Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases

In the past 5 years, 25 mutilated digits were reconstructed with immediate toe-to-hand transfers after acute hand injuries, for 21 patients. The overall results of the immediate toe-to-hand transfers were evaluated and compared with the results of 65 elective procedures performed during the same period by the same surgeon. There were 15 cases of great toe-to-hand transfer for thumb reconstruction, two cases of second toe transfer for index finger reconstruction, and four cases of simultaneous two-toe transfer for reconstruction of multiple-digit amputations. Two cases (two of 25 cases, 8 percent) were successfully salvaged with emergency reexploration. The incidences of emergency reexploration and postoperative infection were not significantly different from those for elective toe-to-hand transfer cases. The duration of industrial insurance coverage was much shorter than for elective cases, averaging 225 days (p < 0.001). Approximately 44 percent of the patients maintained their original jobs after immediate toe-to-hand transfer. The subjective satisfaction self-assessment scores of aesthetic appearance and function for the newly reconstructed thumb averaged 80 and 88 (of a total score of 100), respectively. Although satisfaction was lower than for elective reconstruction (p < 0.001), it was higher than for reconstruction of other digits. The donor-site appearance after great toe harvesting was mostly unsatisfactory. Immediate toe-to-hand transfer provides many advantages over the elective procedure in acute hand injuries, including single-stage reconstruction, shortened convalescence, early return to work, and socioeconomic efficiency. Because there were no significant differences in the success rates, frequencies of complications, or ultimate functional results, immediate toe-to-hand transfer is a safe and reliable procedure that is indicated for specific cases of acute digital amputation.     

Common injuries of the athlete's hand.

Hand injuries are among the most frequent accidents seen in sports medicine. All too commonly they are considered trivial since the athlete may continue to participate actively and neglect his injury. The consequent delay in diagnosis and proper treatment may result in long-standing or even permanent disability. This paper describes the more commonly encountered hand injuries, their diagnosis and their optimal treatment. Included are soft-tissue injuries, ligamentous injuries, fractures and tendon avulsions. The basic principles applicable to skeletal and soft-tissue trauma of the hand, which physicians at all levels of sports medicine may encounter, are stressed.     

Wound botulism: a life-threatening complication of hand injuries

Botulism is usually associated with the ingestion of food contaminated with Clostridium botulinum, and these organisms occasionally contaminate traumatic injuries. It is unusual for them to result in clinical infection, but when this occurs, it is a catastrophe completely out of proportion to the degree of wound injury. A case is presented in which typical manifestations of descending cranial nerve and generalized motor paralysis were noted. Prolonged respiratory and general supportive assistance was required, as is usually the case. Although mortality rates in this disease are high, recovery is usually complete in survivors and was true in this instance.     

Management of human bite injuries of the hand.

On the basis of experience at the Ottawa Civic Hospital over the past 10 years, a classification of and protocol for the management of human bite injuries of the hand are presented. Early exploration of such wounds under local anesthesia improves the outcome by facilitating adequate cleansing of the wound and enabling deep structures to be visualized. In this way the risk of major sepsis and of the disability so frequently associated with these innocent-looking injuries can be reduced.     

Impalement injuries of the hand: repair of damage from broken bean poles

A not uncommon injury of the hands among agricultural workers is impalement on the sharp ends of tomato-vine or bean-vine stakes that shatter as they are being driven. Careful debridement and tetanus prophylaxis are important in treatment. There are several simple precautions and changes in work methods that could greatly reduce the incidence of such injuries.     

Anatomy of the hand and arm in Daubentonia madagascariensis : a functional and phylogenetic outlook

The aye-aye (Daubentonia madagascariensis) is easily the most enigmatic of living primates. It sports a unique combination of derived characters, including continuously growing incisors, functional claws, the largest hand of any primate and a highly modified middle finger. The specialised middle finger is no longer used in locomotion and serves as a probe-like instrument for investigating, locating and extracting xylophagous (wood-boring) larvae as well as other food items. Its phalanges can be moved both at great speed and independently of each other. The present study reports on dissections of the forelimbs of two individuals of D. madagascariensis and one specimen each of Lemur catta and Cercopithecus cephus. Derived characters of the forelimb musculature in Daubentonia are interpreted within the context of its distinct locomotor and foraging adaptations. The primary adaptations underlying speed and mobility in the third manual digit of Daubentonia are found in the intrinsic hand musculature and notably in the arrangement of the dorsal aponeurosis. Implications for the interpretation of suggested convergences between the aye-aye, the diprotodont marsupial Dactylopsila palpator and the early Tertiary apatemyid genus Heterohyus are discussed.