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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 163-167

Prosthetic rehabilitation of an amputated finger


Department of Prosthodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Meenu Garg
A-49, Kalkaji, New Delhi - 110 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.191734

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  Abstract 

Amputation of finger causes devastating physical, psychosocial, and economic damage to an individual. The concealment of an amputated part with the help of prosthesis can shield an amputee from social stigma. Prosthesis for such patient must be comfortable to wear lightweight, durable, cosmetically pleasing easy to put on and remove. The restoration of finger amputations depends on the amount of tissue involved, the involvement of bone, the angles and levels of amputation, and the involvement of other fingers. The microsurgical reimplantation helps to save many severely injured and traumatically amputed finger. The prosthetic rehabilitation of an amputated finger is considered when microvascular reconstruction is not possible, unavailable, unsuccessful, or unaffordable. Most accepted material is silicones because of their better esthetics, ease of manipulation, and availability. This paper presents prosthetic rehabilitation of index finger of the right hand with custom made silicon prosthesis.

Keywords: Amputation of finger, prosthesis retention, silicone materials


How to cite this article:
Garg M, Pathak C, Tangri SB, Gupta A. Prosthetic rehabilitation of an amputated finger. Indian J Dent Sci 2016;8:163-7

How to cite this URL:
Garg M, Pathak C, Tangri SB, Gupta A. Prosthetic rehabilitation of an amputated finger. Indian J Dent Sci [serial online] 2016 [cited 2019 May 20];8:163-7. Available from: http://www.ijds.in/text.asp?2016/8/3/163/191734


  Introduction Top


Prosthetics is an art and science which offers a natural appearance to the lost structures of the patient. Finger and partial-finger amputations are some of the most frequently encountered forms of partial-hand losses. Loss of even one finger produces significant esthetic and functional deficiencies.[1] The main causes of finger amputation are infections and nerve injuries, congenital malformation, malignancy, traumatic injuries, such as frost bite, gun shot, burns, workers having a profession of agriculture, fishing, carpenter, etc.[2] Most common methods to replace the loss of finger are endoprosthesis, e.g., implants and exoprosthesis, e.g., silicon prosthesis, acrylic prosthesis, prosthesis using attachments, and magnets. Passing through various materials, the acceptance rate has been much higher when an individually sculpted custom restoration using silicone elastomer.[3],[4] This report presents a case of rehabilitation of a finger defect with a silicone prosthesis and describes a method of retention for the same.


  Case Report Top


A 34-year-old male patient reported to the Department of Prosthodontics, with a chief complaint of a partially missing index finger of his right hand. History revealed that the patient lost a part of his index finger 5 years back due to traumatic injury. The amputation was partial, involving the mid-part of the middle phalanx of the right index finger. On physical examination, there was no pain on palpation, and the surrounding skin showed no signs of inflammation and infection [Figure 1] and [Figure 2]. The patient had no history of a previous prosthesis. The treatment options included implant-supported fixed finger prosthesis and conventional silicon removable prosthesis. The patient was unwilling for any surgical procedure, so fabrication of conventional silicon prosthesis was planned.
Figure 1: Dorsal view of both hands showing normal and lost finger.

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Figure 2: Hand wrist X-ray showing lost finger.

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Method of fabrication

Impression making

A thin layer of petroleum jelly was applied to the patient's hand prior making an impression. A wide plastic container was selected according to the size of the palm and impressions of affected hand was made with irreversible hydrocolloid impression material (Jeltrate; Dentsply) by asking the patient to place his hand in relaxed state into selected wide container without touching its bottom part [Figure 3].
Figure 3: Alginate impression of affected hand.

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The impression was then poured with ADA type III dental stone (Kal Rock, Kala Bhai Karson Pvt.,) to create positive replica of the amputated finger and associated structures [Figure 4].
Figure 4: Positive replica of amputated finger and associated structure.

