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Friday 3 November 2017

Thimble - Type Prostheses: A Successful Option for Distal Finger Loss


                                    http://austinpublishinggroup.com/anaplastology/#



Finger and partial finger amputations are frequently encountered problems leading to partial hand loss, which occur commonly due to trauma, congenital absence or malformations. All of these may present similar clinical challenges which can vary from loss of fingertip to complete finger amputation. Frequently, the loss of even the tip of a digit can be so emotionally disturbing to the patient that it deserves serious attention. Creating a life like prosthesis with characteristics such as pleasing shape, thin margins, lifelike fingernails, and realistic color, contours and details are essential for patient satisfaction, but to maintain all these qualities it needs good suspension. Recording a suitable impression of the residual supporting structure is primary requirement for obtaining better fit of the prosthesis.

A 24-year-old female patient came to the department with the chief complain of loss of upper phalange of the middle finger of left hand due to childhood injury (Figure 1). The patient was more esthetically and socially concerned with no functional problem reported as she was well adapted with time. Remnant of the nail was seen on the tip of amputated part. The distal amputation level was sub zone II as classified by Ishikawa et al. The patient was advised to cut her nail at timely interval, so that it may not affect the fitting of the prosthesis. A plastic cylindrical small open container (Impression Cap) was used for making silicone impression of the defected finger (Figure 2). Putty and light body addition silicone impression material (Express, 3M ESPE; St. Paul, MN) was used and after that cast was poured. The wax pattern was made using alginate impression (Zelgan, Dentsply India Pvt. Ltd.) of the same fingers of right hand.


was poured in alginate impression and after cooling of wax, minor modification of the pattern was done to simulate it according to the fingers of left hand. Wax pattern was modified and terminated till next joint of the missing finger as margins were least visible at joint area. This pattern closely resembles the shape and size of the missing finger and after hollowing with the hot wax spatula this pattern was properly fitted over the cast (Figure 3). After taking final opinion of the patient pattern was flasked for curing with silicone material (bredent Multisil-Epithetic set, Senden, Germany). Care was taken to avoid undercuts during counter- flasking. The pattern was flasked in such a way that dorsal and the ventral aspects of the finger were separable to enhance the accuracy at the stage of shade matching. Suitable quantity of Multisil-Epithetic transparent was first poured onto a mixing pad. Intensive stains were mixed into the epithetic transparent and direct color comparison of the palmer and dorsal surface of the hand were carried out separately in natural day light. After all stains had been mixed, thickener was used to increase viscosity of silicon material to avoid running of the different stains while adding them into the flask. For the characterization of fingernail, palmer surface shade was used to simulate natural nails. After curing the final prosthesis was retrieved, the flash was trimmed using a sharp blade and the final finishing was completed using fine sand paper. Patient was well satisfied with its retention and esthetic appearance (Figure 4). Proper instructions regarding the follow- ups and handling of the prosthesis were given.

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