J Korean Soc Surg Hand.  2013 Dec;18(4):155-160. 10.12790/jkssh.2013.18.4.155.

Reconstruction of Digits Injured by Punch Press Machine

• Hwang SM
• Lee JS
• Kim HD
• Jung YH
• Kim HI

• KMID: 1840496
• DOI: http://doi.org/10.12790/jkssh.2013.18.4.155

Abstract

PURPOSE
Digits injured by punch press machines show peculiar types with segmental loss of middle part of digits. Although the distal parts of finger survived, thr results is frequently unfavorable with respect to function and appearance after inappropriate reconstruction.
METHODS
From August 2008 to February 2013, five digits injured by punch press machines in four patients were managed. Pinch strength, two-point discrimination and active range of motion were measured to evaluate finger function.
RESULTS
Three digits with a preserved amputated segment underwent replantation. Partial necrosis occurred in one digit in which local flap was performed. Secondary tendon graft was performed in the other digits. Two digits without segment was reconstructed by arthrodesis after shortening the length. The patients were generally satisfied with function and appearance.
CONCLUSION
Reconstruction of digits injured by punch machines are technically difficult. Replantation is the best method in cases of preserved segment, while arthrodesis with shortening is appropriate in cases without segment.

Keyword

Fingers; Amputation; Segmental amputation; Punch press

MeSH Terms

Amputation
Arthrodesis
Discrimination (Psychology)
Fingers
Humans
Methods
Necrosis
Pinch Strength
Range of Motion, Articular
Replantation
Tendons
Transplants

Figure

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  Fig. 1. (A, B) A 25-year-old male patient shows segmental amputation on right index and middle finger by punch press machine.

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  Fig. 2. (A) Preoperative radiologic finding. (B) Postoperative radiologic finding at 7 months after replantation.

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  Fig. 3. (A, B) Favorable appearance at 7 months after replantation.

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  Fig. 4. (A)Active range of motion is 30° in both finger. (B) Sufficient pinch strength to use a pen.

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  Fig. 5. (A, B) A 53-year-old male patient shows segmental amputation on right index finger by punch press machine.

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  Fig. 6. (A) Preoperative radiologic finding. (B) Postoperative radiologic finding at 3 months after arthrodesis.

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  Fig. 7. (A, B) Favorable appearance at 7 months after arthrodesis.

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