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Wax pattern fabrication

Another impression of the contralateral digit using alginate impression material was made, and modeling wax (Y-Dent, MDM corporation, New Delhi, India) was melted and poured into the negative mold to duplicate the anatomic details of the lost finger The overall diameter of the middle phalanx (about 1 cm) was reduced by 0.5 mmt using a flame-shaped tungsten carbide bur to produce an undersized finger sleeve. This was done to get snugly fit of finger prosthesis [Figure 5].
Figure 5: Diameter of middle phalanx reduced by 1 cm.

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The wax pattern was placed over prepared finger stump, and necessary modifications in thickness and anatomy were done. Surface characterization (skin folds and wrinkles) was incorporated so as to reproduce exact anatomy of missing finger. This pattern was assessed and further adjusted keeping in mind the alignment, size, shape, and contours of the contralateral finger. Wax pattern trial was done to check fit and alignment with respect to adjacent fingers. Stump was cut from the hand model using a die saw for wax pattern fabrication [Figure 6],[Figure 7],[Figure 8].
Figure 6: Stump cut from hand model using a die saw.

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Figure 7: Separated stump.

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Figure 8: Wax pattern fabricated.

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Flasking and processing of finger prosthesis

After satisfactory trial, the wax pattern was then flasked using ADA Type IV Die Stone (Kal Dent) into conventional denture curing flask using two pour technique. Necessary steps were taken to avoid incorporation of air bubbles. Undercuts were avoided to facilitate easy opening of the flasks and subsequent removal of the set silicone prosthesis. Dewaxing was done, and mold was obtained [Figure 9].
Figure 9: Mold obtained after dewaxing.

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The finger stump was carefully separated without breaking mold. Soap solution was then applied into mold and on prepared stump as separating media. The finger stump was placed back in the mold, and complete closure of flask was again checked. The maxillofacial silicone was mixed following manufacturer's instructions, avoiding incorporation of air bubbles. The mix was divided into two parts one for dorsal, and other for ventral portion of the finger. Shade matching was carried out by adding an appropriate ratio of intrinsic colors (Mp Sai biomed silicone prosthesis - set of five pigments) available with silicone material preferably under natural light. The obtained shade of mix was sequentially checked with patient's ventral and dorsal aspect of finger [Figure 10],[Figure 11],[Figure 12].
Figure 10: Mixing of material for shade matching.

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Figure 11: Shade checked with patient ventral aspect of finger.

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Figure 12: Shade checked with patient dorsal aspect of finger.

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Once satisfactory shade was obtained, packing of maxillofacial silicone material was done with respect to dorsal and ventral portions. The flask was closed under pressure and was left undisturbed for 24 h for complete polymerization (room Temperature vulcanization of maxillofacial silicone [Figure 13]. Deflasking was done, and finger prosthesis was carefully retrieved from stump and excess silicone trimmed using sharp curved scissors. Burs provided by the company were used to finish the prosthesis. The fit and shade of the finger prosthesis were evaluated on the patient. The customized metal ring was used as an auxiliary aid of retention and also to mask prosthesis and skin junction.
Figure 13: Packing of silicone material.

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Artificial fingernail of appropriate shade was procured from commercial channels and placed on replicated nail bed using medical grade adhesive [Figure 14]. The patient was given instruction regarding finger prosthesis maintenance. Special instructions of avoiding moisture contact and direct sunrays exposure was given to the patient. The patient was recalled after 1 week for recall checkup.
Figure 14: Final prosthesis with artificial nail.

