Öz
Objective: The aim of this case report is to make a partly contribution to the literature about the physiotherapy assessment and treatment methods after toe-to-hand transplantations and to report the results of the treatment program.
Methods: Our patient is a 17-year old boy with a traumatic second and third finger amputation. One year later the injury, he underwent a transplantation surgery that left second toe was transferred as the right index finger. After immobilization of 4 weeks, he was directed to physiotherapy programme that was planned in 3 steps. The first stage of treatment was early rehabilitation. At this stage, through the post-operative 8th week, we aimed to control edema and increase the range of passive and active-assistive motion. Between the 8th and 12th weeks resistance exercises of the transplantated finger were added to the programme. After the 12th week, return to daily life activities was the target of late stage physiotherapy programme.
Results: Post-operative 4th, 8th and 12th week assessments revealed that the range of motion and the grip and pinch strengths of the transferred finger increased while the most significant increase was seen in the pinch strengths. Moreover, functional test score and disability rate, which are both the indicators of the patient’s functional level, improved gradually. Besides meeting a young patient’s aesthetic deficit by the transplantation surgery, the functional benefits of a well-established post-operative physiotherapy programme were inavoidable.
Conclusion: It is suggested that physiotherapists would contribute to the patient’s functional recovery by applying a patient-tailored treatment programme.
Anahtar Kelimeler
Kaynakça
- Replantation surgery in China. Report of the American Replantation Mission to China. Plast Reconstr Surg. 1973; 52: 476-489.
- Redeker J, Radtke C, Handschin A, Vogt PM. Re: Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009; 124(6): 2198-2199.
- Guelinckx PJ, Sinsel NK, Defrene B. Toe tissue transfer for the reconstruction of digital injuries. Acta Chir Belg. 2002; 102(3): 1521
- Cannon NM, Strickland JW.Therapy following flexor tendon surgery Hand Clin. 1985; 1(1): 147-165.
- Dorf E, Blue C, Smith BP, Koman LA. Therapy after injury to the hand. J Am Acad Orthop Surg. 2010; 18(8): 464-473.
- Szczechowicz J, Pieniazek M, Pelczar-Pieniazek M. Restoration of hand function and ability to perform activities of daily living following surgery for carpal tunnel syndrome. Ortop Traumatol Rehabil. 2008; 10(2): 152-167.
- Ebinger T, Erhard N, Kinzl L, Mentzel M. Dynamic treatment of displaced proximal phalangeal fractures. J Hand Surg Am. 1999; 24(6): 1254-1262.
- Imai H, Tajima T, Natsumi Y. Successful reeducation of functional sensibility after median nerve repair at the wrist. J Hand Surg Am. 1991; 16(1): 60-65.
- Gülgönen A, Özer K. Long-term results of major upper extremity replantations. J Hand Surg Eur Vol. 2012; 37(3): 225-232.
- Lei Xu, Yu-Dong Gu, Jian-Guang Xu, Yong-Jun Rui, Kui-Sui Shou. Microsurgical Treatment For Bilateral Thumb Defect: Five Case Reports. Microsurgery. 2003; 23: 547-554.
- Wang YC, Magasi SR, Bohannon RW, Reuben DB, McCreath HE, Bubela DJ, Gershon RC, Rymer WZ. Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox. J Hand Ther. 2011; 24(4): 313-209.
- Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations.J Hand Surg Am. 1984; 9(2): 222-2
- Mathiowetzs V, Weber G, Kashman N, et al.Adult’s norms for 9-hole peg test of finger dexterity. Occup Ther J Res. 1985; 5: 24-38.
- Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç. Kol omuz ve el sorunları (Disabilities of the Arm, Shoulder and Hand—DASH) anketi Türkçe uyarlamasının uyarlamasının güvenirliliği ve geçerliği. Fizyoterapi ve Rehabilitasyon. 2006; 17: 99-107.
- Lutz BS, Wei1 F. Basic Principles on Toe-to-Hand Transplantation Chang Gung Med J. 2002; 25: 568-576.
- Kvernmo HB, Tsai TM. Posttraumatic Reconstruction of the Hand—A Retrospective Review of 87 Toe-to-Hand Transfers Compared With an Earlier Report. J Hand Surg. 2011; 36A: 1176-1181.
- Godshall M. Toe-to-Hand Transplantation Surgery. Orthopaedic Nursing. 2006; 25 (1): 13-19.
- Gentilucci M, Caselli L, Secchi C. Finger control in the tripod grasp. Exp Brain Res. 2003; 149(3): 351-360.
- Yokogawa R, Hara K. Manipulabilities of the index finger and thumb in three tip-pinch postures. J Biomech Eng. 2004; 126(2): 212-219.
- Rivas S, López-Gutiérrez JC, Lovic A, Díaz M, Andrés AM, Ros Z. Double toe to hand transfer in children with symbrachydactyly. Cir Pediatr. 2006; 19(3): 173-176.
Öz
Amaç: Bu olgu sunumunun amacı, parmak transplantasyonu sonrası uygulanan fizyoterapi değerlendirme ve tedavi yöntemleri konusunda literatüre katkıda bulunmak ve bu tedavi programının sonuçlarını sunmaktır.
