• Archives of Plastic Surgery
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• 제38권1호
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• pp.113-116
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• 2011

Purpose: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. Methods: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. Results: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. Conclusion: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.

• Archives of Plastic Surgery
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• 제37권6호
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• pp.788-794
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• 2010

Purpose: The fingertip is the most commonly injured part of the hand and its injury frequently results in avulsion or crushing of a segment of the nail bed and fracture of the distal phalangeal bone. Restoration of a flat and smooth nail bed is essential for regrowth of a normal nail, which is important not only for cosmetic reasons but also for tactile capability of the fingertip. It is also anatomical reduction of the distal phalanx to promote patient's cosmetics and prevent nail bed deformity. Absence or no replacement of the nail plate results in obliterated proximal skin fold. When the avulsed nail plate cannot be returned to its anatomic position or when it is absent, we use a synthetic material for splinting the nail bed and alternative reductional method for distal phalangeal bone fracture, especially, instead of hardwares. Methods: From January of 2006 to June of 2009, a total of ten patients and fourteen fingers with crushing or avulsion injuries of the fingertip underwent using the artificial nails for finger splint. We shaped artificial nails into the appropriate sizes for use as fingernail plates. We placed them under the proximal skin fold and sutured to the fold proximally and to the lateral and medial edges of the nail bed or to the distal fingertip. Our splints were as hard as K-wire and other fixation methods and more similar to anatomic nail plates. Artificial nails were kept in place for at least 3 weeks. Results: No artificial nail related complication was noted in any of the ten cases. No other nail fold or nail bed complications were observed, except for minor distal nail deformity because of trauma. Conclusion: In conclusion, in order to secure the nail bed after injury and reduce the distal phalangeal bone fracture, preparing a nail bed splint from a artificial commercial nail is a cheap and effective method, especially, for crushed or avulsion injuries of the fingertip.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.674-677
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• 2009

Purpose: Typical cross finger flap is still a good method for reconstruction of fingertip injuries. However, it is necessarily followed by great loss and aesthetically unpreferable result of donor finger. Hereby, we introduce a modification of cross finger flap with reduction pulp plasty and full thickness skin graft, with which we could reduce the defect size of injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Method: This method was performed in the patients with fingertip injuries of complete amputation or in case of loss of fingertip due to necrosis after replantation. Firstly, reduction pulp plasty was performed on the injured finger to reduce the size of defect of fingertip. Additional skin flap was obtained from the pulp plasty. Secondly, cross finger flap was elevated from the adjacent finger to cover the defect on the injured finger. At the same time, defect on the donor finger produced by the flap elevation was covered by full thickness skin graft with the skin obtained from the pulp plasty of injured finger. Results: Flap and graft survived without any necrosis after surgical delay and flap detachment. All of them were healed well and did not present any severe adversary symptoms. Conclusion: Cross finger flap with reduction pulp plasty and full thickness skin graft is an effective method that we can easily apply in reconstruction of fingertip injury. We think that it is more helpful than the usual manner, especially in cases of children with less soft tissue on their fingers for preservation and reduction of the morbidity of donor finger.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.70-75
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• 2022

Background Fingertip injuries are very common; however, the reconstruction of volar pulp defects with nail bed defects is challenging in the absence of the amputated segment. We reconstructed fingertip amputations with nail bed defects using a new surgical approach: a subcutaneous flap and composite graft. Methods We treated 10 fingertip amputation patients without an amputated segment, with exposed distal phalangeal bone and full-thickness nail bed defects between February 2018 and December 2020. All patients underwent two-stage surgery: in the first stage, a subcutaneous flap was performed to cover the exposed distal phalanx, and in the second stage, a composite graft, consisting of nail bed, hyponychium, and volar pulp skin, was applied over the subcutaneous flap. Results All flaps survived and all composite grafts were successful. The wounds healed without any significant complications, including the donor site. The average follow-up duration was 11.2 months (range, 3-27 months). The new nail and the shape of the volar pulp were evaluated during follow-up. All patients were satisfied with their natural fingertip shapes and the new nails did not have any serious deformities. Conclusions A subcutaneous flap in combination with a composite graft fitting the shape of the defect could be another option for fingertip injuries without amputated segments.

• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.132-138
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• 2011

Although finger tip replantation is popularized nowadays, it is not easy operations even for experienced surgeons. The indication for replantation to treat fingetip amputation is still controversial, but I think replantation for function and cosmetic absolute indication. This paper will discuss about methods of fingertip replantation and unexpected complications on soft tissue after operation.

• 한국운동역학회지
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• 제29권3호
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• pp.157-166
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• 2019

