• Archives of Plastic Surgery
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• v.34 no.2
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• pp.269-273
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• 2007

Purpose: High-pressure injection(HPI) injury is an injury caused by accidental injection of substances by industrial equipment. HPI injury of the hand is a serious injury that can be potentially devastating. There have been a number of publications on the results of its treatment and its functional outcome of these hands. Unfortunately, the clinical outcomes were unsatisfactory following an initial treatment approach of digital expression of the injection material, elevation, soaks, dressing changes, and antibiotics. Methods: A 43-year-old right handed man sustained a high pressure injection injury to the tip of the left index finger. The injected material was industrial paint thinner. Tissue necrosis was noted at the pulp of the finger. Several debridements and irrigation were required. A pedicled chest flap transfer was performed on the eighteenth day after injury as the dorsal nail complex remained viable. This is a retrospective review of our experience with high-pressure finger injection injury caused by paint. A literature review, retrospective chart and radiologic review were presented. Results: Follow-up length was about 1 year. The injuried hand was left nondominant hand, the index. Patient complaints were cold intolerance, paresthesia, contact pain, and impairment of activities of daily living. Conclusion: The outcome of high-pressure injection injuries of the hand is affected by many factors. The time between injury and operative treatment has been regarded as a key determinant by a number of authors. The nature of the injected material is probably more important. It has been noted by many authors that injuries with paints have a worse outcome than those with oil or grease. This study confirms the fact that high-pressure injection injury caused by paint thinner to the hand is a significant problem. Virtually a patient suffers sequelae of this injury. The injury has significant repercussions for future function and reintegration into the work force.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.304-308
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• 2010

Purpose: Many causes for triggering or locking of the fingers have been discussed in other literatures. The most common one is known stenosing tenosynovitis, which causes, a mismatch between the volume of the flexor tendon sheath and its contents. However, repeated trauma to the hand is uncommon cause of trigger finger. Therefore, we present a case of a rare condition of stenosing tenosynovitis which developed from a repeated relatively weak superficial flexor tendon injury. Methods: The patient was a 62-year-old woman who showed a painless, fixed and round mass on her right hand with no particular cause. Active and passive range of motion of the metacarpophalangeal joint of long finger was limited in flexion and extension. Ultrasonographic finding showed injured flexor digitorum superficialis tendon had fibrillar architecture with swelling between hyperechoic synovial membrane and hypoechoic surrounding area. Surgical exploration revealed that a bunched portion of the flexor digitorum superficialis and A1 pulley cause triggering during operation after adhesiolysis of scar tissue. Results: After releasing the A1 pulley, the range of motion of the metacarpophalangeal joint of long finger showed no limitation and histological examination of the subcutaneous tissue revealed fibrous fatty degeneration. In this case, releasing the A1 pulley with adhesiolysis of the subcutaneous scar tissue was successful and we obtained good functional outcome. Conclusion: We examined a patient in whom a repetitive impact forces to the palm caused longitudinal tear of the flexor tendon, leading to trigger finger. We experienced a rare case of stenosing tenosynovitis and trigger finger caused after close injury to flexor digitorum superficialis and its degenerative changes that caused mass like effect. To the best of authors' knowledge, our case of close injury to the flexor digitorum superficialis and unique morphologic change before rupture of tendon is rarely to be reported.

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

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.139-144
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• 2014

Purpose: Detection and determination of tendon injury in the finger or hand is not easy. Therefore, we aimed to study and evaluate the accuracy and the effectiveness of ultrasonography for the diagnosis of finger tendon injury. Methods: In this study, we enrolled patients, regardless of age and sex, with lacerations on their fingers. Patients with invisible wounds were excluded. We evaluated the accuracy and the effectiveness of ultrasonography and compared the results obtained from ultrasonography and with those obtained by visual observation of the injuries. Results: The sensitivity, the specificity and the accuracy of ultrasonography were found to be 66.7%, 100% and 91.3%, respectively (p<0.001) while those of physical examination were 71.4%, 98.3% and 91.3%, respectively. Small differences were observed between the sensitivities and specificities of the two examinations; however, the accuracies were the same (p<0.001). The area under the receiver operating characteristic (ROC) curve, which was used for diagnosis of tendon rupture using ultrasonography, was found to be 0.985 (95% confidence interval CI: 0.929-0.999),while that of physical examination was 0.938 (95% CI: 0.861-0.980). Conclusion: Ultrasonography can be used an effective diagnostic tool for patients with finger tendon injury.

