Ectopic implantation salvage of the left thumb to reconstruct the right thumb after electrical injury: a case report

The incidence rate of electrical injury has remained stable, while the absolute case number has increased. Amputations, erosions, occlusions, and delayed blood vessel rupture are the common complications. Ectopic implantation salvage has been performed widely in mechanical trauma patients, to preserve viable or possibly viable tissues and organ, without application in the electrical injury patients to the best of our knowledge. Here, we present a case report involving ectopic implantation salvage of the left thumb before contralateral transplantation to the right hand after high-voltage electrical injury. The patient’s left thumb remained viable despite necrosis of the left forearm at 3 weeks post-injury. After debridement, we implanted the left thumb to his thigh where it was anastomosed to the lateral circumflex femoral artery’s descending branch and great saphenous vein. We replanted the left thumb on the right hand with fixation 6 weeks later. The reassembled right hand remained well-circulated 11 months post-reconstruction. We believe this case supports broadening the indication for ectopic implantation salvage surgeries to patients who sustain electrical injuries.

Estimation of Stature from Length and Breadth of Left Thumb in Medical Students of a Medical College in Kathmandu, Nepal

There is enormous importance of identification for forensic experts. Identification of human remains is always challenging for them, worldwide. An individual’s parameter has been an intrinsic representative among the other parameters. To specify the relationship between height and finger length in healthy persons, both male and female, an effort has been made to originate the regression formula. A descriptive and cross-sectional study was conducted at Department of Forensic Medicine, Nepal Medical College Teaching Hospital, Kathmandu with sample size 100 males and 100 females of 18-25 years of age. The stature of male subjects was 170.02 cm mean value with SD (± 6.40). The minimum stature observed was 152.5 cm while maximum was 188 cm. In males, mean of the left thumb length was 3.2 cm with SD (±0.38). Also, breadth of the left thumb showed a mean value of 2.52cm SD (±0.46) with Pearson coefficient (0.258). By means of linear regression analysis a constant (147.096) and Pearson correlation coefficient (0.337) were obtained for the length of left thumb. In female subjects, stature was found to be 157.76 cm mean value with SD (± 6.30). The minimum stature was 136.00 cm and maximum was 175.00 cm. The mean of left thumb length was 2.95 cm and 2.25 cm for breadth with SD (±0.4166) for both. Applying multiple regression, a constant (148.83) and Pearson coefficient (0.25) were obtained for left thumb length and SD (±0.423) was obtained for left thumb breadth. In males the stature can be estimated using standard equation (S= 150.49+4.65LTL+1.82LTB). In females, stature can be estimated using standard equation (S=148.83+4.4114LTL+1.423LTB), where S=stature, LTL= left thumb length, LTB= left thumb breadth. A multiple regression equation derived by our study can be used for estimation of height in Nepalese population. If either of the measurements (left thumb length and breadth) is known, the other can be calculated. It is remarked that length and breadth of left thumb shows positive relationship with the stature.

Onycholemmal Horn: An Exceedingly Rare Subungual Tumor

The onycholemmal horn is an exceedingly rare subungual tumor characterized by trichilemmal-like keratinization pattern. The only previous instance of onycholemmal horn dates back to 1983 when Haneke reported a keratotic subungual tumor clinically and histologically comparable to a trichilemmal horn. No other case of this condition has been reported so far. We present the case of a 72-year-old female patient, with a history of a slowly growing tumor originating from the nail bed epithelium of the left thumb. The lesion was surgically removed, and pathological examination was consistent with the diagnosis of an onycholemmal horn. Additionally, this study aims to elucidate the correlation between the onycholemmal and trichilemmal keratinization.

Clinical Considerations in Initial Evaluation and Treatment of Hardhead Catfish Spine Puncture Wounds

A 17-year-old male presented to our ED complaining of pain and swelling at the base of the first metacarpal after attempting to remove a catfish from his fishing line 12 hours prior to arrival. Radiographic images demonstrated a foreign body (FB), which was detectable by ultrasound. Hand surgery was consulted and took the patient to the operating room for exploration and removal of two serrated radiopaque catfish spines that were deeply embedded in the left thumb. Conclusion. Penetrating injury from hardhead catfish (Ariopsis felis) spines can cause hidden FB, envenomation, infection, and secondary damage to nearby structures. Imaging should be done for these patients to ensure they obtain timely and complete extraction of the venomous structures. Surgery should be consulted for operative management to avoid damage on removal of the catfish spine remnants.

Chemotherapy-related striate melanonychia: a case report

Background Chemotherapy medications are reported to cause discoloration of the nails known as melanonychia. Depending on the nail structure affected and the severity of the insult, the clinical features can be variable. There are a great deal of unreported cases of pigmentary nail changes associated with chemotherapy treatment. By sharing our knowledge, we hope to raise the awareness of these nail changes amongst clinicians. Early recognition is crucial to allay anxiety among patients and avoid any unnecessary investigations. Case presentation We present a case of 36-year-old woman of south Asian origin, who developed dark pigmentation in the left thumb nail during neoadjuvant chemotherapy with 5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel (FEC-D) for triple negative breast cancer. Upon examination, the left thumb nail pigmentation was strikingly linear, uniform, and well demarcated extending from proximal nail fold to free margin. Despite the reassuring clinical features, the patient was understandably anxious that this could be a presentation of acral melanoma and was referred to the plastic surgeons for a nail matrix biopsy. Biopsy reassuringly was reported as melanosis and a diagnosis of striate melanonychia was made. The patient was discharged after 2-year follow-up. Conclusion Chemotherapy medications have improved survival rates and patient outcomes. It is important for clinicians to be aware of the association of melanonychia with certain chemotherapy medications to reduce anxiety and allow successful management of these patients without delay. Striate melanonychia in this patient was felt most likely due to the synergistic effect of chemotherapy drugs compounded with racial predisposition. Chemotherapy agents most likely to have contributed include cyclophosphamide, docetaxel, and 5-fluorouracil.

A Bony Mallet Thumb with Interposition of the Nail Plate

Thumb extensor injuries and bony avulsion in the distal phalanx of the thumb are rare compared with other fingers. The most reported complications are infection, nail deformity, joint incongruity, implant failure, recurrent flexion deformity, and residual pain. This report presents a case of 30-year-old man suffering from an injury in the left thumb distal phalanx with a displaced comminuted intra-articular fracture of the distal phalanx of the left thumb. The nail plate was interposed between the dorsal and palmar fragments. The interposition of the nail plate in the bony mallet thumb has not been described before. Surgical treatment and fixation with a 2-mm miniscrew resulted in successful treatment. Clinical suspicion of this complication is of great importance and can affect treatment outcomes.

Tubercular dactylitis with deformity ipsilateral involvement of hand and foot in an adult: a case report

<p>Tubercular dactylitis is a rare entity and usually involves bones of hands and feet, involvement of feet is less common. Here we report case of 18 years old female with neglected tubercular involvement of her left thumb and left great toe of foot with hallux varus deformity. Her diagnosis was delayed as she did not seek any healthcare advice for a long time and also lack of suspicion of entity. This entity which should be kept in mind when making differential diagnosis that can be treated conservatively when diagnosed early.</p>

Digital Papillary Adenocarcinoma, a Rare Malignant Tumor

We present a case report of a digital papillary adenocarcinoma (DPA) on the left thumb with slow growth that was completely excised, without recurrence or metastasis during 24-month follow-up. DPA is a rare malignant tumor often located on the digits of the hand. Due to its slow growth and a non-specific appearance, the diagnosis is often missed or delayed. Treatment should be surgical with clear resection of the margins due to high risk of recurrence and/or metastasis.