rate the manuscripts for
clinical question and LOE grade. These experts will make the final
determination of the LOE of all accepted papers, and their decisions
will be reflected in the published LOE of the articles. For those papers
that are not gradable, we will leave the LOE grade off of the published
abstract.
112