RESUMEN
Management of fingertip and thumb tip injuries has recently undergone substantial changes. The time-proven traditional armamentarium of local flaps has been expanded and replaced by a wide variety of flaps. Simultaneous with the development of new flaps, the conservative treatment of fingertip and thumb tip injuries with semiocclusive dressings has also become a more acceptable treatment for these injuries. The excellent results with respect to restoring contour, sensibility of the pulp, and aesthetics of the finger justify this more tedious and time-consuming treatment of fingertip and thumb tip injuries. This article gives an update of the most commonly used flaps and the semiocclusive dressing treatments of fingertip and thumb tip injuries.
Asunto(s)
Traumatismos de los Dedos/cirugía , Apósitos Oclusivos , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos , Algoritmos , Desbridamiento , Estética , Humanos , Recuperación de la Función , Sensación , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/cirugía , Pulgar/lesiones , Pulgar/cirugíaRESUMEN
The management of thumb tip injuries has undergone great changes in recent years. The traditional armamentarium of flaps has been expanded and replaced by a wide variety of flaps with more versatility and less donor side morbidity. Parallel to the development of new flaps, the conservative treatment of thumb tip injuries with semi-occlusive dressing has gained ground in the treatment of these injuries. Although tedious and time-consuming, and requiring intensive communication with the patient to explain the look and occasionally fetid smell of the wound, this technique yields excellent results with respect to restoring contour and sensibility in pulp injuries. The article gives an update on the current options for treating thumb tip injuries including the most commonly applied flaps.
Asunto(s)
Traumatismos de los Dedos/cirugía , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/trasplante , Pulgar/lesiones , Desbridamiento/métodos , Educación Médica Continua , Femenino , Traumatismos de los Dedos/diagnóstico , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Apósitos Oclusivos , Pronóstico , Recuperación de la Función , Medición de Riesgo , Traumatismos de los Tejidos Blandos/diagnóstico , Colgajos Quirúrgicos/irrigación sanguínea , Pulgar/cirugía , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
Cutaneous regeneration utilizes paracrine feedback mechanisms to fine-tune the regulation of epidermal keratinocyte proliferation and migration. However, it is unknown how fibroblast-derived hepatocyte growth factor (HGF) affects these mutually exclusive processes in distinct cell populations. We here show that HGF stimulates the expression and phosphorylation of the microtubule-destabilizing factor stathmin in primary human keratinocytes. Quantitative single cell- and cell population-based analyses revealed that basal stathmin levels are important for the migratory ability of keratinocytes in vitro; however, its expression is moderately induced in the migration tongue of mouse skin or organotypic multi-layered keratinocyte 3D cultures after full-thickness wounding. In contrast, clearly elevated stathmin expression is detectable in hyperproliferative epidermal areas. In vitro, stathmin silencing significantly reduced keratinocyte proliferation. Automated quantitative and time-resolved analyses in organotypic cocultures demonstrated a high correlation between Stathmin/phospho-Stathmin and Ki67 positivity in epidermal regions with proliferative activity. Thus, activation of stathmin may stimulate keratinocyte proliferation, while basal stathmin levels are sufficient for keratinocyte migration during cutaneous regeneration.
Asunto(s)
Queratinocitos/citología , Queratinocitos/efectos de los fármacos , Estatmina/farmacología , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Humanos , Antígeno Ki-67/metabolismoRESUMEN
OBJECTIVE: Case report and review of the current literature about febrile ulceronecrotic Mucha-Habermann disease (FUMHD). METHODS: Review of our patient's medical records and of the current literature. RESULTS: The FUMHD is a rare and potentially lethal type of pityriasis lichenoides et varioliformis acuta. It is characterized by the sudden onset of ulceronecrotic skin lesions associated with high fever and systemic symptoms. Because of a high case-fatality rate it requires quick and decisive action. Only 40 cases of this severe form of the disease have been reported in the literature to date. We present the case of a 30-year-old male patient with severe FUMHD who was successfully treated in our burn intensive care unit after failed treatment at a dermatological hospital. The patient was treated with topical antiseptics, moisturizers, and artificial skin substitutes, as well as systemic immunosuppressive therapy (glucocorticoids) with which we were able to control the disease activity so that healing of the patient's skin lesions could be achieved. CONCLUSION: Patients with FUMHD should be treated in a specialized center for severely burned patients. Only such centers can provide the structural and logistical capacities necessary for the treatment of such extensive superficial wounds.
RESUMEN
A variety of local flaps are described for reconstruction of soft tissue defects of the thumb. Restored sensibility, low donor-site morbidity, full restoration of function and range of motion, and an acceptable aesthetic outcome are requirements in thumb reconstruction. Reverse homodigital dorsal radial flap of the thumb provides most of these requirements and allows for dependable coverage of radiopalmar or dorsal thumb defects without affecting other digits.