Recovery Flask

Hand prosthesis: An art of reconstruction

 

Introduction:

"It is the God given right of every human being to appear human".

Any kind of deformity, facial or elsewhere may cause psychological and emotional disturbance to the patient as well as social annihilation. Both function and form are important attributes of the hand. The active function of the hand is represented by its prehensile activities in grip, grasp, transferring and absorbing forces.1

         Nowadays the amputation of one or more fingers of the hand, as the consequence of trauma or congenital absence of one or more phalanxes, carries a serious reduction of hand function and social dysfunction for the patient.2 Currently, many injuries and traumatic amputations of fingers can be rescued by microsurgery through reimplantation. However, in some cases, reconstruction is either not advisable or partially successful.3 It is in this group of patients that prosthesis can be provided and may offer great psychological help.4

         Esthetic prostheses for the hand can offer psychological, functional and rehabilitative advantages. By restoring the natural appearance to the hand, prosthesis eliminates the trauma caused by constant reminder of the handicap and, thus offers true psychological therapy.5 Thus, the purpose of this report is to describe a simple technique for fabrication of acrylic resin hand prosthesis for a patient after an accident at work to provide motor skills recovery and diminished social discrimination.

Case report:

A patient was attended in the clinic for rehabilitation of the left hand with missing middle finger, ring finger and little finger including the respective metacarpal bones (fig 1,2).

 

When multiple fingers are missing, extensive skin coverage must be considered. It was preferred to fabricate partial hand prosthesis for multiple finger loss, with the uninjured fingers left free, because they can apply more force and use the hand for a variety of activities. Upon examination, the remaining stump was found to be stable and rehabilitative process was possible using conventional hand prosthesis.

 

Technique:

An impression of the remaining stump was made using the irreversible hydrocolloid material (Neocolloid; Zhermack: Kab dental supplies) (fig 3).

         To maintain a natural appearance, the prosthesis was sculpted with each joint slightly flexed. Wax pattern was hollowed from inside to make the final prosthesis light in weight. Later it was placed in warm water so that the fingers were shaped to mimic the natural opposing hand when it is held at rest. Borders were merged with the skin adjacent to the defect site (fig 4).

         For retention of the prosthesis, two loops made of orthodontic wire were embedded into the hollow part of the wax pattern. These loops were used to engage the Velcro strap. Additional retention was achieved through a finger ring which engaged the index finger.

         The wax pattern was then tried on the patient. The fit, stability, borders and retention of the pattern were evaluated along with shape and size of the pattern. The anatomic lines were then checked to improve esthetics. Using lost wax technique a three piece mould using type III dental stone was made to fabricate the prosthesis (fig 5).

Heat polymerizing clear acrylic resin (DPI – Heat cure; Dental products of India ltd) was intrinsically pigmented according to the skin color of the patient. Color matching of the under surface was done first as this tends to be lighter than the top surface. For finger nails, acrylic resin was pigmented to mach the patient's natural nails. Both the halves of the flask were closed; light pressure was applied to remove excess flash. The resin was processed at slow curing cycle of polymerization. When the moulds were sufficiently cool, the prosthesis was carefully removed. The fit and shade was evaluated on the patient. Extrinsic coloring was done to match the exact color of the patient and have life-like appearance. Careful coloration is crucial for maximal patient acceptance. The patient was wearing the prosthesis under a variety of light sources (fig 6, 7). To achieve an enhanced realistic appearance, the nail and nail bed were shaped with trimmer according to the nails of the natural fingers. The prosthesis was inserted and the patient was instructed in home care and prosthesis maintenance.

Discussion:

Finger reconstruction, especially of proximal phalanx, requires complex surgical procedures with specific functional and cosmetic requirements. Furthermore, even when these techniques offer several advantages whenever fingers are amputated or mutilated, it is very limited in amputation of the proximal phalanxes of the second and third finger because the transposed digital finger may reveal itself too short and consequently not functional at all.

         Our patient was not willing for any reconstructive surgical correction. Considering the age, general health and economic status of the patient, we were oriented towards the non invasive technique which would solve the aesthetic need of the patient. For these reasons, prosthetic rehabilitation was introduced and a number of materials and technique have been developed to be used in this process. The acrylic resin and silicone are the most common materials used for rehabilitation. Although silicone has texture and flexibility similar to the skin, provides a more comfortable and better capacity for skin – prosthesis linkage. However, this material is more difficult to pigment and degrades due to color instability when exposed to ultraviolet rays.6

         On the other hand, even though acrylic resin is a very hard material and slightly uncomfortable to the patient, but there are added advantages such as easily characterized, presents great durability, cost effective, relined or repaired easily and intrinsic and extrinsic color matching is best achieved.

