• Archives of Plastic Surgery
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• 제47권5호
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.821-828
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• 2011

Purpose: The authors applied Bilhaut-Cloquet procedure to Wassel type III and IV duplicated thumb, which was limited to patients with Wassel type I, II. This procedure was applied in order to improve the growth potential, range of joint motion, joint stability and cosmetic outcome. Methods: Sixteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from May, 2005 to December, 2010. Seven patients were Wassel type III, nine patients were type IV. This procedure was applied not only to balanced type, but also unbalanced type or convergent type. Five patients were balanced type and eleven patients were unbalanced type. Convergent type of Wassel type IV was three. Sex ratio was the same, mean age at the operation was 20.1 months old (8~52 months old). Angular deformity, joint stability and range of joint motion and cosmetic outcome were considered together and estimated in Tada score. Also, postoperative subjective satisfaction score of the parents was evaluated by a 100-points scale. Results: Mean subjective satisfaction scored 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Range of motion was mean 20 degrees in interphalangeal joint and mean 73 degrees in metacarpophalangeal joint. Tada score showed 'good' in eleven patients (68.8%), 'fair' in three patients (18.7%) and 'poor' in two patients (12.5%). In seven patients those who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb. Conclusion: Bilhaut-Cloquet procedure can be applied not only to balanced type of Wassel type III, IV duplicated thumb, but also to unbalanced type or convergent type that focused on functional reconstruction and cosmetic improvement.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.708-711
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• 2010

Purpose: The sheath of tendon is uncommon site of tuberculous involvement as compared to other parts of the body. Especially, tuberculous tenosynovitis affecting flexor tendon of the hand is a rare condition. In recent years, furthermore, the incidence of tuberculosis is increasing in our country. Tuberculous tenosynovitis is a chronic, slowly destructive disease, which is difficult to diagnosis before operation, but can be definitively diagnosed by the pathologic microscopic examination. Early detection and surgical excision combined with antituberculous medication is important. We report a rare case of tuberculous tenosynovitis of the flexor tendon of the hand. Method: A 12-year-old woman presented with a painless, nontender mass on palmar side between distal interphalangeal joint and proximal area of metacarpophalangeal joint of the left third finger. We had surgical excision of the involved flexor tendon sheath and studied histopathologically. Result: The histopathological findings were chronic granulomatous inflammation with caseating necrosis consistent with tuberculosis. We started antituberculous medication. Conclusion: Tuberculous tenosynovitis is a rare condition, especially involving on the flexor tendon of the hand. But because of increasing tendency of tuberculosis, it is important to differentiate it from other tumors of the hand.

• 로봇학회논문지
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• 제11권4호
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• pp.193-204
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• 2016

This paper presents an anthropomorphic finger prosthesis for amputees whose proximal phalanx is mutilated. The finger prosthesis to be proposed is able to make the amputees to perform the natural motion such as flexion/extension as well as self-adaptive grasping motion as if normal human finger does. The mechanism of finger prosthesis with three degrees-of-freedom (DOFs) consists of two five-bar and one four-bar linkages. Two passive components composed of torsional spring and mechanical stopper and only one active joint are employed in order to realize an underactuation. Each passive component is installed into the five-bar linkage. In order to activate the finger prosthesis, it is required for the user to flex and extend the remaining proximal phalanx on the metacarpophalangeal (MCP) joint, not an electric motor. Thus the finger prosthesis conducts not only the natural motion according to his/her intention but also the grasping motion through the deformation of springs by the object for human finger-like behavior. In order to reveal the operation principle of the proposed mechanism, kinematic analysis is performed for the linkage design. Finally both simulations and experiments are conducted in order to reveal the design feasibility of the proposed finger mechanism.

• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.252-255
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• 2018

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

• International Journal of Internet, Broadcasting and Communication
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• 제13권2호
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• pp.260-266
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• 2021

Handwriting using the dominant and nondominant arms was analyzed in 52 young adults with the aid of a three-axial accelerometer. We measured a signal vector magnitude (SVM) and the percentage of the total signal vector magnitude (%TSVM) for the metacarpophalangeal joint (MCP), radial styloid process (RSP), and lateral epicondyle (LE) of both arms. The SVM for the MCP was lower in the dominant arm than the nondominant arm, whereas that for the RSP was higher. %TVSM was lower for the MCP than for the RSP and LE in the nondominant arm, but higher for the MCP than for the LE in the nondominant arm. These findings suggest that controlling the MCP will improve the quality of handwriting, including when using the nondominant arm.