• Archives of Plastic Surgery
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• v.43 no.2
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• pp.134-144
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• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.83-88
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• 2010

Purpose: It is not always easy to determine the existence of tendon injuries when it comes to patients with finger lacerations. Thus, we tried to find the difference in effectiveness and in compliance of patients when we employed two different types of diagnosis, conventional gross confirmation and ultrasonographic confirmation. Methods: From December 2009 to March 2010, we enrolled 14 patients with finger tendon injury at Soonchunhyang University Cheonan Hospital. The median age of the patients was $35.9{\pm}14.4$, and the ratio of females to males was 1:2.5 We evaluated the compliance of each patient by measuring four different categories (level of cooperativeness in showing their wound and in following the instructions, level of movement of their fingers during the diagnosis and total number of attempts to diagnose) by using a score from 1 to 3 for each category, for a total possible score of 12 for each patient. We also measured the painfulness of each patient by using a score of 1 to 10 and the time required for each diagnosis. Results: The levels of patients' compliance was $8.9{\pm}2.1$ when diagnosed with gross confirmation and $9.8{\pm}2.1$ when diagnosed with ultrasonographic confirmation (p value=0.042). The pain score of the patients was $3.7{\pm}1.7$ with gross confirmation and $2.9{\pm}1.2$ with ultrasonographic confirmation (p value=0.020). The median duration of time in each test was $6.7{\pm}4.8$ minutes with gross confirmation and $10.5{\pm}4.2$ minutes with ultrasonography (p value=0.006). Conclusion: Comparing gross confirmation and ultrasonographic confirmation, gross confirmation is a better method than ultrasonography because of time efficiency. However, ultrasonographic confirmation has advantages over gross confirmation in pain scale and better compliance of patients. Emergency physicians generally employ gross confirmation rather than ultrasonography in determining the existence of tendon injury in patients. In patients with finger lacerations without bone injury, ultrasonography can be considered as a secondary diagnostic tool, especially when patients have much pain.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.82-85
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• 2013

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to Our Hospital. He had large dorsal soft-tissue defects ($5{\times}3cm$) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.7-12
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• 1993

Traumatic loss of the fingers present significant functional disability and the index finger is an important component of hand function. Since 1900, many attempts and efforts have been done in reconstruction of amputated fingers with toes. Authors clinically analyzed 8 cases of toe-to-finger transfer in traumatic amputation of the index finger to be followed for more than one year at Korea University Hospital from August 1982 to December 1991. The results were as follows: 1. The most common cause of injury was mechanical accident in 7 of 8 cases. 2. Average interval between injury and operation was 8 year 3 months. 3. Average operation time was 5 hours 58 minutes and average ischemic time of transferred toe was 1 hour 52 minutes. 4. Skin flaps have survived in 7 of 8 cases, and the functional results in 6 of 8 cases were over than fair.

• Journal of Korean Physical Therapy Science
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• v.6 no.1
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• pp.905-913
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• 1999

The hand is a part of the body which has various functions and a sophisticated structures bone, Joint, tendon, ligament and logical nerve organ are aggregated densely in the hand of anatomy its functions are delicate. The hand's functions are very important for doing ADL and a worker's As the hand is structure which is used often and commonly it is a site that can be easily damaged by a accident on work. This study was investigated and analyzed by the results from 238 workers who had hand injury and physical therapy from January, 1997 to June, 1998 at Shin-Pung, Jang-Lim industrial complex which is located in Pusan. 1. A hand injury most frequertly happened in worker in their 30's and 20's(66 case, 28%), second was 57 case(24%) their 40's. 2. Among workers suffering from injury, who had one or less than 2 years on the job, a injury most frequently occurred. 3. Scale of workers, A injury most frequently happend in a place where had workers from 10 to 50. 99 workers from that place were 42% of total. 4. Month of occurrence rate in March were the highest compared to other months 40 injury workers in march were 17% of the total. Second was July, and the least was April that injury appeared with 10 workers. (4.2% of the total) 1. Frocture was the most common lesion 82 workers had that lesion(34%) soft tissue rupture was 71 workers who were 30% of total in type of lesion. 2. Of the site of lesion multiple case was the most common in which 57 workers had that lesion it were 24% of the total. The next was the index finger site in which 44 workers were 19% of the total. The index finger was the most common mono-site that can be lesion 36 workers were the middle finger lesion workers who were 15% of the total. Of the joint lesion, PIP was the most in which 76 workers were 44% and in MC 27 workers were 15% of the total. 3. Interval of physical therapy 79 workers from one month to 2 months, was 33% of the total and 174 workers who had therapy below 3 months were 71% 4. Post injury of disablity of the site, phalangeous disability was the most in which 148 workers had that injury and they were 62% of the total of the grade of disability 110 workers who were 46% of the total state from less than 25% disability in hand-function and 59 patients who were 25% had no disability. There were 6 workers (3% of the total) who had over -75%-dibability in the hand-function.

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