- Fingertip amputations treated with occlusive dressings. [Journal Article]
- HSHand Surg Rehabil 2019 Jun 08
- The aim of this study was to analyze a series of patients who suffered a distal finger amputation and who were treated with occlusive dressings. A retrospective study was done of 19 patients from a s…
The aim of this study was to analyze a series of patients who suffered a distal finger amputation and who were treated with occlusive dressings. A retrospective study was done of 19 patients from a single hospital. At the review, an independent examiner evaluated the time required for wound healing, the number of occlusive dressings used, fingertip trophic skin changes, epicritic sensitivity using the Weber two-point discrimination (2PD) test, sensitivity based on the monofilament test, complications, the presence of dysesthesia or cold intolerance, and the QuickDASH score. The mean follow-up was 12.6 months (6-25). A mean of 3.2 occlusive dressings (3-5) were used per patient, and the mean healing time was 4.3 weeks (4-5). The skin texture, fingertips and nail bed were good or excellent in 18 cases. The 2PD test was good or normal in 16 cases. Eighteen patients were satisfied or very satisfied with the outcome. The mean QuickDASH score was 5.53 (0-20.45). In the literature, the recovery of tactile sensation is good after use of occlusive dressings (2PD of 2.5 to 4.0mm). The mean sensitivity reported in various studies is better than that observed after use of a skin flap. While the sample size in our study was small, the functional outcome and appearance were good. Thus we prefer using occlusive dressings in Zone 1 and 2 fingertip amputations, and flaps in zones 3 and 4 to ensure better fingertip viability and sensation.
- A novel anatomy-based five-points eight-line-segments technique for precision subtotal tongue reconstruction: A pilot study. [Journal Article]
- OOOral Oncol 2019; 89:1-7
- CONCLUSIONS: The anatomy-based FIPELS technique is an innovative and effective solution for subtotal tongue reconstruction.
- Tactile sensitivity thresholds for the radial hemi-pulp of the index: A comparison between the Semmes-Weinstein and Cochet-Bonnet tests in 25 healthy subjects. [Journal Article]
- HSHand Surg Rehabil 2018; 37(5):295-299
- The purpose of this work was to determine whether the Cochet-Bonnet (CB) corneal sensitivity test has a lower cutaneous pulp sensitivity threshold than the Semmes-Weinstein (SW) monofilament test. Ta…
The purpose of this work was to determine whether the Cochet-Bonnet (CB) corneal sensitivity test has a lower cutaneous pulp sensitivity threshold than the Semmes-Weinstein (SW) monofilament test. Tactile sensitivity thresholds for the radial hemi-pulp of the index finger of 25 healthy adult subjects aged 30 years on average were measured using SW and CB esthesiometers. The sensitivity threshold of the radial hemi-pulp of the index was lower with the CB test than with the SW test. The sensitivity and specificity of the CB test on palm wounds still needs to be determined to rule out nerve damage.
- Nerve injuries to the volar aspect of the hand: A comparison of the reliability of the Weber static test versus the gauze test. [Journal Article]
- IInjury 2017; 48(11):2582-2585
- When examining lacerations to the volar aspect of the hand a gauze test may usually be performed to detect nerve injuries. However, published literature suggests that its sensitivity and specificity …
When examining lacerations to the volar aspect of the hand a gauze test may usually be performed to detect nerve injuries. However, published literature suggests that its sensitivity and specificity are lower than 100%. The aim of this study was to determine whether a Weber static (main hypothesis) and dynamic test or a Semmes-Weinstein test (secondary hypotheses) could be a more reliable test than the gauze test to rule out any nerve injury and avoid unnecessary wound explorations. Our case series included a total of 102 patients presenting with 123 palmar lacerations and 158 nerve injuries. On arrival at the emergency department, every patient was tested for epicritic sensation at the pulp of the injured and contralateral fingers with the Weber static and dynamic tests and the Semmes-Weinstein monofilament test. All lacerations underwent exploration under anesthetic to rule out nerve injury. The sensitivities of the gauze test, the Weber static test, the Weber dynamic test and the Semmes Weinstein monofilament test were proven to be 82.5%, 98.6%, 97.9% and 86.7% respectively. The specificities of the gauze test, the Weber static test, the Weber dynamic test and the Semmes Weinstein monofilament test were 79%, 79%, 79% and 78.9% respectively. Examination of lacerations to the volar aspect of the hand to rule out any nerve injuries should include a Weber static test instead of a gauze test. A negative Weber static test should not however discourage a surgical exploration of the laceration to rule out tendinous or vascular injury.
- Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review. [Journal Article]
- JSJ Stomatol Oral Maxillofac Surg 2017; 118(6):389-392
- The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal.…
The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery®. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.
- The Slip Hypothesis: Tactile Perception and its Neuronal Bases. [Review]
- TNTrends Neurosci 2016; 39(7):449-462
- The slip hypothesis of epicritic tactile perception interprets actively moving sensor and touched objects as a frictional system, known to lead to jerky relative movements called 'slips'. These slips…
The slip hypothesis of epicritic tactile perception interprets actively moving sensor and touched objects as a frictional system, known to lead to jerky relative movements called 'slips'. These slips depend on object geometry, forces, material properties, and environmental factors, and, thus, have the power to incorporate coding of the perceptual target, as well as perceptual strategies (sensor movement). Tactile information as transferred by slips will be encoded discontinuously in space and time, because slips sometimes engage only parts of the touching surfaces and appear as discrete and rare events in time. This discontinuity may have forced tactile systems of vibrissae and fingertips to evolve special ways to convert touch signals to a tactile percept.
- Ipsilateral Facial Tactile Hypesthesia in a Patient with Lateral Medullary Syndrome. [Case Reports]
- JSJ Stroke Cerebrovasc Dis 2015; 24(11):e315-7
- CONCLUSIONS: There are two types of tactile sensation: epicritic and protopathic. Facial tactile sensation is usually thought to be associated with epicritic tactile sensation, which travels through principal sensory nuclei of the trigeminal nerve. The protopathic pathway travels down through the spinal tract via the trigeminal nerve and is not considered a primary pathway. However, in this case the protopathic tactile sensation pathway might be involved, and it caused facial tactile hypesthesia. Because most of previous case reports and literature reviews focused only on thermal/pain hypesthesia, we believe that this case provides critical information on the brainstem neuroanatomy, especially for the protopathic tactile sensation pathway in patients with stroke.
- Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face. [Journal Article]
- MMicrosurgery 2015; 35(3):177-82
- Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represen…
Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.
- The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. [Clinical Trial]
- PRPlast Reconstr Surg 2013; 132(3):656-65
- CONCLUSIONS: The reinnervated mushroom-shaped anterolateral thigh perforator flap was found to be an innovative and effective option for subtotal tongue reconstruction.
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- Epicritic sensation in cervical spinal cord injury: diagnostic gains beyond testing light touch. [Journal Article]
- JNJ Neurotrauma 2013 Aug 01; 30(15):1342-8
- Abstract Applied as a bedside test of gross dorsal column function, the testing of light touch (LT) sensation is of high clinical value in the diagnosis of human spinal cord injury (SCI). However, th…
Abstract Applied as a bedside test of gross dorsal column function, the testing of light touch (LT) sensation is of high clinical value in the diagnosis of human spinal cord injury (SCI). However, the assessment of overall dorsal column deficit by testing only LT may be limited, because the dorsal column pathway conveys several large diameter afferent modalities (e.g., sensation of touch, two-point discrimination, and proprioception). Therefore, the objective of this study was to compare the epicritic sensation assessed by LT, Semmes-Weinstein monofilament (SWM), and electrical perception threshold (EPT) across cervical dermatomes (C3-C8) in individuals with cervical SCI. A multicenter cross-sectional study was performed at 6 months after cervical SCI, applying combined measures of LT, SWM, and EPT, bilaterally over predefined key sensory points (C3-C8). A total of 300 left- and right-sided dermatomes were tested for each outcome measure in 25 participants. The percentage agreement between classifications according to LT and SWM/EPT testing for all dermatomes between C3 and C8 ranged from 95.5% to 36.2%. The degree of agreement showed considerably variable κ coefficients (-0.1≥kw≤0.7) for each dermatome between C3 and C8. The additional measurements of epicritic sensation by SWM and EPT increased sensitivity by detecting and quantifying differences in sensory thresholds above, at, and below the LT level of injury. This is relevant for early clinical trials (phase 1/2), in which disclosing any biological activity of an intervention may be revealed by subtle sensory changes that might gain a clinical relevance.