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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 84-88

Thumb prosthesis restoring fingers, hope and more


Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka, India

Date of Submission29-Sep-2018
Date of Acceptance20-May-2019
Date of Web Publication13-Nov-2019

Correspondence Address:
Dr. Disha Patel
Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_48_18

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  Abstract 


Partial or complete fingers are the most commonly encountered forms of partial hand losses. Although finger amputations are commonly due to traumatic injuries, digit loss may also be attributed to congenital malformations and disease. Irrespective of the etiology, the loss of a finger has a considerable functional and psychological impact on an individual. Maxillofacial prostheses replace the lost body parts using the silicone materials to alleviate these problems, and partial or complete finger prosthesis may be fabricated. This clinical report portrays a method to fabricate silicone rubber prosthesis for a patient who had a partial amputated thumb caused due to trauma. These prostheses support the patients physically as well as psychologically, thus enhancing their confidence and social acceptance.

Keywords: Amputation, partial finger, thumb prosthesis, vacuum retention


How to cite this article:
Patel D, Mehta S, Chethan M D, Nandeeshwa D B, Singh M, Hesham H. Thumb prosthesis restoring fingers, hope and more. Int J Oral Health Sci 2019;9:84-8

How to cite this URL:
Patel D, Mehta S, Chethan M D, Nandeeshwa D B, Singh M, Hesham H. Thumb prosthesis restoring fingers, hope and more. Int J Oral Health Sci [serial online] 2019 [cited 2019 Dec 9];9:84-8. Available from: http://www.ijohsjournal.org/text.asp?2019/9/2/84/270884




  Introduction Top


A finger is a limb of the human body and a type of digit, an organ of manipulation, and sensation which is found in hands of humans and other mammals. Humans have five digits which are termed as phalanges present on each hand. This organ enables the human body to perform various day-to-day functions. Out of all the phalanges present, the thumb is the most important digit.[1],[2]

Amputation is defined as removal of all or a part of body enclosed by skin. The word amputation is derived from the Latin word “amputare” which means to excise or to cut out. The most common causes of these amputations are trauma (77%), congenital (8.9%), tumor (8.2%), and malformations.[3] In India, farming is a major occupation. Thus, this holds a strong reason for most of the partial traumatic finger amputations. Any deformity, especially with the hands, affects the psychology of the patient and is a major functional deficiency, although, advances in surgical sciences in the form of microvascular reimplantations have helped to save many severely injured and traumatically amputated digits. However, prosthetic rehabilitation remains as one of the most economical and lucrative treatment options.[4]

A maxillofacial prosthesis restores and replaces the lost body parts using artificial substitutes.[3] The fabrication of partial amputated finger prosthesis is as much an art as it is a science. The form of prosthesis, shade matching, and texture must be as indiscernible as possible from the surrounding natural tissues. The ideally constructed prosthesis must duplicate the missing parts to as normal as possible. The most commonly used materials for this purpose are room temperature vulcanizing silicones (RTV silicones). The advantages of RTV silicones include chemical inertness, flexibility, elasticity, long-term color stability, easily molded and colored.[5],[6] This report describes the fabrication of silicone finger prosthesis for a patient who had partial finger loss caused due to trauma. Retention was achieved by passive vacuum fit. Such treatment avoids costly procedures and is the cost-effective choice for patients with financial constraints.


  Case Report Top


A 46-year-old male patient reported to the Department of Prosthodontics and Crown and Bridge, Bapuji Dental College with a chief complaint of missing thumb finger in the right hand and wanted replacement for the same. History revealed that the patient had lost his finger 5 years ago because of an unfortunate farming accident. On examination of the affected site, it was seen that the amputation was till the level of the middle of the middle phalanx, and the amputated stump had healed well with minimal discoloration. There was no sign of infection or swelling. There were no undercuts present, and the overlying tissue was mildly compressible. The advantages and limitations of the treatment were explained to the patient before the start of treatment procedure, and consent was obtained.