         Among the sculpture techniques there is the analogous finger technique, which is performed by moulding and sculpture of another person finger or can also be carried out based on anatomical reproduction.7,8

         Currently, the methods for prosthesis retention to the remaining part of the finger include ring, double ring, adhesives and osseointegrated implants.4,9Although the patients frequently require optimal reconstruction of the hand in cases of injury or amputation, prosthetic devices recover only basic functions of the hand. Minute finger control requires considerable mechanical engineering that encompasses an efficient motor drive and adequate power supply which renders possible prototypes for hand prostheses in everyday performance.10

         Bone anchoring is another alternative method used since 25 years in oral surgery; it was first described by Branemark11,12 as an alternative technique to dental prosthesis. For many years it was treatment of choice for teethless patients until Lundborg13 in 1993, started the use of osseointegrated implants to anchor prosthesis of long bones of the leg. Later this technique was applied to retain the maxillofacial prostheses. The limitations of this procedure are, it requires preservation and normal functioning of the metacarpal phalanx joint and the presence of an adequate consistency of the bone to allow implants anchoring. The major complications are: lack of osseous integration of the implant, but is very rare, detachment of the prosthesis or lack of acceptance by the patient.4,14

CONCLUSION:

Good suspension alone is not sufficient for patient   acceptance   of hand prosthesis. For many patients, a high level of cosmesis is paramount. Characteristics such as a pleasing shape, thin margins, lifelike finger nails, realistic color, contours, and detail are essential for patient satisfaction. This level of restoration is most successful when hand prostheses are individually sculpted and colored in situ under variety of lighting conditions.

 

References:

1. Pereira BP, kour AL, Leow EL, Pho RWH. Benefits and use of digital prostheses. J Hand Surg (Am) 1996; 21: 222-28.
2. Cervelli V, Bottini DJ, Arpino A, Grimaldi M, Rogliani M, Gentile P. Bone anchored implant in cosmetic finger reconstruction.Annales de chirurgie plastique esthetique 2008; 53: 365 – 67.
3. Wilson RL, Carter- Wilson MS. Rehabilitation after amputations in the hand. Orthop clin north Am 1983; 14: 851- 72
4. Pilley MJ, Quinton DN. Digital prostheses for single finger amputation. J Hand Surg (Br) 1999; 24(5): 539-41
5. Pillet J. Esthetic hand prosthesis. J Hand Surg (Am) 1983; 8: 778 – 781
6. Gary JJ, Huget EF, Powell LD. Accelerated colour change in a maxillofacial elastomer with and without pigmentation. J Prosthet Dent 2001; 85: 614 – 20
7. Alison A, Mackinnon SE. Evaluation of digital prostheses. J Hand Surg (Am) 1992; 17: 923 – 26
8. O'Farrell DA, Montella BJ, Bahor JL, Levin LS. Long term follow-up of 50 duke silicone prosthetic fingers.  J Hand Surg (Br) 1996; 21: 696-700
9. Yazdanie N. Prosthetic rehabilitation of an amputated thumb. J Coll Physicians Surg Pak 2003; 13: 355 – 6
10. Matussek J, Neff G. The artificial hand - An overview of hand prostheses. Orthopedics 2003; 32: 406- 12.
11. Tjellstorm A, Rosenhall U, Lind Storm J, HAllen O, Albrektsson T, Branemark PI. Five year experience with skin penetrating bone-anchored implants in the temporal bone. Acta Otolaryngol 1983; 95(5-6): 568 – 75.
12. Eriksson E, Branemark PI. Osseointegration from the perspective of the plastic surgeon. Plast Reconstr Surg 1994; 93(3): 626 – 37
13. Manurangsee P, Isariyawnt C, CAtuthong V, Mekraksawanit S. Osseointegrated finger prosthesis: An alternative method for finger reconstruction. J Hand Surg(Am) 2000; 25(1): 86 – 92.
14. Lundborg G, Branemark PI, Rosen B. Osseointegrated thumb prostheses: A concept for fixation of digit prosthetic devices. J Hand Surg(Am) 1996; 21(2): 216 – 21.