Objective: This study examined the effects of stimulating fingertip temperature on the patterns of force sharing and stability properties during multi-finger force production tasks. Method: 9 adult subjects (male: 3, female: 6, age: $26.11{\pm}4.01yrs$, height: $169.22{\pm}5.97cm$, weight: $61.44{\pm}11.27kg$) participated in this study. The experiment consisted of three blocks: 1) maximal voluntary contraction (MVC) task, 2) single-finger ramp task to quantify enslaving (i.e., unintended force production by non-task fingers), and 3) 12 trials of multi-finger steady-state force production task at 20% MVC. There were three temperature conditions including body-temperature (i.e., control condition), $40^{\circ}C$, and $43^{\circ}C$, and the stimulation was given to the index finger only for all experimental conditions. Results: There were no significant differences in the MVC forces, enslaving, and the accuracy of performance during the steady-state task between the conditions. However, the share of stimulated index finger force increased with the index fingertip temperature, while the share of middle finger force decreased. Also, the coefficient of variation of both index and middle finger forces over repetitive trials increased with the index fingertip temperature. Under the framework of the uncontrolled manifold (UCM) hypothesis used to quantify indices of multi-finger synergies (i.e., stability property) stabilizing total force during the steady-state task, the two variance components within the UCM analysis increased together with the fingertip temperature, while no changes in the synergy indices between the conditions. Conclusion: The current results showed that fingertip temperature stimulation only to index finger does not affect to muscle force production capability of multi-finger, independence of individual fingers, and force production accuracy by the involvement of all four fingers. The effect of fingertip temperature on the sharing pattern and force variation may be due to diffuse reflex effects of the induced afferent activity on alpha-motoneuronal pools. However, the unchanged stability properties may be the reflection of the active error compensation strategies by non-stimulated finger actions.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제4권4호
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• pp.618-632
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• 2010

This paper presents a novel approach to control the augmented reality (AR) objects robustly in a marker-less AR system by fingertip tracking and hand pattern recognition. It is known that one of the promising ways to develop a marker-less AR system is using human's body such as hand or face for replacing traditional fiducial markers. This paper introduces a real-time method to manipulate the overlaid virtual objects dynamically in a marker-less AR system using both hands with a single camera. The left bare hand is considered as a virtual marker in the marker-less AR system and the right hand is used as a hand mouse. To build the marker-less system, we utilize a skin-color model for hand shape detection and curvature-based fingertip detection from an input video image. Using the detected fingertips the camera pose are estimated to overlay virtual objects on the hand coordinate system. In order to manipulate the virtual objects rendered on the marker-less AR system dynamically, a vision-based hand control interface, which exploits the fingertip tracking for the movement of the objects and pattern matching for the hand command initiation, is developed. From the experiments, we can prove that the proposed and developed system can control the objects dynamically in a convenient fashion.

• Archives of Plastic Surgery
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• 제32권6호
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• pp.763-766
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• 2005

The restoration of the fingernail is not simple in case of amputated distal fingertip which involved the pulp and nail. The nail should maintain a length of at least 2 mm from the eponychium for an adequate grip and decent appearance. Various methods to reconstruct the fingernail bed are available. The nail bed graft from amputated finger or great toe, and free onychocutaneous flap are commonly used. The nail bed of the injured tip tends to be atrophied, deformed and failed as a graft. And the great toe is often turned down as a donor. We have restored satisfactorily the nail beds of three injured finger tips with eponychial cutaneous flaps. The pulps were reconstructed with either a reverse dorsal digital island flap or free pulp graft. Repeated again. A mean follow- up was six months. The nail grew up to the average of 3.7 mm. All patients were satisfied with the length of the nail and met with good cosmetic results. An eponychial cutaneous flap is useful to restore the nail of the distal fingertip amputation. The procedure is relatively simple and morbidity is minimum.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.311-317
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• 2009

Purpose: Traditionally, external bleeding is needed when only an arteriorrhaphy can be performed in cased where a venorrhaphy cannot be done at the initial reconstruction for a zone1 complete amputation. However, this salvage procedure has several iatrogenic complications. Therefore, we did not perform an external bleeding procedure, in cases where external bleeding was not appropriate due to the small size of the stump. Methods: From September 2006 to August 2007, 19 fingertip amputations, among 18 patients, were performed using only arteriorrhaphy without external bleeding; In total 95 fingertip amputations, with venorrhaphy or external bleeding procedures were excluded. The results were reviewed retrospectively to compare survival and complication rates. Results: The survival rate of only arteriorrhaphy without external bleeding is 84.2%. Additional operations for soft tissue problems of total or partial necrosis were performed in 5 cases. Conclusions: We found no difference in the survival and complication rates of only arteriorrhaphy without external bleeding compared to results of only arteriorrhaphy with external bleeding in other articles. Therefore, our results suggest that in some cases with a fingertip amputation, performing arteriorrhaphy only, without external bleeding, might be a better option than external bleeding due to reduced iatrogenic injuries and complications.

• 한국컴퓨터그래픽스학회논문지
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• 제25권5호
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• pp.11-20
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• 2019

딥러닝 기술의 발전으로 가상 현실이나 증강 현실 응용에서 사용하기 적절한 사용자 친화적 인터페이스에 관한 연구가 활발히 이뤄지고 있다. 본 논문은 사용자의 손을 이용한 인터페이스를 지원하기 위하여 손 끝 좌표를 추적하여 가상의 객체를 선택하거나, 공중에 글씨나 그림을 작성하는 행위가 가능하도록 딥러닝 기반 손 끝 객체 탐지 방법을 제안한다. 입력 영상에서 Grad-CAM으로 해당 손 끝 객체의 대략적인 부분을 잘라낸 후, 잘라낸 영상에 대하여 Atrous Convolution을 이용한 합성곱 신경망을 수행하여 손 끝의 위치를 찾는다. 본 방법은 객체의 주석 전처리 과정을 별도로 요구하지 않으면서 기존 객체 탐지 알고리즘 보다 간단하고 구현하기에 쉽다. 본 방법을 검증하기 위하여 Air-Writing 응용을 구현한 결과 평균 81%의 인식률과 76 ms 속도로 허공에서 지연 시간 없이 부드럽게 글씨 작성이 가능하여 실시간으로 활용 가능함을 알 수 있었다.