Kumar Rajesh, John Jerry R, Gupta Tarush, Sharma Ramesh K
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Plast Surg. 2024 Jul 30;57(Suppl 1):S43-S49. doi: 10.1055/s-0044-1788664. eCollection 2024 Dec.
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. 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. 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. 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.
手指截肢旨在保留功能并优化美观。在此关键决策是保留残端还是进行射线截肢。本研究旨在比较射线截肢或经近端指骨截肢后的功能结局和术后生活质量。
2019年1月至2020年6月，对需要经近端指骨或掌骨进行单指截肢的患者进行了一项前瞻性研究。患者分为两组；A组：经近端指骨截肢；B组：手指射线截肢。评估了以下功能参数：握力、手周长、手掌容积和指蹼间距。采用密歇根手部结局问卷（MHQ）评分来评估双手在6个月时的手部功能和感觉。
共纳入30例患者。对26例患者（52只手）的结果进行了进一步分析，A组12例，B组14例。与对侧正常手相比，两组患者的握力均显著下降（A组为29.22±14.88，B组为34.57±19.12）；然而，两组之间在统计学上无显著差异。两组受累手的平均手掌周长均减小，但仅B组周长减小在统计学上具有显著意义。B组患者在MHQ的所有六个子量表中的得分均更高；然而，只有美学得分显著更高。手术手的指蹼间距相对于对侧正常指蹼平均显著增加了4.55毫米。
该研究得出结论，应与患者详细讨论两种截肢水平的手术选择，同时考虑他们的职业和个人需求。我们的研究结果将有助于客观地向患者提供咨询，说明两种技术在功能和美学结局方面的预期。