About the Author

1. Dr Nivedita  Mankani

 MDS, senior lecturer, department of prosthodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India

Phone no - +919481212040

E-mail id – drniveditam@yahoo.co.in

  2. Dr Nagaraj. E 

 MDS,  senior lecturer, department of prosthodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India

Phone no - +919916809032

E-mail id – dr_nagaraj_e@yahoo.co.in

3. Dr  Brijesh A. Patil

MS (Ophthalmology), Associate Professor, S.Nigalingappa Medical college and hospital, Bagalkot, Karnataka,India

Phone number: +919481212020

Email id : drbrij74@yahoo.co.in

4. Dr Gangadhar B.Angadi

BDS, Lecturer, department of periodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India.

Hottest Thoughts On Wines Decanter Work With

Wine decanters are fantastic methods to supply vino in a very fresh and also fascinating technique. A huge selection of wines equipment currently available extends to wines decanters and you will be capable of finding a huge range of design along with variety and acquire the appropriate wine beverages decanter for your home.

Alessi Michael Graves Pitcher

You will see these questions traditional vogue and with extremely fundamental style and design, and they are best for part. They may merely enable your current red take in and stay a stupendous technique to make flask from the dining room table in addition to give a hint regarding selection and sophisticated style for a night.

Alfi Juwel Lacquered Thermal Carafe, Velvet Burgundy, 8-Cup

You can also find some beautiful regular very layouts, most of which will be intricate in ornament. The particular stopper is often exceptionally beneficial in addition to is useful, rendering it a sensible way to retail store ones red wine specifically. Alternatively you are able to pre-chill a person's wines decanter and after that grow it having a light wines that'll be eaten promptly.

Arthur Court Elephant Wine Cooler

If you're a more modern decorator, you will be more interested in decanters which are really spectacular along with seem more like bronze sculpture when compared with useful glass wares. You can also obtain them inside alternative products for instance polymer, which is fantastic if you worries about break.

Vino decanters have got truly turn into method to voice your own design and style.

You don't need to share the same form of decanter your parents experienced when you were being we were young unless of course this type you like. If not then you can certainly use a wholly new path and appear in to a lot of the creator portions alternatively. These are typically stunning possibilities and may even sit down empty with your dining room table and appear becoming a work of genius. You can fill up all of them with different materials amongst uses and make them displayed always.

In the beginning decanters ended up built to assist servants throughout having wine beverages to the table more readily. In the beginning manufactured in glass, following the fall on the Roman Empire, other materials needed to be observed along with porcelain solutions ended up being made as a substitute coupled with precious metals like rare metal in addition to bronze. A wine glass seemed to be reintroduced for usage while in the Renaissance after which it during the early 1700's the particular stopper ended up being put into the structure. This specific granted the wine to go longer, and prevent almost any disease which could have happened.

If the vino is large together with deposit after that decanter has been made for an individual. It really is manufactured to help you go away the particular deposit in the bottle of wine plus shift precisely the vino per se over directly into another fishing boat.

These days to weeks generally some sort of wine decanter is utilized strictly to get model as an alternative to initial perform. It's actually a much more pleasing technique to exhibit wines on the dining table and it also makes for the particular coordinator to hide the particular content label. If you must use a residence wine beverage superior products then you can sense a lot less than very happy to illustrate it well and a wine beverages decanter is the best increase for your glasses.

Homemade wine decanters can be bought in various styles, patterns and are actually easily obtainable in distinct colours by using coloured goblet building a organization recovery inside the layout picture.

Percentage Recovery Question?

Its for my project:

I Weighed out 0.04g of GHB and spiked in a 10ml volumetric flask containing Red Wine.

I extracted it using SPE method (Solid Phase Extraction).

I measured it using the LC-MS (Liquid Chromatograpy-Mass Spectroscopy)
I diluted the sample into a concentration of 1microgram/ml and obtained a intensity peak.

So i calculated the concentration which was 0.7micrograms.

How much is recovered?

After dilution, you expect the concentration to be 1 microgram / mL, but the analysis show that concentration is only 0.7 microgram / mL.

If the analysis result and calculation are both correct

Percentage Recovery = ( 0.7 / 1.0 ) x 100
= 70 %

( Yes, as simple as described )

Broken Flask of Alabaster