Indian Journal of Plastic Surgery最新文献

Objective  The aim of this study is to create clinical normative data for ulnar length in the pediatric population and to demonstrate the usefulness of such data. Materials and Methods  A nationally representative sample of healthy children aged 1 day to 18 years from five centers across India was collected. The percutaneous length of the ulna was measured by using a certified calibrated measuring tape across all centers. Other variables such as geographical domicile, dominance of the hand, age, body mass index (BMI), and sex of the child were also recorded. Results  In total, 1,300 children (883 males and 417 females) with age ranging from 1 day to 18 years were included in the study. Gradual lengthening of the ulna was seen in both male and female children with increasing age without a significant difference; however, at 8, 9, and 14 years, there was significant lengthening of the ulna in males compared with females although the difference was statistically insignificant at 17 years. Apropos BMI at 16 years of age, a longer ulna was observed in obese children. Later on, at 18 years, the difference in ulnar length was insignificant. South Indian children had a significantly longer ulna up to the age of 11 years, but after the age of 11 years there was no difference in ulnar length in all zones. The length of the ulna was not affected by hand dominance. There was good inter-observer agreement and reliability between different centres. Age, zone, and gender, had statistically significant effect on the length of ulna but BMI and hand dominance was not significant. Conclusion  This multicentric study provides normative data on the percutaneous length of the ulna in the Indian pediatric population. Gradual lengthening of the ulna was seen in all children with increasing age. The length of the ulna was significantly more in male, obese, and in South Indian children. However, except for age, other factors become insignificant at maturity.

A 21-year-old male laborer sustained bilateral degloving injury of the hands with multiple digital amputations and devascularized digits. After X-rays, preliminary debridement was done, when digital amputations were completed, including index ray amputation on both sides. The next day, two anterolateral thigh (ALT) flaps and one second toe transfer were done to restore coverage in the palm and the web and reconstruct the lost thumb. This ensured both coverage and thumb length on the right side, but on the left side the procedure was terminated with flap transfer only. After 3 months, the other second toe was harvested with a dorsalis pedis flap for reconstruction of the left thumb, and a free gracilis flap was done for optimal donor site coverage in the donor left foot. Evaluation after 2 years showed functional hands with reasonable power grasp, pinch grip, and dexterity to manipulate small and large objects that permitted an independent living.

Background  The normative data for finger range of motion (ROM) are not available for the Indian population. The aim of our study was to measure the active ROM of finger joints in normal healthy volunteers in a sample of Indian population. Materials and Methods  This is a prospective observational study conducted as a part of the Indian normative data project of the Indian Society for Surgery of the Hand (ISSH). The study included one participating center from four geographical regions of the country. Certified goniometers were used to measure the ROM of fingers in all centers. A standardized methodology was devised. A pilot study was done to assess the interobserver and intraobserver reliability, following which data were collected by one measurement. Results  This pilot study was performed in 20 hands that showed good interobserver and intraobserver reliability correlation. A total of 390 hands were measured in four participating centers. Active flexion of metacarpophalangeal (MCP) joint was the highest in the middle finger (86.6 ± 10.4 degrees) followed by the index finger (86.0 ± 9.2 degrees), little finger (85.0 ± 8.4 degrees), and ring finger (84.2 ± 8.6 degrees). The index finger (97.2 ± 16.9 degrees) showed maximum proximal interphalangeal (PIP) joint flexion followed by the middle finger (96.2 ± 15.8 degrees), ring finger (96.0 ± 15.9 degrees), and little finger (91.8 ± 12.7 degrees). Distal interphalangeal (DIP) joint flexion increased from the index finger (81.6 ± 13.9 degrees) to the little finger (84.6 ± 12.9 degrees). The little finger MCP joint (26.3 ± 6.2 degrees) showed maximum extension followed by the index finger (25.7 ± 6.8 degrees), middle finger (24.7 ± 6.7 degrees) and ring finger (22.3 ± 7.1 degrees). The middle finger (15.6 ± 8.1 degrees) and ring finger (16.2 ± 8 degrees) had more PIP joint extension when compared to the index (13.7 ± 7.8 degrees) and little finger (13.2 ± 8.4 degrees). The ring finger (8.1 ± 6.8 degrees) and the middle finger (8.4 ± 6.9 degrees) had more DIP joint extension when compared with the index finger (6.0 ± 6.0 degrees) and the little finger (6.8 ± 6.7 degrees). Total active motion (TAM) of the middle finger (315.9 ± 31.0 degrees) was the maximum followed by the index finger (310.2 ± 27.3 degrees), ring finger (308.8 ± 29.1 degrees), and little finger (307.8 ± 25.2 degrees). Gender, body mass index (BMI), mother tongue, geographical location, and occupation were factors that had significant correlation, while no significant differences based on side, hand dominance, and age were noted. Conclusion  We have reported normative data of finger ROM and TAM for the index, middle, ring, and little fingers in the Indian population. Finger ROM in the Indian population is highly variable. The observed TAM in the Indian population is higher than what is reported earlier.