Yöntemler: Vaka; sağ el 2. ve 3. parmakta travmatik amputasyon meydana gelmiş 17 yaşında erkek hastadır. Yaralanmadan 1 yıl sonra sol ayak 2. parmağı, sağ el indekse transplante edilmiştir. Dört haftalık immobilizasyon sonrası fizyoterapi için yönlendirilen hastanın tedavisi üç aşamalı olarak planlanmıştır. Birinci aşama erken dönem rehabilitasyondur. Cerrahi sonrası 8. haftaya kadar devam eden bu aşamada ödem kontrolü, pasif ve aktif-asistif eklem hareketinin arttırılması planlanmıştır. 8 ve 12. haftalar arasında programa transplantasyona yönelik dirençli egzersizler eklenmiştir. 12. haftadan sonraki geç dönem rehabilitasyon programında ise günlük yaşama geri dönüş hedeflenmiştir.
Bulgular: Cerrahiden sonraki 4.,8. ve 12. haftalarda yapılan değerlendirmelerde transfer edilen parmağın eklem hareket açıklığı ve kavrama kuvvetlerinde artış olduğu görülmüş, en fazla artışın pinch kuvvetlerinde olduğu dikkati çekmiştir. Ayrıca, fonksiyonellik ölçütü olan el fonksiyon testi ve özür seviyesi skorlarında gelişmeler kaydedilmiştir. Cerrahi sonrası uygulanan planlı fizyoterapi programı ile hastada fonksiyonel kazanç sağlanmıştır.
Sonuç: Hastaya uygun planlanan fizyoterapi programı ile, hastanın fonksiyonel geri dönüşüne katkıda bulunulacağı düşünülmektedir.
Anahtar Kelimeler
Kaynakça
- Replantation surgery in China. Report of the American Replantation Mission to China. Plast Reconstr Surg. 1973; 52: 476-489.
- Redeker J, Radtke C, Handschin A, Vogt PM. Re: Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009; 124(6): 2198-2199.
- Guelinckx PJ, Sinsel NK, Defrene B. Toe tissue transfer for the reconstruction of digital injuries. Acta Chir Belg. 2002; 102(3): 1521
- Cannon NM, Strickland JW.Therapy following flexor tendon surgery Hand Clin. 1985; 1(1): 147-165.
- Dorf E, Blue C, Smith BP, Koman LA. Therapy after injury to the hand. J Am Acad Orthop Surg. 2010; 18(8): 464-473.
- Szczechowicz J, Pieniazek M, Pelczar-Pieniazek M. Restoration of hand function and ability to perform activities of daily living following surgery for carpal tunnel syndrome. Ortop Traumatol Rehabil. 2008; 10(2): 152-167.
- Ebinger T, Erhard N, Kinzl L, Mentzel M. Dynamic treatment of displaced proximal phalangeal fractures. J Hand Surg Am. 1999; 24(6): 1254-1262.
- Imai H, Tajima T, Natsumi Y. Successful reeducation of functional sensibility after median nerve repair at the wrist. J Hand Surg Am. 1991; 16(1): 60-65.
- Gülgönen A, Özer K. Long-term results of major upper extremity replantations. J Hand Surg Eur Vol. 2012; 37(3): 225-232.
- Lei Xu, Yu-Dong Gu, Jian-Guang Xu, Yong-Jun Rui, Kui-Sui Shou. Microsurgical Treatment For Bilateral Thumb Defect: Five Case Reports. Microsurgery. 2003; 23: 547-554.
- Wang YC, Magasi SR, Bohannon RW, Reuben DB, McCreath HE, Bubela DJ, Gershon RC, Rymer WZ. Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox. J Hand Ther. 2011; 24(4): 313-209.
- Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations.J Hand Surg Am. 1984; 9(2): 222-2
- Mathiowetzs V, Weber G, Kashman N, et al.Adult’s norms for 9-hole peg test of finger dexterity. Occup Ther J Res. 1985; 5: 24-38.
- Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç. Kol omuz ve el sorunları (Disabilities of the Arm, Shoulder and Hand—DASH) anketi Türkçe uyarlamasının uyarlamasının güvenirliliği ve geçerliği. Fizyoterapi ve Rehabilitasyon. 2006; 17: 99-107.
- Lutz BS, Wei1 F. Basic Principles on Toe-to-Hand Transplantation Chang Gung Med J. 2002; 25: 568-576.
- Kvernmo HB, Tsai TM. Posttraumatic Reconstruction of the Hand—A Retrospective Review of 87 Toe-to-Hand Transfers Compared With an Earlier Report. J Hand Surg. 2011; 36A: 1176-1181.
- Godshall M. Toe-to-Hand Transplantation Surgery. Orthopaedic Nursing. 2006; 25 (1): 13-19.
- Gentilucci M, Caselli L, Secchi C. Finger control in the tripod grasp. Exp Brain Res. 2003; 149(3): 351-360.
- Yokogawa R, Hara K. Manipulabilities of the index finger and thumb in three tip-pinch postures. J Biomech Eng. 2004; 126(2): 212-219.
- Rivas S, López-Gutiérrez JC, Lovic A, Díaz M, Andrés AM, Ros Z. Double toe to hand transfer in children with symbrachydactyly. Cir Pediatr. 2006; 19(3): 173-176.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Articles |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Ocak 2014 |
| Gönderilme Tarihi | 30 Ocak 2014 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 3 Sayı: 2 |
Kaynak Göster