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  Discussion Top


Loss of any finger affects esthetics and functionality, greatly impacting dexterous individuals. Most cases involving distal phalanx amputations can be restored to near normal functionality using appropriate prosthesis. Allen's classification is commonly used to describe the level of amputation for fingertip amputations. Type 1 injuries are those involving the pulp only. Type 2 injuries consist of injury to the pulp and nail bed. Type 3 injuries include distal phalangeal fracture with associated pulp and nail loss. Type 4 injuries involve the lunula, distal phalanx, pulp and nail loss.[5]

Despite the advances in the microsurgical techniques, the reconstruction of the amputated digits for a number of patients may not be successful and they can be more benefitted with passive prostheses. The primary purpose of prosthesis is to allow the patient to pass unnoticed, and concealment of prosthesis usage has been found to be an effective coping strategy.[6]

The traditional method of prosthesis is replacing the lost finger by an artificial digit. The artificial digit is made of a silicone elastomer (chemical name-polysiloxane). The finger prosthesis requires an optimum retention for functions such as grasping, carrying, and holding. A significant advantage of using this technique is the exact duplication of the anatomical and the fine surface details of the digits. This allows the surface characteristics of the prosthesis to be closely matched to that of the remaining digits of the hand. With the appropriate alignment modifications, the technique can be applied to cases of partial hand amputations involving the other digits, including the thumb. Owing to the wider rate of acceptance, comfort, durability, stain resistance of customized silicone prostheses and patients unwillingness to go for any surgical procedure involving implants, the above-explained method of fabrication of prosthesis was opted. The additional functional benefits of silicone prostheses include desensitization and protection of the painful hypersensitive tissue at the amputation site by constant gentle pressure exerted over the affected area. It has also been speculated that silicone gel improves the hydration of the stratum, making the scar tissue more pliable, and comfortable. Various methods of retention are available (i.e., using rings over the margins of the finger prosthesis, using medical grade adhesive, or by implant-retained prosthesis).[7],[8],[9]


  Conclusion Top


Good suspension alone is not sufficient for patient acceptance of finger prostheses. For many patients, a high level of cosmesis is paramount.

Characteristics such as a pleasing shape, thin margins, lifelike fingernails, and realistic color, contours, and detail are also essential for patient satisfaction.

This level of restoration is most successful when finger prostheses are individually sculpted and colored in situ under a variety of lighting conditions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Taylor TD. Clinical Maxillofacial Prosthetics. Chicago: Quintessence; 2000.  Back to cited text no. 1
    
2.
Shanmuganathan N, Uma Maheswari M, Anandkumar V, Padmanabhan TV, Swarup S, Jibran AH. Aesthetic finger prosthesis. J Indian Prosthodont Soc 2011;11:232-7.  Back to cited text no. 2
    
3.
Buckner H. Cosmetic hand prosthesis a case report. J Prosthet Orthot 1980;3:41-5.  Back to cited text no. 3
    
4.
Kini AY, Byakod PP, Angadi GS, Pai U, Bhandari AJ. Comprehensive prosthetic rehabilitation of a patient with partial finger amputations using silicone biomaterial: A technical note. Prosthet Orthot Int 2010;34:488-94.  Back to cited text no. 4
[PUBMED]    
5.
Yeo CJ, Sebastin SJ, Chong AK. Fingertip injuries. Singapore Med J 2010;51:78-86.  Back to cited text no. 5
[PUBMED]    
6.
Yeshwante B, Parasrampuria N, Baig N. Prosthetic rehabilitation of an amputated finger. IOSR J Dent Med Sci 2014;13:10-7.  Back to cited text no. 6
    
7.
Larcher S, Espen D. Post-acute management of fractures of the proximal interphalangeal joint with metal prosthesis: first experience. Handchir Mikrochir Plast Chir 2007;39:263-6.  Back to cited text no. 7
[PUBMED]    
8.
Onishi Y, Fujioka H, Doita M. Treatment of chronic post-traumatic hyperextension deformity of proximal interphalangeal joint using the suture anchor: A case report. Hand Surg 2007;12:47-9.  Back to cited text no. 8
[PUBMED]    
9.
Bickel KD. The dorsal approach to silicone implant arthroplasty of the proximal interphalangeal joint. J Hand Surg Am 2007;32:909-13.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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