Neural hand reconstruction using an RGB image

Background This study presents a neural hand reconstruction method for monocular 3D hand pose and shape estimation.Methods Alternate to directly representing hand with 3D data,a novel UV position map is used to represent a hand pose and shape with 2D data that maps 3D hand surface points to 2D image space.Furthermore,an encoder-decoder neural network is proposed to infer such UV position map from a single image.To train this network with inadequate ground truth training pairs,we propose a novel MANOReg module that employs MANO model as a prior shape to constrain high dimensional space of the UV position map.Results The quantitative and qualitative experiments demonstrate the effectiveness of our UV position map representation and MANOReg module.

Modification of hand reconstruction with unilateral foot donation

Multiple toes transplantation is an effective method for-restoring the prehension of the hands.Generally, the thumb, index and middle finger are reconstructed by transferring a free big toe skin-nail flap with the second and third toes from a same foot. The great saphenous vein, superficial veins on the dorsum of the foot, the dorsalis pedis artery, and the first dorsal metatarsal artery are resected to be used as the donor pedicle. The arterial pedicle is freed up to the dorsal digital artery of the big and second toes. Both the second and third toes are supplied by the dorsal digital artery of the second toe on the tibial side. By using unilateral toe donation to reconstruct a digitless hand, we can preserve the normal form and function of the contralateral foot.

Dorsal hand reconstruction with radial artery perforator-based adipofascial flap

Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons.Depending on the degree of defect,extensor tendon reconstruction may also be necessary.Various reconstruction methods are commonly performed to cover dorsal hand defects,such as skin grafting and distant,free,or local flaps.Among them,free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap may have been damaged,and the affected limb can be reconstructed using a flow-through method.Although free flap surgery has advanced,few surgeons can choose this option due to its technical difficulty and uncertainty.On the other hand,distant flaps have been commonly used for the reconstruction of dorsal hand defects,and local flaps,such as reverse forearm flaps and retrograde posterior interosseous flaps,do not require microvascular anastomosis.However,they have some problems;distant flaps require at least two surgeries,reverse forearm flaps sacrifice major vessels and leave a scar at the donor site,and retrograde posterior interosseous flaps require meticulous dissection of the vascular pedicle.The radial artery perforator-based adipofascial flap is a versatile flap that is safe and easy to elevate without sacrificing the radial artery.In addition,elevating it as an adipofascial flap enables surgeons to avoid an unacceptable donor scar.We present two cases,demonstrating the usefulness of this pedicled perforator flap.

TIBIALIS ANTERIOR VASCULARIZED TRIPLE FLAPS IN ONE STAGE RECONSTRUCTION OF MUTILATED HAND WITH LOSS OF THUMB

Objective To introduce a one stage technique in the reconstruction of mutilated hand with lossof thumb and eventual digits. Methods Tibialis anterior pediculated triple flaps ( TAPTF) including distal lateral leg, dorsalis pedis flaps for skin defect covering and trimmed hallux for thumb reconstruction were presented. Results Mutilated hands in five patients were repaired by the technique with acceptable cosmetic and functional success. A three to twelve months follow-up in three patients resulted in the recovery of protective thermal sensation and pinch action of the reconstructed thumb. The donor sites were free from major disability. Conclusion TAPTF is ideal for one stage reconstruction of the mutilated hand with loss of digits.

Survey on depth and RGB image-based 3D hand shape and pose estimation

The field of vision-based human hand three-dimensional(3D)shape and pose estimation has attracted significant attention recently owing to its key role in various applications,such as natural human computer interactions.With the availability of large-scale annotated hand datasets and the rapid developments of deep neural networks(DNNs),numerous DNN-based data-driven methods have been proposed for accurate and rapid hand shape and pose estimation.Nonetheless,the existence of complicated hand articulation,depth and scale ambiguities,occlusions,and finger similarity remain challenging.In this study,we present a comprehensive survey of state-of-the-art 3D hand shape and pose estimation approaches using RGB-D cameras.Related RGB-D cameras,hand datasets,and a performance analysis are also discussed to provide a holistic view of recent achievements.We also discuss the research potential of this rapidly growing field.

Anterolateral thigh free flap for simultaneous reconstruction of digital extensor tendon and defect of the dorsal hand： A case report

This paper describes a new technique in the repair of the hand defect with digital extensor tendon injury. The anterolateral thigh flap with the thick femoral fascia has been used in the reconstruction of the composite defect of the dorsal hand, especially the defect of tendon. This technique requires short period of treatment and hence causes less damage to the donor site but shows a better recovery of the hand function. A favorable curative effect has been obtained in this patient.

A totally laparoscopic peritoneal free flap for reconstruction of hand

Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm × 12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.

Review of the optimal timing and technique for extensor tendon reconstruction in composite dorsal hand wounds

Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstruction. This review evaluates existing literature to determine the optimal management of composite hand defects. Methods: A MEDLINE database review was performed including objective measurements such as number of operations, total active motion, grip strength, days to maximum range of motion (ROM), and return to work. Data extraction included demographics, surgical techniques, complications, and relative outcome. We compared primary and secondary staged reconstruction to correlate any significant differences in outcome and determine optimal timing and technique for extensor tendon reconstruction. We extracted information on flap types including regional and free tissue transfer with tendinous components vs. staged tendon grafts. Results: Comparison of outcomes showed that patients with immediate reconstruction had fewer operations, faster return to maximum ROM, and greater chance of returning to work. The most successful single stage flaps include the radial forearm, suitable for reconstructing one to three tendons and the dorsalis pedis for three or four tendons;however, there were significantly more complications in immediate reconstruction particularly regarding donor site morbidity. Pedicled flaps had better total active motion. The two-stage approach resulted in acceptable functional outcomes without significant complications. ;Conclusion: Immediate cutaneous tendinous flaps have clear advantages over staged approaches for reconstruction ofcomposite dorsal hand wounds. Benefits include less operations, faster time to maximum ROM, and higher percent of patients returning to work;however, significantly more flap related complications were seen. Immediate pedicled radial forearm provided the best total active motion with least complications. When patient circumstances dictate, a fascial perforator free flap offers a suitable environment for staged tendon grafts with good functional outcomes reported albeit longer time to achieve them.

Principles of reconstruction.Like with like and flap thinning:two essential tools

The"like with like"and the"flap thinning"are two workhorse principles the surgeon must keep in mind to achieve a functional and cosmetic reconstruction of the hand.These principles are underpinned by a thorough knowledge of anatomy and functional hand units,with a wide range of reconstructive procedures that must be finalized to the necessity of the impaired structures."Like with like"means that a lost tissue must be replaced with another one that can be compared in appearance and function.In addition,good cosmetic is often associated with good function because the complex attempt to get a proper aesthetic always traduces itself into a better functional reconstruction."Flap thinning"is essential because soft tissue injuries of the hand represent a more difficult reconstructive challenge than similar injuries elsewhere,and the need for thin tissue to wrap the superficial noble structures of the hand is constant.However,the procedure of thinning a flap can be dangerous and must adhere to the vascular architecture of the flap.This paper aims to review and briefly summarize the current literature in this field.

Digit amputation prosthetics

Digit amputations are the most common amputation worldwide.This manuscript describes the impairments imposed by digit loss and the potential benefits of digit prosthetics.This review of the literature is designed to provide a reference for healthcare workers and patients for identifying and selecting prosthetic options for digit amputees.