Fabrication of the prosthesis

Making the impressions and working model

A plastic container was chosen to confine the impression material and was tried on the patient's hand to provide adequate clearance of at least 2 mm around for the impression material. Regular setting alginate (Coltene, Mumbai) was mixed and poured into the container.[7] The patient's hand was dipped vertically into the container without touching the sides or the bottom of the container. The impression was poured in Type III dental stone (Dentsply, Mumbai), and working model was made[8] [Figure 1].
Figure 1: Working model of the residual stump

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Stump preparation

Hydrocolloid impression of the resected stump was made and poured in a dental stone [Figure 2]. To ensure a snug fit of the prosthesis to the tissue, the stump was reduced overall by around 0.5–1 mm with a tungsten carbide bur.[4] Scoring ensures that the silicone prosthesis can stretch and flex over the stump to provide better vacuum fit [Figure 1].
Figure 2: Surface modification of the working model

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Selection of a donor finger and making wax patterns

A donor finger for making the wax pattern was essential to avoid the laborious task of sculpting. Patient's left thumb was chosen as a donor finger. Impression of the donor finger was made by polyvinyl siloxane putty impression material (3M ESPE, Sweden) and poured with modeling wax (DPI, Mumbai). After the wax cooled down, it was retrieved from the impression and tried on the working stump. Final carving and adjustments were made to blend the margins with the working stump. The completed wax pattern was then finally tried on the patient's stump [Figure 3] and [Figure 4].
Figure 3: Wax pattern tried on the working model

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Figure 4: Try in of the wax pattern on the residual stump

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Flasking

The residual stump with the wax pattern was then flasked using two pour techniques in a varsity flask. Dewaxing was carried out, and two-part mold was obtained [Figure 5].
Figure 5: Two-part flask mold obtained after dewaxing

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Shade matching

Cosmesil series materials (Technovent, USA) and stains were used [Figure 6] and [Figure 7]. These materials are supplied in two components (Part A and Part B). Part A consists of base material and Part B consists of curative. The base color was matched by mixing the intrinsic stains with the silicone. Palmar surface of the finger was matched first with a lighter shade. Next, the color on the dorsal surface, usually a darker shade [Figure 8], was matched, characterization was incorporated, Part B was mixed, and packing was done [Figure 9]. The material was allowed to cure at room temperature for 24 h under bench press. The prosthesis was retrieved after 24 h [Figure 10]. Prostheses were finished using silicone finishing bur. To better match, the skin color external staining was also carried out.
Figure 6: Cosmesil series material

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Figure 7: Intrinsic stains

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Figure 8: Darker shade matched on the dorsal surface

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Figure 9: Mixing of the silicone and packing

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Figure 10: Final prosthesis retrieved after processing. Artificial nail incorporated

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Incorporation of artificial nail

The prefabricated artificial nail was properly shaped and trimmed to the required size. Cyanoacrylate adhesive was then applied on the undersurface of the nail for bonding with silicone surface to achieve a realistic appearance [Figure 10].

Final prosthesis

The final step was the placement of the prosthesis on the patient's stump in lieu of the missing region. The patient was given proper instructions to use and maintain the prosthesis [Figure 11].
Figure 11: Finished and polished thumb prosthesis on the residual stump

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  Discussion Top


Prosthetic rehabilitation of the patients with missing body parts has always been a challenging task; however, it is our responsibility as a prosthodontist to make the best use of the available materials and techniques to provide cost-effective treatment modalities. The amputation of one or more fingers of the hand, which occurs as a result of trauma or congenital absence of one or more phalanges, possesses a serious reduction of hand function and social dysfunction for the patient. Many injuries and traumatic amputations of fingers can be corrected by microsurgery through reimplantation. However, in some cases, it may not be advisable or not possible in some such as the patient's unwillingness or factors such as cost. In such cases, prosthesis can be provided and it can offer great psychological aid. This prosthesis also restores a part of the functions.[9],[10]

According to Ware, individuals who sustain amputation of a finger or thumb often begin rehabilitation immediately following surgery. Although there are various ways to medically and surgically manage digital amputations, the goals of rehabilitation remain the same, i.e., preserve the functional length, preserve useful sensitivity, prevent symptomatic neuromas, prevent adjacent joint contractures, achieve short-duration morbidity, and enable the patient to perform tasks of daily life as quickly as possible.[11]

