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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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