• Annals of Occupational and Environmental Medicine
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• 제34권
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• pp.10.1-10.11
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• 2022

Background: Repetitive hand use increases the risk of hand osteoarthritis (OA). This study aimed to investigate characteristics of and risk factors for hand OA in Korean women farmers. Methods: This cross-sectional study included women farmers resident in Jeollanam-do, Korea. The participants were interviewed, and radiographs were taken of both hands. Radiological hand OA was defined based on the Osteoarthritis Research Society International imaging criteria of joint space narrowing or the presence of osteophytes. The participants were divided into age groups of < 60 and ≥ 60 years. Obesity was defined as body mass index of > 25 kg/m². Annual working time was divided into < 2,000, 2,000-2,999, and ≥ 3,000 hours. Agricultural working type was divided into rice farming and field farming. Robust Poisson regression was used to identify factors associated with radiographic hand OA, with adjustment for age, obesity, annual working time, and agricultural classification. Results: A total of 310 participants with a mean age of 58.1 ± 7.6 years, were enrolled. The prevalence of radiologically confirmed OA was 49.0%, with an OA prevalence of 39.4% the interphalangeal joint in the thumb (IP1). The prevalence of OA was higher in the distal interphalangeal joint than in the proximal interphalangeal, metacarpophalangeal, and carpometacarpal joints. The prevalence of OA varied by age, annual working time, and agriculture type. Conclusions: Korean women farmers have a high prevalence of OA, particularly in the IP1 joints. OA is associated with age, working hours, and agriculture type.

• 한국전문물리치료학회지
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• 제12권4호
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• pp.33-40
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• 2005

The purpose of this study was to define more precisely the anatomy of the thumb flexor pulley system and to determine the relative contribution of each of the pulleys to the biomechanics of thumb motion at the metacarpophalangeal (MP) and interphalangeal (IP) joints. For this, 22 hands from 11 cadavers were used and randomly assigned to two groups. In the first group, the first annular (A1) pulley was cut first followed by the variable annular (Av) pulley and then the oblique pulley. In the second group, the oblique pulley was cut first followed by the, pulley and then the Av pulley. In 7 of 22 hands, it was a transverse structure parallel to the, pulley with a gap between the A1 and Av pulleys, referred to here as type I. In 9 hands, the A1 and Av pulleys were connected without any gap (type II). In 6 hands, the space between the A1 and Av pulleys were triangular in shape with fibers of the Av pulley converging toward the radial side (type III). In biomechanical study of both first and second experiments, there was no significant difference in MCP joint flexion between the all intact, A1 section, A1/Av section, A2 intact (A1/Av/oblique section), and no pulley configuration (p>.05). In occurring displacements less than 10 mm, there was no significant difference in IP joint flexion (p>.05). However, there was a significant decrease in IP joint flexion occurred in both 15 mm and 20 mm excursion (p<.05), when the oblique pulley was resected additionally after cutting the A1 and Av pulleys in first experiment, and when the A1 pulley was resected additionally after cutting the oblique pulley. According to the results, the injury of only the oblique pulley does not decrease thumb motion significantly. The oblique pulley injury with both the A1 and Av pulleys laceration decreased thumb motion significantly. The additional laceration of the A2 pulley does not decrease thumb motion.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.138-142
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• 2012

Background : Electrical burns are one of the most devastating types of injuries, and can be characterized by the conduction of electric current through the deeper soft tissue such as vessels, nerves, muscles, and bones. For that reason, the extent of an electric burn is very frequently underestimated on initial impression. Methods : From July 1999 to June 2006, we performed 15 cases of toe tissue transfer for the reconstruction of finger defects caused by electrical burns. We performed preoperative range of motion exercise, early excision, and coverage of the digital defect with toe tissue transfer. Results : We obtained satisfactory results in both functional and aesthetic aspects in all 15 cases without specific complications. Static two-point discrimination results in the transferred toe cases ranged from 8 to 11 mm, with an average of 9.5 mm. The mean range of motion of the transferred toe was $20^{\circ}$ to $36^{\circ}$ in the distal interphalangeal joint, $16^{\circ}$ to $45^{\circ}$ in the proximal interphalangeal joint, and $15^{\circ}$ to $35^{\circ}$ in the metacarpophalangeal joint. All of the patients were relatively satisfied with the function and appearance of their new digits. Conclusions : The strategic management of electrical injury to the hands can be both challenging and complex. Because the optimal surgical method is free tissue transfer, maintenance of vascular integrity among various physiological changes works as a determining factor for the postoperative outcome following the reconstruction.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.135-145
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• 1998

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but it's indication has been limited distal to the metacarpophalangeal(MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of $30^{\circ}$ flexion and $45^{\circ}$ internal rotation but in 6 cases in the fixation of $30^{\circ}$ flexion and $30^{\circ}$ internal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint, it is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of $30^{\circ}$ flexion and $45^{\circ}$ infernal rotation for the better functional outcome.