Background  Finger amputations aim at preserving function and optimizing cosmesis. The crucial decision here is whether to preserve a stump or to do a ray amputation. The present study aimed to compare the functional outcome and postoperative quality of life after ray amputation or amputation through the proximal phalanx. Materials and Methods  A prospective study was conducted from January 2019 to June 2020 in patients requiring single-finger amputation through the proximal phalanx or metacarpal. Patients were divided into two groups; Group A: amputation through the proximal phalanx and Group B: ray amputation of the finger. The following functional parameters were assessed: grip strength, hand circumference, palmar volume, and webspace span. The Michigan Hand Outcomes Questionnaire (MHQ) score was employed to score hand function and aesthesis at 6 months in both hands. Results  Thirty patients were enrolled. Findings in 26 patients (52 hands) were subjected to further analysis, 12 in Group A and 14 in Group B. Patients in both groups lost grip strength significantly compared with their contralateral normal hands (29.22 ± 14.88 [Group A] and 34.57 ± 19.12 [Group B]); however, it was statistically nonsignificant between the two groups. There was reduced mean palmar circumference in both groups' involved hands, but the decrease in circumference was statistically significant, only for Group B. Group B patients scored better in all the six subscales of the MHQ; however, only the Aesthetics score was significantly superior. The operated hand's webspace span increased significantly with respect to the normal contralateral web by a mean of 4.55 mm. Conclusion  The study concluded that both the surgical options for the level of amputation should be discussed with the patients in detail, taking into account their occupational and personal requirements. Our study findings will help to objectively counsel the patients regarding expectations in functional and aesthetic outcomes following either technique.

Introduction  This article aims to establish the relative thumb length in comparison to the index finger in central Indian adults. Materials and Methods  Five hundred normal adult hands (1,000 thumbs), 316 men and 184 women, mean age 30 years, were included in the study. The relative length of the thumb was measured using the length of the proximal phalanx of the index finger (thumb-proximal phalanx index) and the distance between the proximal digital crease and proximal interphalangeal crease of the index finger (thumb-digital crease index). Results  The tip of a normal adducted thumb extends to 69% of the length of the proximal phalanx of the index finger and 38% of the distance between the two proximal creases of the index finger. The tip of a normal adducted thumb extends to 68% for male and 69% for female of the length of the proximal phalanx of the index finger. For the dominant hand the tip of a normal adducted thumb extends to 68%, while for nondominant hand it reaches 71% of the length of the proximal phalanx of the index finger. The difference between the laterality, gender, and hand dominance was not statistically significant. Conclusion  The tip of a normal adducted thumb extends to 69% of the length of the proximal phalanx of the index finger and 38% of the distance between the two proximal creases of the index finger. Relative normal thumb length is independent of gender, laterality, or hand dominance.

Introduction  Radiography is the most often accessible and affordable imaging modality. Accurate assessments of wrist X-rays can aid in the diagnosis and prognostic evaluation of various wrist problems. This study aims to identify normal radiographic anthropometry reference values and variations of carpal bones and joints by gender and age in sample Indian population, with the potential to be clinically applicable. Materials and Methods  Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology Information Systems and Picture Archiving and Communication Systems were used to collect standard digitized normal X-rays without significant osseous pathology over a year. We conducted measurements of length, angles, and indices in a standard posteroanterior and lateral wrist X-rays in order to establish the standard dimensions and variances based on age and gender. Results  A total of 18 measurements which included eight linear measurements, eight angles, and two ratios were documented. A total of 500 X-rays of 250 males and 250 females with 125 of each in two age groups of 20 and 40 years and 41 and 60 years were evaluated. Conclusion  This work is a comprehensive database of the Indian population measuring parameters in normal wrist radiographs of posteroanterior and lateral views. The results of our study indicate that men and younger individuals had a significantly higher carpal height ratio. The width of distal radial ulnar joint space was significantly lesser in older subjects. Additionally, males showed a significantly higher lunate uncovered ratio and radial height. When compared to the literature, the study revealed a significant positive ulnar variance in elderly people and women. However, we noted an overall increase in the percentage of positive ulnar variance individuals in our study. We also recorded a marginal increase in radial inclination with no variations across gender and age.

Distal nerve transfers are frequently used for the treatment of patients having brachial plexus injuries. Spinal accessory nerve to suprascapular nerve transfer by dorsal approach is advantageous since it brings the site of neurotization closer to the neuromuscular end plate and minimizes donor muscle weakness. This surgery is found to be challenging owing to the small and deep operative field. In this article, the authors describe the surgical technique for this procedure.

Aesthetic genital surgeries are on the rise globally. Labia minora reduction, the most common aesthetic genital surgery, can be done either by the edge resection or by the wedge resection techniques. The edge resection technique trims the edge of the labia minora and leads to unnatural results as it does not maintain the color gradation that is naturally present on the inner surface of the labia minora or the minor irregularities that are naturally present in the labia besides posing problems like scar pain at edges during intercourse and chances of overresection. Wedge resection has the advantage of retaining the color gradation and the minor natural irregularities on the edge of the labia minora and is considered to be a better technique than the edge resection technique. However, the classical central wedge reduction technique suffers from a deformity in long term in the form of a visible notch at margins of the labia minora at the site of suturing. The author suggests a modification of this technique to overcome this problem to give better natural long-term results.

Fishing as a hobby is fairly popular among youth in hilly and mountainous areas of the world. Hence, injuries to extremities are also common by fishing equipment, especially in untrained people using indigenous equipment. The mechanism of injury is that of penetrating trauma. There is a paucity of literature regarding fishing equipment injury to extremities. In this article, we have presented a case series of fishing arrow injuries presented to us in the Department of Plastic and Reconstructive Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India. Most of these injuries were treated under the wide-awake local anesthesia no tourniquet technique which has revolutionized the management of extremity injuries. Also, special precautions regarding the prevention of further tissue injury by arrow hooks while retrieving the arrows have been highlighted.