Over time, various materials have been used and have been developed further. Wood, leather, polyurethane, and polyvinyl chloride have been used to produce maxillofacial prosthesis, but silicone rubber has proved to achieve the desired life-like effects.[12] Customized silicone prostheses are accepted widely, owing to their comfort, durability, and stain resistance, which are far superior to any other extraoral maxillofacial materials.[13] Additional functional benefits of silicone prostheses are desensitization and protection of the painful hypersensitive tissue at the amputation site by exerting constant gentle pressure over the affected area. Various methods of retention are available such as scraping grooves into the positive model, creating separate vacuum chambers, using medical grade adhesives, being vacuum retained on the stump, placement of finger ring, and osseointegrated implants.[14],[15] However, the degree of retention depends on the available length and form of residual stump. In this case, the vacuum retention provided by the snug fit of prosthesis was adequate for retention of the thumb prosthesis. A lubricant should be used to lubricate the skin to facilitate donning and doffing of the prosthesis.


  Conclusion Top


For most patients, the esthetic appearance of partial or complete amputated finger plays a more important role than function. With the advancement in skill, technology, and materials available today, the rehabilitation of an amputated finger is no more esthetically challenging. Rehabilitation of any missing part of the body simulating to the natural color, shape, size, and texture is the primary responsibility and intention of a clinician. Fabrication of the prosthesis in a conventional manner has its own limitations as long as the esthetics and function are concerned. In spite of this fact, providing the best to our patients should be our aim. When fabricated with immense care, they can be made life like and as natural as possible. A well-fabricated esthetic prosthesis can help in providing the patients with psychological support.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
James CH. Amputations of Hand. Campbell's Operative Orthopaedics. 10th ed. St. Louis: Mosby Inc.; 2003. p. 611-22.  Back to cited text no. 1
    
2.
Pillet J. The aesthetic hand prosthesis. Orthop Clin North Am 1981;12:961-9.  Back to cited text no. 2
    
3.
Marty J, Porcher B, Autissier R. Hand injuries and occupational accidents. Statistics and prevention. Ann Chir Main 1983;2:368-70.  Back to cited text no. 3
    
4.
Kumari N, Ashwini BL, Jain JK, Allama Prabhu CR, Vivek HP. A simplified silicone finger prosthesis. Int J Oral Health Med Res 2015;2:45-7.  Back to cited text no. 4
    
5.
Kanter JC. The use of RTV silicones in maxillofacial prosthetics. J Prosthet Dent 1970;24:646-53.  Back to cited text no. 5
    
6.
Buckner H. Cosmetic hand prosthesis – A case report. Orthot Prosthet 1980;34:41-5.  Back to cited text no. 6
    
7.
Yadav RS, Mahajan T, Sangur R, Chauhan M, Sahare P, Bhardwaj R, Trived R. Finger prostheses – Overcoming a social stigma: Clinical case reports. Indian J Multidiscip Dent 2012;2:407-10.  Back to cited text no. 7
    
8.
Tripathi S, Singh RD, Chand P, Mishra N, Yadav LK, Singh SV, et al. Amodified approach of impression technique for fabrication of finger prostheses. Prosthet Orthot Int 2012;36:121-4.  Back to cited text no. 8
    
9.
Pilley MJ, Quinton DN. Digital prostheses for single finger amputations. J Hand Surg Br 1999;24:539-41.  Back to cited text no. 9
    
10.
Shanmuganathan N, Maheswari MU, Anandkumar V, Padmanabhan TV, Swarup S, Jibran AH, et al. Aesthetic finger prosthesis. J Indian Prosthodont Soc 2011;11:232-7.  Back to cited text no. 10
    
11.
Ware LC. Digital amputation and ray resection. In: Clar GL. Hand Rehabilitation: A Practical Guide. 2nd ed. New York: Churchill Livingstone, Inc.; 1998.  Back to cited text no. 11
    
12.
Jacob PC, Shetty KH, Garg A, Pal B. Silicone finger prosthesis. A clinical report. J Prosthodont 2012;21:631-3.  Back to cited text no. 12
    
13.
Miglani DC, Drane JB. Maxillofacial prosthesis and its role as a healing art. J Prosthet Dent 1959;9:159-68.  Back to cited text no. 13
    
14.
K RK, Bandela V, Bharathi M, Giridhar Reddy SV. Acrylic finger prosthesis: A case report. J Clin Diagn Res 2014;8:ZD07-8.  Back to cited text no. 14
    
15.
Pereira BP, Kour AK, Leow EL, Pho RW. Benefits and use of digital prostheses. J Hand Surg Am 1996;21:222-8.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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