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Case Report: 35-Year Follow-up for Nonvascularized Toe Phalangeal Transfer for Multiple Digit Symbrachydactyly.

ABSTRACT: Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.

SUBMITTER: Naran S

PROVIDER: S-EPMC5256662 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Case Report: 35-Year Follow-up for Nonvascularized Toe Phalangeal Transfer for Multiple Digit Symbrachydactyly.

Naran Sanjay S Imbriglia Joseph E JE

Hand (New York, N.Y.) 20160728 4

<b>Background:</b> A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. <b>Methods:</b> We present a case report which is discussed in the context of long-term follow-up, and ...[more]

PMID: 28149225

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Project description:RationaleMultiple myeloma (MM) is a hematologic malignancy characterized by proliferation of clonal plasma cells in the bone marrow. The median survival has increased to 6 years in recent years. But MM remains incurable. Some studies about the effects of Chinese herb medicine on MM have been carried out. Long survival in MM patients through Traditional Chinese Medicine (TCM) therapies has been reported rarely before.Patient concernsWe report a case of a female patient who was diagnosed with MM in 2000 at the age of 49. She received 9 cycles of multiple chemotherapeutic regimens mainly based on melphalan from September 2000 to May 2001. Though her condition was under control in some degree, she discontinued treatment due to significant side effects such as fatigue, hyperhidrosis, fever, chill, larynx mucosa ulcers, pharynx mucosa ulcers, and poor appetite. Instead, she sought treatment with TCM alone.DiagnosesBased on the TCM theory, the patient's condition was categorized as Xue Bi.InterventionsUp to the present, the patient has been using modified Huangqi Guizhi Wuwu Tang (HGWT) continuously for 18 years. In this prescription, Radix Astragali is an important herb. When the patient's condition worsened, its dosage was increased from 30 to 120g. Besides, she has been eating Radix Astragali porridge or drinking Radix Astragali tea for almost 18 years at the same time.OutcomesThroughout the period, no obvious side effects have been observed and her health condition remains stable.LessonsPolysaccharides isolated from Astragalus membranaceus (Radix Astragali) and Polyporus umbellatus could promote maturation of dendritic cells. Polysaccharides and flavonoids isolated from Astragalus membranaceus could regulate bone marrow microenvironment by inhibiting secretion of interleukin (IL)-6, IL-12 p40 and bidirectionally regulating the osteogenic capacity of osteoblasts. Besides, Rhizoma Atractylodis Macrocephalae, another important component of the prescription, has inhibitory effects on osteolytic bone lesions. This case suggests TCM treatment may have a positive therapeutic effect on MM. Modified HGWT, especially the Chinese herb medicine Radix Astragali could potentially be an alternative option for the treatment of MM. Both pharmacological studies and randomized clinical trials are needed in the future.

Dataset Information

Case Report: 35-Year Follow-up for Nonvascularized Toe Phalangeal Transfer for Multiple Digit Symbrachydactyly.

Publications

Case Report: 35-Year Follow-up for Nonvascularized Toe Phalangeal Transfer for Multiple Digit Symbrachydactyly.

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